What is the Roll-Over?

The roll-over is a series of gravity-friendly maternal positions in which the birthing woman rests in eight positions as she rolls over. Contractions help this technique to work effectively, especially when labor progress is slow.

Penny Simkin and Ruth Ancheta named it the Roll-Over and it is featured in their Labor Progress Handbook. Other doulas have called this concept “flipping pancakes.”  Some call it the “flip-flop” too, but I have another series of techniques for resolving shoulder dystocia that I call FlipFLOP, so I chose the name used by Penny and Ruth.

At Spinning Babies®, I’ve said, “When you want to move the baby, move the mother.” This technique literally rotates the mother to help the baby rotate and we’ve used variations of this technique for many years. Around the country, nurses, doulas, and midwives praise the effectiveness of this series of maternal positions.

 

Why use the Roll-Over?

The various positions give the woman a plethora of options to rest in that may assist labor progress. This could rotate the baby, but also simply let the baby “explore” which position helps descent. Sometimes, one particular position is noticeably more effective, and for other labors, it’s a combination of all the positions and the movement of the mother.

When a woman is confined to a bed because of blood pressure concerns or due to the numbing effect of an epidural or narcotics, her support people can help her change positions. The roll-over is a great way to keep track of which position to choose next—it’s simply the next position you would use if you were rolling over and stopping at each quarter turn or less.

 

How to use the Roll-Over

  1. Start with the Hands-and-Knees position. For two to three contractions, the mother rests on her hands and knees. She can certainly have her forearms resting over the raised back of the hospital bed or leaning on a birth ball to save her wrists from any strain.
  2. After three contractions, the mom then lays on her side (either side is fine, but we’ll start with the left for this example). A long pillow or rolled blanket separates her knees and ankles to reduce pulling on her pelvic ligaments. She lies with the right hip directly over her left. Her back is straight and she doesn’t lean forward or backward in bed.
  3. After three contractions, she rearranges herself so that she is now leaning quite forward. A pillow is there for her higher shoulder and the pillow between her legs is moved in front of her abdomen so that her right knee can be bent and rest upon a high pillow. I call this position “left lean-over.” The mother’s belly button points into the mattress as much as possible without lying on the baby. A pillowy nest will raise the mother’s pelvis and ribs a bit to give the baby room, if needed.
  4. After three contractions, the birthing mom gets into an Open-knee Chest position if she is able to move readily. If a woman is on an epidural, she may need a lot of help. If not, she then goes to the next position.
  5. After three contractions, she lies on her right side, leaning forward as described above for the left-lean over. She is now in a right lean-over position.
  6. Start again with the Hands-and-Knees position. Continue this for two more rounds, if necessary.

Please note:

  • There are two ways to lay on one’s side. Leaning over normally, and with hips stacked and a pillow from knee to ankle. Use both.
  • A fun way to be belly down is to lie on pillows with two semi-inflated swim rings to support the bump. Use pillows under the pubic bone, breasts, and feet for an essential lift.

 

Roll-over to get to 10 centimeters dilation

The Roll-over is also useful to reduce an anterior lip. An anterior lip is when a bit of cervix (less than a complete circle of cervix) is coming in front of the head. Instead of having the caregiver manually push the cervical lip back over the head (which doesn’t address the cause), the mother might try a round of the roll-over techniques.

 

Roll-over for flexion

The roll-over may also be useful for helping the lifted chin to tuck. When the caregiver can feel the front fontanel during a vaginal exam, this technique may help the chin tuck, which means it increases the flexion of the head and neck. The baby whose head is flexed fits the pelvis better, can rotate more easily, and can descend with less difficulty. Sometimes head flexion is the difference between a long labor/cesarean and a vaginal birth.

 

When should you do it?

  • Unlike many of the techniques on the Spinning Babies® website, it is okay to use this technique even when labor is progressing regularly. In the case of a “normal” labor, the idea is simply to rest in various gravity-friendly positions.
  • When labor progress is slow. The roll-over gives a systematic rotation for the mother’s positions.
  • When labor contractions are coming regularly and somewhat strong (or quite strong) but progress has either stalled or is slow.
  • When the baby is known to be in a posterior position, or has his or her head deflexed (the chin is up or not well-flexed).
  • The roll-over can be used in pregnancy too.

 

When should you not do it?

  • Of course, some positions should be avoided if the mother has high blood pressure, or the baby gives a deceleration in the heart rate during that position. These are rare occurrences that don’t warrant avoiding the technique unless proven otherwise. Use your discretion.
  • If your baby isn’t engaged yet and labor has begun, focus on getting the baby engaged first with the Abdominal Lift and Tuck and/or Opening the Brim.
  • Before any series of activities using gravity and motion, I like to suggest activities for balance. The Side-lying Release may be helpful when possible.

 

Before you use the Roll-Over

Before doing this or other gravity-dependent techniques, relax the abdomen with Rebozo sifting, a Standing Sacral Release, and an inversion.

 

After you use the Roll-Over

If this set of general postures doesn’t work in an hour or two, get specific to the baby’s station and presentation to choose your techniques. Of course, that can be done before too, depending on the time you have.

Try the lunge or dangle while grasping an overhead rope or shawl.  Add a bed-lunge as needed to open the mid-pelvis.

 

Further reading

Visit PennySimkin.com to buy the Labor Progress Handbook! This is one of the most important books available to avoid that unwanted cesarean due to a slight malposition in the baby’s head.

The roll-over is a favorite in Labor and Delivery wards. If the laboring woman must be in bed, this is a great option!

Videos
Daily Essentials
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Spinning Babies® Parent Class
Spinning Babies® Parent Class provides clear instructions on how to use Spinning Babies® for a more comfortable and confident pregnancy and labor.