As a mom navigating her way through a high-risk pregnancy, news of one more complication just leaves you with more questions and concerns. When the news is that your baby is not in the head down (or vertex) position, your questions go something like this: Will my baby turn on its own? Will I need external cephalic version? Can I even have that? Is it safe? Will I need to have a C-section?
If your particular high-risk situation doesn’t automatically require Cesarean, a breech (or transverse or oblique) presentation greatly increases that chance. Even in the case of low-risk pregnancies, abnormal position near the end of term commonly results in surgical birth. In fact, 2003 data from the National Center for Health Statistics shows that 87.2% of all breech presentations were delivered by Cesarean.
If your baby has not turned head-down by approximately 36–37 weeks, your doctor may suggest attempting external cephalic version. In this procedure, your doctor tries to turn your baby while still in the uterus by pushing on the baby with his or her hands through your abdomen. This procedure can bring about complications for any mom, including vaginal bleeding, premature rupture of membranes, fetal distress and premature labor. For many high-risk pregnancy situations, external cephalic version would not be recommended due to these possible complications. For some high-risk pregnancies, external cephalic version is contraindicated, meaning it is not even considered as a possible option due to the high likelihood that it would cause serious problems.
So, once you and your doctor realize that your baby is not positioned head-down, the most likely approach in a highrisk pregnancy is to wait and see if your baby will spontaneously turn. If your doctor is comfortable with the idea of external cephalic version in your case, you may weigh the pros and cons and decide to give it a try. Depending on the study you read, external version only has a 35-65% success rate. If you cannot try, or are not comfortable trying, external cephalic version, or if it is unsuccessful, you are usually left waiting again for your baby to turn on his or her own. At this point, you will be well aware that if your baby has not turned head-down by the time you begin labor, you will need a C-section. What else can you possibly do other than just wait? What other options do you, as a concerned mother, have to attempt to prevent this scenario?
Let’s take a step back and talk about the “why’s” of abnormal presentation. Remember that your baby has innate programming that helps him or her know what to do during growth and development and in preparation for birth. Most babies do assume a vertex position before labor, because their instincts direct them to. This is the same way they innately know to push with their feet off the top of the uterus during contractions or to latch on to a breast even when they have never before seen one. So why hasn’t your baby turned vertex? Because your baby didn’t get the programming to know to do that? Of course not.
Something is preventing the head down process from occurring in your situation. In some cases, it can be a structural issue within the womb, such as a fibroid or other space occupying presence. Often, pre-term labor is accompanied by abnormal presentation because the “time to turn” in the baby’s programming had not yet occurred. However, according to Danforth’s Obstetrics and Gynecology, there is no apparent cause for the failure to go vertex over 50% of the time. It would be ludicrous to assume that over 50% of the fetuses in abnormal position simply “didn’t get the memo” about turning head-down. So, it logically follows that something is preventing the baby from turning.
In the late seventies, Larry Webster, D.C., founder of the International Chiropractic Pediatric Association, noted a connection between subluxations of the sacral and pelvic bones and abnormal fetal positioning. He developed a gentle chiropractic adjusting technique (called the Webster Technique) to restore movement and alignment in the pelvis to be used throughout pregnancy. Clinically,Dr.Webster observed that babies in malposition would self correct to an optimal position on their own after the adjustment. During his career of working with over 1,000 pregnant moms, Dr. Webster reported that over 90% of the babies optimized their positioning in-utero when the mother received this specific sacral adjustment.
The key to this approach is simple anatomy. The uterus is physically attached to the pelvis and sacrum by way of the uterosacral ligaments behind the uterus and the round ligaments in front and the broad ligament on each side. During pregnancy, the increased physical loads on the skeleton and the presence of the hormone relaxin in soft tissues make it easy for the sacrum and pelvic bones to shift and become subluxated. Extended bed rest can also contribute to sacral subluxations, as can improper postures and other minor traumas. When this occurs, the ligaments described above may be pulled and create undue tension in the uterus.
This uterine tension may decrease the ability of the baby to move into a more desirable position for birth. Imagine pulling on two sides of a balloon. The balloon shortens and becomes rigid in response to the pulling forces. The same thing occurs with the uterus, essentially constraining the baby in whatever position it was in at the time of subluxation. Until the pull on the uterus can be removed, the constraint will remain and the baby may not be able to make its way into the vertex position. Moms will often report a decrease in the baby’s movement, or a development of jerky, tense movements, indicating that the baby’s ability to move freely is restricted.
The Webster chiropractic adjustment begins the process of realigning the sacrum, which may relieve the pull that creates the tension in the uterus. Once that tension is removed, your baby may be free to assume its best possible position for birth. This adjustment involves no external forces on the baby directly, and it is very comfortable and extremely safe. There have been numerous case reports examining this clinical outcome.
The Webster analysis and adjustment is recommended as a specific analysis and adjustment throughout pregnancy to enhance normal pelvic function throughout pregnancy in preparation for birth. Unfortunately, many women wait until the the seventh or eighth month when mal-position has been diagnosed by the birth provider to seek out a chiropractor trained in this adjustment. Starting this care at the “eleventh hour,” is not the best approach. Chiropractic works to facilitate normal pelvic balance, and this is therefore advantageous throughout pregnancy. Continued adjustments throughout pregnancy and right up until birth may help create a safer and easier birth for the mother and baby.
Due to its proposed success in balancing the pelvis in pregnancy, the Webster technique should be the logical first choice for mothers and birth practitioners to facilitate normal function throughout pregnancy. Should a woman not hear of the Webster technique until later in pregnancy, it is still prudent for her to seek out this natural approach to restore pelvic balance and potentially optimize natural function. Without undue tension to her uterus, the baby has more room for movement and proper in-utero development. Free of pelvic and sacral subluxations, the nervous system function may be significantly enhanced and the birth canal's diameter may be maximized, thus decreasing her chances for difficult labor and additional complications during delivery. Due to the gentle nature of the Webster technique, it is a safe adjustment throughout pregnancy.
How do you find a chiropractor who is trained in the Webster Technique? The best resource is the “Find a Doctor” search on the website of the International Chiropractic Pediatric Association (ICPA), www.icpa4kids.org. All the doctors listed have special interest and training in the care of pregnant mothers, infants and children. Their active listing on the website shows their continued recognition by the ICPA.
About the Author:
Nicole A. Whitehead, DC is a family chiropractor in Mooresville, NC. She has extensive post-graduate training and experience in the care of pregnant moms, infants and children. She is a member of the International Chiropractic Pediatric Association, and is, of course, Webster Technique certified. Her private practice, Advanced Spinal Fitness, is a diverse community where infants and kids achieve maximum health alongside “grown-ups,” including race car drivers and crew members— Dr. Whitehead’s other special interest patient population.
Key Words: Subluxation - a misalignment of the vertebrae affecting neuro-biomechanical function.
For references and additional information about the author and topic, please visit: http://pathwaystofamilywellness.org/references.html
This article appeared in Pathways to Family Wellness magazine, Issue #14.
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