Breech presentation of the fetus. Different types of exercises.
MEDXPERT Ultrasound Diagnostic Center, Osh
As a rule, the fetal presentation is finally established by the 34th-36th week
of pregnancy. Therefore, if breech presentation is detected, it is recommended from 29 weeks
to begin corrective exercises - correcting breech presentation without
manual intervention by an obstetrician. There are many sets of exercises developed by I.I.
Grishchenko, A.E. Shuleshova, I.F. Dikan, V.V. Fomicheva, E.V. Bryukhina and others. The exercises
are performed either independently or individually at a school of psychophysical preparation for childbirth.
It is known that labor with breech presentation of the fetus often involves complications,
so in such cases doctors often have to resort to a cesarean section.
But this is still not the way to solve the problem - recently more and more attention has been paid
to changing breech presentation to head-first (cephalic) presentation before birth. One of the methods of such change
is special exercises. What are they and how effective are they?
Starting position - standing, feet shoulder-width apart, hands on the waist. Spread your arms to the sides - breathe in; turning
the torso to the side, bring your arms, straightened in front of you, together - breathe out (repeat 3-4
times to each side at a slow pace).
V.V. Fomicheva's method is used from 32-34 weeks to 37-38 weeks of pregnancy.
A session lasts 20-25 minutes; the set is performed 2 times a day (in the morning and in
the afternoon), no earlier than 1-1.5 hours after a meal. The exercises are performed at
a slow pace, combined with breathing, in a specific sequence from simple
exercises to more complex ones. Clothing should be light and should not restrict movement,
and the room should be aired. You will need a chair with a sturdy back and a mat for performing
exercises lying on your side.
With this method, the turning of the fetus to head-first position is explained not only by a mechanical factor
(increased motor activity of the fetus, increased peristaltic movements
of the amniotic fluid), but also by a change in uterine tone as a result of increased stimulation of its
receptors when changing position from one side to the other. The method is harmless, accessible,
and is used even in women with a complicated course of pregnancy, that is, even when
the contraindications listed below are present, it does not lead to an increase in cases of the umbilical cord wrapping
around the neck, torso and limbs of the fetus.
Before the main part of the exercises, a warm-up is done for 3-4 minutes (walking on tiptoes,
on the heels, on the outer edge of the foot, with high alternate raising of the knees to the side of
the abdomen).
Starting position - standing, hands on the waist. A slight bend backward - breathe in; a slow bend forward, arching in
the lower back - breathe out (repeat 5-6 times).
Starting position - standing facing the back of a chair, holding the back of the chair with outstretched arms at waist level.
Alternately raise one leg, bent at the hip and knee joints, to the side of the abdomen,
touching the hand with the knee; while lowering the leg, arch the lower (lumbar) spine - breathe out
(repeat 4-5 times with each leg).
I.F. Dikan's method is used from 29-40 weeks of pregnancy. Lying on a bed or couch,
the pregnant woman turns alternately onto one side and then onto the other and lies on each side
for 10 minutes. The procedure is repeated 3-4 times. Sessions are held 3 times a day before meals.
Starting position - standing, feet shoulder-width apart, arms down. Bend to the side - breathe out;
return to the starting position - breathe in (repeat 5-6 times to each side).
After the head has settled above the pelvic inlet, the pregnant woman is advised to lie (including during
sleep) on the side corresponding to the baby's back, and to wear a support belt. Wearing the support belt correctly
helps reduce the transverse size of the uterus and increase its longitudinal size, and
prevents the fetus from turning back from head-first to breech presentation.
Starting position - kneeling, leaning on the elbows. Alternately and slowly raise a straight leg backward and
upward (4-5 times with each leg).
- Starting position - standing with one foot on the floor, the knee of the other leg resting on the seat of a chair, hands on the waist;
- spread your arms to the sides - breathe in; turn the torso and pelvis outward, slowly bend over,
lowering your arms down in front of you - breathe out (repeat 2-3 times to each side, changing the supporting
leg).
Starting position - lying on the right side. Bend the left leg to the side of the abdomen - breathe in; return to the starting position - breathe out
(repeat 4-5 times).
Starting position - on all fours. Straighten the legs, resting on the front part of the feet (i.e. the heels
should come off the floor), raising the pelvis upward (repeat 4-5 times).
Starting position - lying on the back, resting on the feet and the back of the head. Raise the pelvis - breathe in; return to the starting position - breathe out
(repeat 3-4 times).
After the main part - lying down or sitting, 4-5 breathing exercises to
calm down.
When this set is performed, there are rhythmic contractions of the back muscles, as well as
the internal oblique and transverse abdominal muscles, whose fibers enter the round ligaments
of the uterus. Thus, under the influence of the exercises, the increased tone of the skeletal muscles
spreads to the uterus, and its tone increases. In addition, bending the torso forward and
bending the legs at the knee and hip joints reduce the length of the uterus, helping
the head move in the right direction.
Starting position - lying on the left side. Repeat exercises 7 and 8.
Starting position - the same. Breathe in - slowly bend the torso down, touch the hands with the chin; breathe out -
smoothly return to the starting position (repeat 4-5 times).
Starting position - the same. Slowly raise the straight right leg up, move it to the side, touch the floor with the toes,
return to the starting position. Perform 3-4 times alternately to both sides; breathe freely.
When this set is performed, a positive change in the condition of the cervix
is noted, which may be related to improved blood supply to the pelvic organs.
The introductory part of the set is the same as in V.V. Fomicheva's method, and in the final part
it is recommended to perform exercises to strengthen the pelvic floor muscles with a gradual
reduction in load. The most common is the Kegel exercise. Here is one of
the variants of this exercise: tighten the pelvic floor muscles (draw in the muscles of the vagina and anus)
and count to 10, then relax; then repeat, counting to 8, 6, 4, 2.
Starting position - lying on the right side, leg raised 30-40° above the floor. Circular movements with the left leg 4
times in each direction (repeat 3-4 times).
Starting position - kneeling, leaning on the elbows. Breathe in, then breathe out (repeat 5-6 times).
Starting position - on all fours. Lower the head down, round the back - breathe out; slowly arch
the back in the lower back, raise the head – breathe in (repeat 8-10 times).
The doctor at the antenatal clinic will determine the uterine tone and advise the necessary set of
exercises - it is not recommended to use all the described sets at once. In 76% of cases of
breech presentation, it is possible to achieve turning of the fetus to head-first position by performing
the exercises.
Starting position - on all fours. Lower the head down, round the back, breathe in; return to the starting position,
arching in the lower back - breathe out (repeat 10 times slowly).
E.V. Bryukhina's method is recommended from 32-34 to 37-38 weeks of pregnancy. Sessions are held
daily 2 times a day, no earlier than 1-1.5 hours after a meal. The method is based on
physical exercises to relax the abdominal muscles, using
the knee-elbow and knee-hand (all fours) starting positions.
It is known that the effectiveness of different methods also depends on uterine tone, so an
individual, differentiated choice of exercises is important. Thus, with increased
uterine tone, exercises according to I.F. Dikan's method are effective. With normal and reduced
uterine tone, V.V. Fomicheva's method is recommended, and with uneven uterine tone (tone
in the body and lower segment is higher, and in the fundus lower) - exercises according to E.V. Bryukhina's method.
Stay healthy!
The main contraindications to corrective exercises
are: placenta previa - a condition in which the placenta
blocks the exit from the uterus; threatened miscarriage.
Be careful!
If pregnancy is complicated by gestosis (preeclampsia; most often it shows as swelling,
increased blood pressure, and protein in the urine), or in the case of
serious pathology with decompensation of the heart, kidneys or liver,
exercises in the knee-elbow position should be avoided.
This article is strictly for informational purposes; before taking any action, you should consult a doctor!
