In response to the question about turning a breech by elevating the trunk
above the head [Issue 2:6]:
A tilt board with the head lower than the buttocks is commonly used for 15
to 30 minutes one or two times a day to encourage a breech to turn. Most
women use an ironing board with a blanket for padding and elevate the end
about 12 inches. The idea is to lift the baby's head out of the pelvic
girdle so it has room to turn without being stopped by the bones. The best
time for this is one to two hours after a meal when blood glucose is
higher. That is the time the baby is most likely to be awake and active. If
the baby is asleep then it cannot turn itself.
Some moms like to place earphones with pleasant music playing on their
lower abdomen while this procedure is being done. The theory is that babies
are more active when they hear music and will often move head down to get a
better listen. Repetitive classical music is said to be most favored.
Studies have shown that babies have a definite predisposition for Bach.
Some mothers find the slant board position uncomfortable and instead elect
to choose a hands and knees position with their head and chest lowered
close to the floor. Pillows are needed to be comfortable.
If neither approach is effective, seek a care provider who has experience
with performing an external version, where the baby is slowly and gently
manipulated through the outside of the mother's abdomen. The head is lifted
out of the pelvis and the baby is gradually turned the direction it is
facing until it is head down. The baby's heart rate must be monitored
throughout the procedure to ensure that the position change is not creating
cord entanglement that could harm the baby. Some babies turn quite easily;
others take an hour or more. In some cases the baby simply cannot be turned
due to lack of room or change in the heart rate that indicate a version is
not a good idea. In those instances the baby is gently returned to its
former position.
Most practitioners like to do an ultrasound before an external version to
check for anomalies, look for cord wraps around the baby's neck and to
identify where the placenta is located. If a placenta is located
anteriorly, or along the front of the mother's abdomen, a version is often
not attempted because the placenta may be disturbed in the process. Some
mothers have bellies that contract a lot when they are being "massaged." In
these cases doctors will sometimes give a medication called a tocolytic,
such as terbutalin, to temporarily stop the uterus from contracting during
the procedure. These medications can make a mom feel "jittery" like she has
had a few shots of espresso. The jitters leave when the medication wears
off. If you are RH negative, your physician or midwife may give you an
injection of Rhogam after the version to protect you from becoming
sensitized just in case there was small undetected placental disturbance
during the procedure.
Whatever the method, after a baby turns, spend a lot of time walking and
squatting during braxton hicks contractions to encourage your baby to
engage in the pelvis and minimize the chance of a return to a breech
position.
-Maryl Smith
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After the baby turns, continue to place music at the bottom of the abdomen
to encourage the baby to stay head down. I know it sounds silly, but I have
seen it work so many times that I routinely recommend "musical version" to
anyone with a breech presentation.
-Kathy Herron
Reprinted from Midwifery Today E-News (Vol 2 Issue 7 February 18, 2000)
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