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How to do a Diaphragmatic Release
"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."
A Butcher's Dozen - Nancy Wainer Cohen.
A must read article by a midwife & childbirth educator who co-authored the book "Silent Knife: Caesarean Prevention and VBAC", A Butcher's Dozen appeared in Midwifery Today, Issue 57.
Here are some relevant quotes from the article.
On posterior babies:
"If the woman is in the hospital, the obstetrician will most likely suggest Pitocin, which often causes other problems: maternal and/or fetal distress; stronger, but still ineffective contractions which are more difficult for the mother and so she needs-begs for-drugs or an epidural; and then we get into that whole CASCADE of interventions, and, most importantly/ominously, forcing the baby down in-and thus actually committing the baby to-the unfavorable position.
Others suggest that the woman squat if she is not making progress-this may also encourage the baby to come down in the unfavorable position, causing a deep transverse arrest. Doctors often break the bag of waters, hoping to get things going-this is not generally recommended either, as this, too, often commits the baby to the unfavorable position."
On turning posterior babies:
"The position that we find most always rotates posterior babies is called the Polar Bear Position. This term was coined from a magnificent picture in National Geographic magazine of a polar bear who is birthing her baby. Her front paws are down as low as they can go, as are her shoulders, and she has a big arch in her back with her knees apart and her butt way up in the air. (It has also been called the Playful Puppy Position, or Sleeping Baby).
Women assume the position in early labor, when the contractions are established. If after 45 minutes or so the baby has not turned on its own, it is easy to go in (with the woman still in that position) and reposition the baby by gently but firmly pushing the baby back in. Many obstetricians tell women that the baby's position cannot be adjusted until the woman is at least seven or eight centimeters or more, and unless the baby's head is quite low in the pelvis.
The problem, of course, is that many women never get to seven or eight with a posterior or asynclitic baby, and if they do, it has usually taken hours and hours. Adjusting the baby's head position in early labor is imperative: it saves the mother from exhaustion, saves the baby from distress and eliminates the problem of a baby that is unable to turn.
It is not unusual to have a mother who has been "stuck" at four or five centimeters for a while to automatically progress very quickly, because the head is now well applied to a cervix which has very much wanted to cooperate but has been unable to do so due to unequal (or non-existent) pressure."
On prevention of posterior babies:
"Prevention of posterior babies is possible! We are all beginning to pay attention to this fact. We are telling pregnant women: Never recline during pregnancy-if you are going to sit and read or watch TV, for example, make certain that your back is absolutely straight.
Reclining can weaken back muscles and create a situation that encourages babies to hang out in unfavorable positions (and look at how all our little American babies are carried around in bucketed car seats for hours at a time, creating generations of girls who will later be predisposed to posterior babies as a result!)"
