The Birth Beat : stories, articles and instruction for the modern midwife
SO the thing about Asynclitism is that it happens most commonly while the head is negotiating the mid pelvis, so the baby is almost always R or L OT, i.e, facing her side.
There are two kinds.
1. Posterior - baby's body is tilted toward the mom's back - baby's head has the forehead/ crown towards her pubic bone.
2. Anterior - babies body is tilted toward her belly - head is prominent in mom's spine.
These two conditions need opposite treatments, which is why sometimes techniques work and sometimes they don't. An Anterior Asynclitic baby needs to be lifted out of the belly and into the mid-line of the mother’s body, so rebozzo belly techniques and binding work well as well as reclining in the tub (miles circuit because of the reclining bit). These babies usually are born to multips with rectus diastasis. A posterior asynclitic baby needs to be dropped out of the back and into the belly space. Mom needs forward-leaning, belly hanging exercises and frequently disengagement from the pelvis (knee Chest). These babies usually have first-time mamas.
My favorite techniques for a Posterior Asynclitic baby is to spend a contraction or two in knee/chest or couch floor doing an inversion, using the rebozzo over her bottom, with a slight shifting jiggle between contractions and then come up to level for two contractions. After about 2 of these cycles, the progress you’ve been missing will be evident and/or moms pain will be reduced.
My fav for Anterior asynclitic is to have mom do one or two contractions inverted as deep as she can and then come up to a birth ball and then slide back, rolling the ball along her bum and back until she is leaning across it in a back bend for 3 contractions. Then while still in the back bend, we bind her belly with a Velcro belly binder (rebozzo would work but is less comfortable) It is rare to have to do more than one of these circuits, but I have occasionally. Anterior Asynclitism increases the risk for anterior lip too, so belly lifting after this move of baby can be proactively helpful.
Any technique to solve asynclitism ideally will be offered before mom is complete. It should be noted that normally all properly positioned babies enter the mid-pelvis in end of pregnancy or in labor a bit anterior asynclitic and as they rotate anteriorly their head naturally moves to synclitic and well flexed without any outside assistance. So simply lifting the moms belly of an anterior asynclitic presentation can apply the baby to the pelvic tissues and help cause that rotation.
It is much harder to move a baby already impacted from pushing, although not impossible. Frequently, though, midwife will need to add umph from below to help move baby out of pelvis when mom is inverted and then help baby with manual rotation.
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