One of the issues that can arise with a baby presenting breech in the third trimester is a head that seems to restrict a baby from turning. There are different patterns for head restriction. This blog is written with the assumption that the Forward Leaning Inversion has been used to address nonphysiological twists in the uterus itself and when there are those twists, they can be an obstruction for a transverse or breech baby. Because I’m finding more heads on the right side that seem to be “caught,” I am also acknowledging that there may be some issue with right obliquity contributing to this pattern. This is developing work for me as I learn with my hands, but so much of my work is noticing what I’m feeling and patterns that I see in those who see me. These patterns can persist even with the bum free from the pelvis. I wonder, what else can be in the way of an oblique baby whose head seems to have cleared the bony ribcage and yet not release? What seems to be restricting head movement and do you too see it more often on the right, rather than the left side? What are the soft tissue patterns involved in this restriction?
I know after being pregnant with my third baby who was breech, my theory of her not turning was her long legs and bum trying to turn in a space that was occupied by my placenta on the lower right. She seemed quite uninterested or unable to rotate her head past my placenta while disengaging from my pelvis. Besides the placenta as a restriction, I have also had pregnant parents come in at the end of pregnancy having fibroids next to or in the pathway of the head. Right now I’m playing with the notion that this restriction seems to happen on the right side of the body more than the left. In any case, a particular mother came for bodywork with me just having discovered a breech baby at 39 weeks and having a 10 cm fibroid right next to the baby’s head. We both honestly didn’t think the baby would turn, but at least she left with less back pain and having had a good conversation about the surprising situation.
Having acknowledged the complexity of space, which also includes the amount of space in the torso as well as the size of the baby, we, of course, must also discuss the role other soft tissues of the body with head restriction. However, just because fibroids or a lower lateral placenta might be present, it doesn’t mean that we cannot assist in facilitating space to free the head. In many cases, we can.
When a head seems to be restricted, it can also manifest in symptoms of heartburn, pain in the ribs, and difficulty breathing. This is because the round head is providing a constant source of pressure in late pregnancy on the respiratory diaphragm. I think of this situation as “which came first, the chicken or the egg” scenario. Was it the tight respiratory diaphragm that prevented the head from releasing or was it the head up there that created inflammation in the respiratory diaphragm and restricted the space? In any case, releasing this anterior muscle is the first thing that I was taught to do, and the first thing that I do in breech body balancing session (thank you, Adrienne Caldwell for your dedication to this craft).
The respiratory diaphragm is in most of our life located under the ribs, but in later pregnancy, it comes up to the surface and out from under the ribcage. This is because of the pressure in the lower ribcage increases and the respiratory diaphragm’s curvature increases. Organs are pushed up by the growing uterus and baby displacing the respiratory diaphragm.
Softening the respiratory diaphragm makes such a difference in palpation of position. There are many times I am not sure of the upper pole of the baby being a head or bum, but once softened, the movements and shape become more defined. It is as if the fluids in the area also distribute more evenly allowing my touch to be more refined. When this muscle softened, there are reports of more comfort and easier breathing. We can also open up the respiratory diaphragm on the side by mechanically and fascially opening the side of the body. This entails, while on one’s side, us placing our hands on the bottom portion of the scapula and the other hand on the top of the iliac crest and applying gentle traction. This can be done along with Side Lying Release (SLR) as well. When the head is caught underneath the ribs and seems to be in the way of softening this muscle, it typically falls out of the way when the parent lies down on their side with their arm over their head. This, too, creates space for head release. I find this shift from side to the back with massage as being useful in our work and utilizes the principles (thank you Spinning Babies®) of balance, gravity, and movement.
We know that the respiratory diaphragm and the psoas are linked as well. They are both involved in breathing and walking (and chronic stress), they share tendons that extend to the psoas major, they share the medial arcuate ligament wrapping around the top of the psoas, and they are connected through fascial grouping. Since breathing and walking are involved as well as fascial lines of flexion and extension, we also know that these areas are affected by stress in or out of pregnancy. Many people have various methods of releasing the psoas, and one can find manifestations of single-sided compression patterns that can affect that head release on the constricted side as well.
The Quadratus Lumborum (QL) runs parallel to the psoas and connects from the rib to the back side of the lumbar spine to the top of the pelvis. This too can contract the space for rotation of the head. When reaching over the torso and kneading the area of the broad ligament, the tight QL or psoas can also be softened with massage.
The broad ligament, the abdominal muscles, and also the fascial networks connected to this area seem to be softened with this work as well. We also affect these soft tissues with manteada of the belly and the buttocks and even the warming of the lower back (moxa warms this area too). I find doing this work while the nervous system is calm (maybe after standing sacral release) is most useful. Fascia therapy across the belly can also be ingredients for softening, calming, and connecting. Pacing is essential in all birth work, but we must track the body and its reception to our work. If we go too fast, it becomes mechanical like a checklist. If we track the body and its rhythms and follow it, it can show us the way to how the work we do can be taken up most efficiently.
The suggestions here are just parts of a full body balancing as we focus on head restriction. Feeing the head is easier when done earlier like 32 to 33 weeks, but waiting for bodywork to be done can still make a difference. There is more space before baby grows and more space once the tissues have been softened and released! I have other small or simple tricks of the trade to employ when assisting the head, but this crosses into midwifery skills, comfort levels, and consent. Much of this work would really be a game changer when applied right before or even during an External Cephalic Version or variation of titrated external versions. In fact, even when planning a vaginal breech birth, such bodywork can assist with one’s preparation.
Caldwell, Adrienne, MT breech mama and more. Advanced Anatomy for Fetal Positioning. 2016, MN.
Morales, Nilaya. Contributions for personal experiences for her mother.
Mossay, Jaimie, MT. Had patience when I didn’t know anything about things like the QL and much more.
Sciuva, Charisse, MT. Good Solid Advice on Respiratory Diaphragm Release and the breath.
Spinning Babies and Gail Tully
Windolph, Marcello, Fasciae therapist, Danis Bois Method. ITB. Presence and pacing and more.
All the people who have come in for assistance and contribute to my everyday learning.
#craftingmidwifery #ECV #breechpregnancy #breechrestrictions #bodyworkforpregnancy #breechbodybalancing #breech #breechheadrelease