Why do the Open-knee Chest?

Does your baby seem stuck just inside the top of the pelvis (nurses would call this -2 station)? Would you like to help the labor start over again and go smoother? Then the Open-knee Chest (OKC) may be the technique for you. The OKC helps back the baby out of the pelvic brim so you can start over in a better position.

How to do the Open-knee Chest position

1. Start with a knee-chest position (see below). Set your chest on the floor. Cheek is on the floor (or a cloth covering the floor).
2. Now move the chest and shoulders forward—way forward! The knees stay put. Slip a pillow under the chest (not the face). See how the thighs and spine make a letter “A”?
3. The helper in the back holds a long cloth (or rebozo) like reigns, wrapped across the mother’s upper thighs. This cloth is not on her abdomen at all. The helper leans back to take the weight of the mother’s lower body off her chest during the Open-knee Chest.
4. A helper at the front—if you have an extra person—sits so that the mother can put her shoulders up on their ankles. This is very comforting during this position.
5. The mother gets into the Open-knee Chest position for 40 minutes during active labor. To make it easier, a helper can sit in front of the mother so she can brace her shoulders on the helper’s ankles.

“Open” means there is a wider distance from your spine to your pubic bone. The spine and thigh make a “letter A.”

It is not strictly necessary to jiggle the mother’s hip, but it may help the baby back out more quickly.

How does it work?

Labor contractions help Open-knee Chest work. OKC allows the spaces between the contractions to let the baby back up about 1 centimeter and lets the contractions have a chance to rotate the baby to a better position. This is why the mother is in this position between and through the contractions.

Open-knee Chest is not about how wide open the knees are, but rather that the knees are far from the spine, opening the pelvic inlet.

Please note: There is a certain level of commitment to make this technique work. The birthing woman should know that this is effective, but requires her to be in this position for about 40 minutes (It may be effective in less time, but we can’t assume it will).

When should you do it?

Open-knee Chest can be used in:

1. Pregnancy: to help reposition a breech-presenting baby
2. Labor: to help reposition a head-down baby whose head is inadvertently locked in the brim or mid-pelvis

Some doulas and midwives suggest the Open-knee Chest for a stall in labor. This position may be especially useful for:

• A baby that is somewhat high
• Posterior
• Asynclitic at the brim
• When the baby has a hand across the pelvis in a way that has significantly slowed labor

The indications may be:

• Back labor without progress
• Strong contractions without progress, even without back labor
• Pain in the pelvic girdle (it could be hip pain or one-sided pain) during labor
• No pain (but no progress either), yet there are regular contractions. They may be strong but they aren’t getting stronger and closer together.
• A known posterior or asynclitic position without progress
• The baby is stuck in the brim (the pelvic inlet)
• The baby is stuck at the ischial spines (the mid-pelvis)

When should you not do it?

Ask your care provider if there is any reason you wouldn’t want to be upside down in the inversion or Open-knee Chest position.

Don’t do Open-knee Chest if:

• The head-down baby is not engaged and is floating
• The woman is at risk of a stroke, or has a history of high blood pressure which warrants medical supervision
• There’s an abundance of amniotic fluid and a loose abdominal tone which could risk a baby flipping breech

Before doing an Open-knee Chest

Is the baby engaged? If not, do engagement activities first, such as the Side-lying Release.

During an Open-knee Chest

To potentially reduce the time it may take to reposition the baby, do the Shake the Apple Tree technique. The mother’s buttock are grasped and shaken mildly, in short “shivers” for a long time. Her muscles are relaxed from rapid, gentle jiggling.

After doing the Open-knee Chest

Follow this challenging inversion with a nice, relaxing shower. Bend your knees and lean forward, resting your arms on the wall of the shower. Or, if you don’t want a shower, lean and rest your upper body on a dresser while your knees are slightly bent and you can sway your hips back and forth to relax your muscles.

Are there any good alternatives?

Midwife Nicole Morales, CPM and Spinning Babies® Approved Trainer in San Diego, teaches us to Shake the Apple Tree during a Forward-leaning Inversion as a replacement for Open-knee Chest.

This article is to show you what OKC is, but it is not highly recommended. It’s handy occasionally, but balance your body before relying on gravity, in general, and sometimes you don’t have to do these more extreme positions.