It is easy to recognize a persistent posterior baby. You cannot feel the
back on palpation, rather only little lumps and bumps of limbs. To do a
diaphragmatic release, it is best to have the mother lie on her back. If
she is in advanced pregnancy and this makes her very uncomfortable, you can
have her lie in a recliner or semi-sitting position. If you use that
position, place a small pillow or adequate support behind her lower back.
One hand will go horizontally across her lower back where the uterine
ligaments attach. This is where you would put lower back pressure during
labor. You do not need to press, as just the pressure of the mother lying
on your hand will be sufficient. (Be sure you take off any rings you may be
wearing, for your hand's sake!)
The top hand will go on top of the abdomen, horizontally just above the
pubic bone with the thumb upward. Just rest it lightly on the abdomen, no
pressure. Then all you have to do is wait. Things may start right away or
it may take several minutes before you feel anything. What you will feel is
a motion beneath your hands. For the hand in back it will feel much like it
does when there is a contraction taking place during labor as you feel the
muscles tighten and contract beneath your hand and release. For the top
hand it will be either a waving motion or a circular motion under your
hand. At first you will think you are just imagining it, but you are not.
The best description I can give is that it feels as if the mother has a
tennis ball in her abdomen that is being bounced back and forth between
your hands. As it hits one hand it will roll across it or around underneath
it and then bounce back to the other hand. Sometimes the motion is so great
that it will actually make your hand wave on the abdomen. Sometimes the
mother will feel things inside, sometimes not. What she feels may not be
located where your hand is located. The movement under your top hand may
stay all in one place or move around. If it moves, try to gently follow it
with your top hand to keep it centrally located under your hand. Do not
move the back hand. Sometimes it will move around in a circle, sometimes
off to one side, or even clear down to a hip. It all depends on the muscles
that are involved and the type of injury that precipitated all the spasm of
abdominal muscles. Our muscles really only know how to contract and
shorten, not how to relax and lengthen. They depend on another counter
muscle to contract and pull the first one out of contraction. Abdominal
muscles do not have as many counter muscles, so this technique allows the
muscles to relax.
If you go back into the mother's history, you will almost always find a
history of a car accident (especially with a seat belt on, where there has
been a twisting of the abdominal muscles because we use only one-shoulder
restraints) or severe fall. However, I have had a mother cause it simply by
doing too much hoeing in the garden.
You continue the diaphragmatic release as long as you feel motion under
your hand. Usually it will just fade away and you will no longer feel it.
Sometimes, if you end up over a bony prominence, it will end with a
vibration. The process takes some time, often at least 20-45 minutes. But
if you consider the time you save in labor, it is well worth it. You may
need to repeat the process over several visits. I usually start at about
the 6th month unless I have a mother with a history of car accident or
several prior posterior babies. This procedure has also been used this
technique to turn breech babies. I use it for transverse but find it less
effective for breech. I usually use a tilt board for breech and then do a
diaphragmatic release after the baby turns. It works marvelously well for
posteriors. I have never done one where the baby did not turn to anterior.
However, on some occasions, after a few days the baby will turn back to
posterior and you will need to repeat the process more than once. The more
severe the history, the more likely you will need to do it several times
before the baby will stay anterior.
Posterior babies use to be the worst problem I had in births. The long hard
back labors wore us all out and occasionally ended in transfers for
maternal exhaustion. I am thrilled not to have these any more. Now my
biggest problem is cervical lips! But I am working on a solution for that
also, using evening primrose oil!
I do believe every midwife should have this valuable tool, the
diaphragmatic release, in her bag of tricks. It is so easy and
non-interventive. It is much better than other suggestions I have seen of
putting your fingers in the baby's suture lines and trying to turn the head!
Reprinted from Midwifery Today E-News (Vol 2 Issue 18 May 5, 2000)
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