Walcher’s: Open The Brim

Walcher’s position

Learn more about creating a safer birth by clicking this link for info on engagement.

There are various birth positions to open the top of the pelvis, the pelvic brim, so baby can engage. This is a last choice when others haven’t worked or the birthing person is on an epidural and can’t choose an easier position or technique.

One indication for opening the brim with any brim opening position could be a head that needs more room. This need for room at the top of the pelvis can be shown by one or more of the following:

an overlapping head in labor. The head may overlap the pubic bone or not, this is not visible usually but can be felt with your fingertips at the top of the symphysis pubis.
the baby may be posterior, but may not.
the chin is lifted (extended).
the pelvic inlet may be a bit narrow front-to-back (AP diameter) for her baby’s head.

When?

Use this as an “engagement” technique in labor. This is not appropriate in pregnancy. Don’t use when baby is low in the pelvis. The baby is -3 station, high, above the pelvis.

Use Walcher’s when strong, frequent contractions are not helping baby to engage.

How Long?

Use this position through and between three contractions in a row to lower baby into a normal pelvic brim. Contractions make it work. If labor isn’t dramatically faster after three contractions in this position, then the issue is not likely an engagement issue. Cephalopelvic disporportion should be considered, yes, but ask “Where’s baby?” and adjust your strategy.

Pictured: The mother’s legs hang off the edge of the bed from the top of her thighs. This makes a huge arch in her back. Ouch for some! A roll is used to create comfort in the curve that is exaggerated by this position. This technique is only used when other techniques fail. I’m lifting her calves from far beneath the knees so her knee-caps are not hurt.

Where’s Walcher?

Walcher was a German physician reporting on a technique that is also shown in Italian text describing midwifery techniques.

Dr. Walcher taught his technique for unusual cases when the baby was high and not coming down into the pelvis. Labor has to have already begun. Walcher wrote a description in the late 1800s about moving a laboring woman to the edge of the bed and letting her legs hang off so the weight of her legs could pull her symphysis pubis far from her spine. The wide arch opens the anterior posterior (AP) diameter to let the baby’s head enter the pelvis. Walcher’s position is done off the side of a high, firm bed. Legs hang freely!

Other uses of Walcher’s are during a breech birth to free a head or during a shoulder dystocia to free shoulders stuck at the inlet. 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.

In Walcher’s position the pubic bone will be the highest bone, opening the pelvis to let baby in during labor contractions. If a high bed isn’t available, use a “Trochanter Roll” shown below.

But First

Though this technique is effective to help a baby engage it is intense on the lower back for most people. A few people love this position, but most don’t. Try the following first:

10 contractions with Abdominal Lift and Tuck for someone who can stand
5 posterior pelvic tilts on one side and 5 on the other for someone in bed

Here’s a story from a doula who suggested a laboring woman try this, and it was tough but effective:

Got to the mama’s home and checked to see if baby was lodged (using your suggestion to palpate up from the pelvic bone), and he was not. We got her into Walcher’s position for a few minutes before she had a contraction and the intensity of her contraction in that position put her into tears. She was unwilling to continue the position. That was at about 9:15am. About 30 minutes later we decided to leave to the birth center. When we arrived at 10:15 she was checked at 6cm. Baby was born at noon on the dot with essentially no pushing (using HypnoBirthing). Truly seems like baby did just simply need to engage – and is possible that even just one contraction in Walcher’s was all she needed. Mama had a beautiful water birth, no tearing and is resting and overjoyed at how empowered she felt for her birth. (Supported by an amazing husband!)…

Here’s a story from a relieved Grandmother who found this article during an internet search:

Hello, I’m not sure if this is the email I should contact regarding your wonderful website or not, but I just had to tell someone about the Walcher Technique for engaging the baby’s head and how it was a lifesaver for my daughter. My youngest daughter, A____, was in labor since Tuesday night, having contractions every 10 min. She couldn’t sleep through the contractions and would get out of bed to work through the contractions. She was literally ExHAUSTED…..the baby’s head wasn’t engaged so her labor/dilation of her cervix wasn’t happening/progressing. We made two trips to the hospital (Tuesday night and Thursday night) only to come back home. She had a midwife appointment on Friday and still no progress. Finally on Saturday afternoon, I searched the internet for something to tell me how to help her baby engage. Well, the Lord led me to spinningstg.wpengine.com. It showed the Walcher technique for engaging the baby’s head. After four days of labor, we were willing to try anything. We followed the directions, and it was amazing. It said the uterus would then ‘rest’ and she could sleep/drink/eat until the uterus went to work again. Well, it happened just like the website/technique said. A___ was able to sleep for an hour and a half with no contractions. Around 8 Sat. night we went to the hospital again and they checked her and found that his head indeed had finally engaged. I was pretty upset that her midwives didn’t know about the technique They just kept saying to walk. Baby L___ was born at 3:26 a.m. yesterday (3/24/13) morning. Thank you thank you thank you. I only wish I would have searched web help and found your page four days earlier. A proud and thankful grandma, Diana D

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.

Alternatives to Walcher's

Trochanter Roll

What if there isn’t a high bed or a bed that raises?

Open the brim by using a Trochanter Roll. The person is on their back. Lift the pelvis by a 15-18 inch (38-45 cm) roll of material under the lower buttocks at the level of the trochanter of the femur. In simple language, put a big roll under the buttock where the bottom of the butt cheeks end. This is the very top of the thigh.

Trochanter roll with blankets to open the top of the pelvis

This position, like 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.

Have the birthing person lie over a large, tight and firm roll. The tightly packed roll is placed at the top of the thighs, right where the thigh bone connects to the hip socket. This is lower than the sacrum where you might imagine she needed support. They lay back like that, almost a backbend, through three contractions. Stay in between the contractions, too. It’s tough. The lower back is not supported. Don’t put the roll at the small of the back or at the sacrum. It goes at the top of the leg bone.

Froggie Walcher's

What if there is a high BMI or dense epidural? What if I don’t feel safe doing the classic Walcher’s position in bed?

Adapt the brim opening position with a “Froggie Walcher’s”. See the feet? In this variation, the soles of the feet are together and knees are wide apart. The knees are as far away from the abdomen as possible.

Froggie Walcher’s position to open the top of the pelvis to help baby drop in during labor contractions

I wish the knees were lower. A trochanter roll would help make that possible.

These pictures are a bit misleading. I would add a trochanter roll to this hospital bed because the foot of the bed, even with the mattress removed, doesn’t let the knees drop lower than the hips.

Froggie Walcher’s is a popular alternative for many hospital birthing situations.

Flying Cowgirl

Can I lay on my side in bed and open my pelvis?

Adapt the brim opening position with a “Flying Cowgirl”. See the feet? In this variation, the soles of the feet can’t quite touch together. Again, the knees are wide apart. The knees are as far away from the abdomen as possible. The back is arched and the pelvis is forward. That’s the point.

Flying cowgirl

Flying Cowgirl is a favorite position to help a baby engage when an epidural is in place. Spinning Babies^® Approved Trainer, Nikki Zerfas made this a popular alternative in our community of nurses using Spinning Babies^®.

Water Walcher's

How does one open the pelvic brim in a water birth?

When in a deep pool, the top of the pelvis can be opened by angling the femurs far from the belly.

In water, it is easy to bring the knees far from the abdomen. Bend the knees in a birthing pool so that the feet are actually out of the water! This creates the space at the top of the pelvis to help baby engage. The position is held through three contractions in a row. But in the water, it’s easy to come out of this position and go back into it for the contraction.

I first noticed the woman who shares her story in “The Long Labor that Wasn’t” doing this in her birthing tub and asked her to continue with it during a contraction. I’ve since suggested it for others who need help engaging their babies while in the birth tub.

Open the brim to help baby engage

Make sure the feet come out of the water

Open the brim in a water birth with “Water Walcher’s”. See the feet out of the water? That shows the knees are away from the abdomen, a necessary component to open the brim in an all-fours position.

Here is a story that starts on the page that describes the Sidelying Release, it finishes here because the persevering mother used Walcher’s in the water tub during her pushing stage of labor:

…Now it was apparent that the baby was not at all low. She had a little cervix left, but it soon left (opened to full dilation at 10 cm). She’d gently pushed an hour in the bathroom and actively for another 30 minutes in the tub (after her cervix was found to have opened fully) and yet the baby wasn’t coming down. In fact it was rather high. I suggested Walcher’s variation for the birthing tub. She didn’t seem to like me or my suggestion right at that moment, the laughter was over. She seemed to really want the relief of the tub. But contractions pressed the baby hard on her pubic bone. Once she said that I knew what was needed was to open the brim (pelvic inlet) and let the baby’s head slip off the front of her pelvic bone. So I suggested opening her brim in the tub (with the Walcher’s variation) by being on hands and knees but having her knees far away from her belly, not spread open far, just hip width, but far from her belly so her feet are up and out of the water. She didn’t care to do that. After a while when she asked why her baby still wasn’t coming, my friend’s midwife partner asked her if she would try my suggestion. She now did and it took 3-4 tries (it was hard to stay in that open position when the contraction peaked) but at least once she did and the baby slipped into the pelvis and progress resumed. In 7-8 pushes the baby was born in the water. She was a little slow to start but didn’t need help other than suctioning her mouth and nose, rubbing her and lifting her back a little to “open her wings” so her lungs could inflate. (Rather than have her shoulders cuddled together over her chest the back is straightened so that her shoulders arch back as if she were in a standing posture but she is still in her mama’s arms.) I was tickled to have helped a family out and possibly prevented a homebirth transport with the combination of techniques.

Other ways to help baby engage

Walking briskly, chiropractic, Standing Sacral Release, and sitting upright 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. It’s 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.

When not to do Walcher’s

When the baby’s head or shoulders are not stuck on the pelvic brim. When baby has engaged and/or isn’t stuck at the brim. Effectiveness is usually found in 3 contractions. If not effective, recheck maternal position and if incorrect, correct the position and try for 3 more contractions.

Before doing Walcher’s

Use Walcher’s before agreeing to high forceps or a cesarean when labor doesn’t progress simply because the head isn’t engaged. This position was designed to avoid “high forceps” which were in more common use over 100 years ago.

After doing Walcher’s

Once the baby is in the pelvis (engaged) then labor may proceed quickly. If not, continue with encouraging labor in appropriate ways.

History of Walcher’s

Gustav Adolf Walcher was born September 21, 1856, and died on June 30, 1935, in Ellwangen (Jagst) in East Württemberg, Germany. He began his medical assistant job at the Women’s Hospital under John of Säxinger. He directed a state midwifery school in Stuttgart for his career. His commitment to breastfeeding, citing his principle. “A woman’s child can give birth, it can also breastfeed.”

Old Obstetrics literature sites the first description coming from Italy in the mid-1700s. Dr. Walcher’s in Stuttgart, Germany described this position carefully to German obstetricians over 100 years later. Dr. Comstock of St. Louis sang the praises of Walcher’s technique in an 1897 Obstetric review called The Medical Brief. After a short and bright promise, the position was soon lost to American Obstetric literature. Walcher’s reappears today in my 2011 article in Midwifery Today.

Variations

The Trochanter Roll is a variation in which I learned from a local nurse-midwife using an adaptation of Walcher’s for when the bed is low, or the woman is on the floor (see 2nd photo of the article).

Walcher’s in the pool, or the Open-Knee Stretch is an adaptation I took advantage of when watching women labor with posterior–asynclitic babies and then asking them to hold that instinctive position through 3 contractions in a row.

I haven’t seen this fail to engage a baby when the mother was in a non-progressing labor combined with lack of engagement in the 5 years since I’ve come across the position, but I haven’t seen everything, either. Still, it’s pretty amazing!

References

Geburtshilfe Frauenheilkd 2014; 74(6): 541-543 DOI: 10.1055/s-0034-1368504

Why?