Walcher's Trochanter Roll to "engage" baby

This is a technique to use only occasionally in labor. Walcher's Position  is used to engage a baby that is high, not really in the pelvis yet, yet contractions are regular and strong. The baby may be stuck at the brim or inlet of the pelvis. I don't know if it works in pregnancy, before labor. But I know that if you can use this position through and between three contractions in labor that it will bring the baby into a normal pelvic brim. Contractions make it work. 

Babies normally engage by 38 weeks of pregnancy for a first baby. Subsequent babies may engage before labor begins, or will usually engage with a bout of early labor contractions.

Engagement means the widest part of the baby's head has dipped below the entrance to the pelvis (the brim).

Standing and allowing the belly to hang forward (lordosis) keeps the brim open enough for the average baby to engage nicely.

There are various maternal positions to open the pelvic brim more so baby can engage. One is done off the side of a high, firm bed; another on the floor or a low bed (using a "Trochanter Roll"); and finally, we can open the pelvic brim in a deep birth pool.  Dr. Walcher taught his technique for unusual cases when the baby couldn't engage in late pregnancy or in early labor. 

Why Walcher's?

Walcher's position opens the brim front to back. The pubic bone opens away from the spine. This makes more room for the baby to get into the pelvis. Kneeling opens the brim. A back bend opens the brim. Standing and letting the belly hang opens the brim a little. Walcher's opens the brim a lot.

Slouching closes the brim. Squatting closes the inlet while it opens the outlet. 

When Walcher's?

Use Walcher's when strong, frequent contractions are not helping baby to engage. The head may overlap the pubic bone or not, this is not visible usually but can be felt with your finger tips at the top of the symphysis pubis.

The baby is likely to be posterior. The chin is likely to be lifted (extended). One or both of these may be the reason, or it may be that the mother's pelvic inlet is a bit narrow front-to-back (AP diameter) for her baby's head.

How do you do Walcher's?

The laboring woman's legs hang off the bed into the air.  The legs are NOT supported. The weight of the hanging legs pulls the pelvis open more at the inlet. The edge of the bed is at the "smile" at the lower border of the buttocks. This is the level of the trochanter of the thigh bone (near the hip socket) but at the woman's back. 

A good support person will keep close eye contact with her face and speak soothingly to her through the approximately 15 minutes that it takes for 3 contractions to come and go.

Alternative: Trachanter Roll. Have the birthing woman lie over a large, tight, firm, roll. The roll is placed at the top of her thighs, right where her thigh bone connects to the hip socket. That's the trochanter of the femur. This is lower than the sacrum where you might imagine she needed support. 

The mother lays back like that, almost a back bend, through three contractions. She remains there in between the contractions, too. Its tough. Her lower back is not supported. Don't put the roll at her sacrum. It goes at the top of her leg bone.

What about Walcher's in a waterbirth?

In the pool, we could call this position the Open-knee stretch. The mother's feet are actually out of the water! Her knees are further from her head than her hips are, that's what makes this the "open-knee" - not to be confused with the open-knee chest position which is not practical for the birthing pool!

This seems to work well, too, when the mother holds the position through three contractions in a row.

I first noticed the woman in "The Long Labor that Wasn't" doing this in her birthing tub and asked her to continue with it. I've since suggested it for other women in the birth tub.

 Other uses of Walcher's are during a breech birth or shoulder dystocia. Those uses are not listed here, as the provider would have to have a clear understanding of the application of Walcher's in those situations. This page is more general. 

Other ways to help baby engage. 

First babies are expected to engage at 38 weeks, or about two weeks before the expected birth. Read about engagement to learn more about what's expected here.

Walking briskly, chiropractic, standing sacral, and sitting up right are helpful for engagement. Sitting with feet wide apart on a firm exercise ball (birth ball) and making vigorous circles on the ball can help. Its good to rotate the posterior baby before forcing engagement when there is time to do the various methods and techniques for rotation in pregnancy and/or labor.