Israel Doula

The blog of a birth doula in Jerusalem, Israel.


About Me
My name is Michal Levy, and I am the writer of this blog, Israel Doula. It is a blog about my adventures as a birth doula, and as a professional massage therapist for pregnant women.
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Monday, November 19, 2007

How to turn a breech head-down.

R. called me with the message that her baby is breech. She was 37 weeks pregnant and about to give birth to her first baby. During our first prenatal meeting, R. had told me that she has a bi-cornuate uterus and that makes her chance on a breech much higher, so I was not very surprised.

R. sees a doctor that I like very much, but is too biased towards the Bikur Cholim hospital in my opinion. No wonder, he's affiliated with them himself. So I was not surprised to hear that he had sent R. to another Bikur Cholim doctor to do an ECV (external cephalic version) to turn the breech head-down.

I told R. to hold her horses and check out her options first. She was 37 weeks which means that there wasn't much time. The fetus is already big at 37 weeks, and the bigger they get, the harder it will be to turn them.
Normally when a lady finds out that her baby is breech, it's a little earlier (around 33-34 weeks) and there is time to try some less invasive techniques first.

A known technique is this one:


Lie on the floor and pace your feet against the wall, pelvis up in the air. Support yourself well with pillows. Do this for about 10-15 minutes, twice a day. Alternatively, you can place an ironing board against the couch or your bed and lie on it head-down. Put some pillows under your head.

Another pose is this one:



Also known as the knee-chest position. Kneel down on the floor (rest your knees and head on a pillow or sit on a yoga mat). Make sure that your pelvis is higher than your chest by placing your chest on the floor as well. Sit like this for 15-20 minutes, a couple of times per day.

Well-known alternative treatments for turning a breech include moxibustion (acupressure/shiatsu) and the Webster technique (chiropractics).

Only when these techniques don't work and the baby is still breech by 37 weeks, I advice my ladies to do an ECV, or external version.
I sent R. to the most experienced ECV doctor in Israel, Dr. Kanetti. He has a very high success rate.
Unfortunately, it didn't work for R. Her baby was still breech.

She went to several doctors and professors in the field to ask their professional opinion on how she could best give birth. On the one hand, outcomes for first babies who are breech who are born by c-section are slightly better than for first babies who are breech who are born vaginally. But a c-section has a lot of implications for subsequent pregnancies and births. Mothers who deliver their first babies by c-section, have a higher chance of ending up with subsequent c-sections than mothers who have already given birth vaginally.
But all the doctors R. turned to said unanimously that in her specific case, because she has a bi-cornuate uterus, a c-section was the only option. A c-section was scheduled.


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Thursday, November 1, 2007

Pregnancy massage using body pillows

My client M. is getting a weekly massage from me. She is 36 weeks pregnant with her first child, and really treats our weekly hour as her pamper moment. Usually when I do pregnancy massage, I put the lady on her side, do my whole massage routine, flip her over to her other side and repeat the whole thing.

Women with a pregnant belly can't lie on their stomachs, and later on in the pregnancy lying on the back also becomes problematic. Many women can't breathe while lying on their backs, because the heavy uterus is pressing on the vena cava and causes dizziness and breathing difficulties.
So I always prop pregnant ladies up on their side, supported by lots of pillows. But this time, M. really wanted to try to lie on her belly. I always use this pillow for massages:



So I propped M. up so that her belly was right in the hole of the pillow, and her chest was leaning on the top. And I put lots of pillows under her head. She was comfortable that way, and I could massage the whole back part of her body like that.
Then I flipped her over for another few minutes of chest- and belly massage.

Another great pillow is this one:



I ordered the bigger one with a special cover which is easy to wipe clean. When I put a lady on her side for a massage, which I usually do, she can hug this pillow and put one knee on it so she'll feel supported and it also keeps her hips level. This pillow is perfect for that.


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