1	WEBSTER TURNING TECHNIQUE Spinal analysis and Treatment of Posterior, Transverse or Breech presentations and the reduction of dystocia
2	What controls the Uterus? Nerves!! Specifically Lower Thoracic Sympathetic T10-L3 and Lower Parasympathetic outflow S2-S5. Netter Collection Vol.1 Nervous Sys.
3	3. Abnormalities of presentation, position, or development of the fetus Understanding the role of the Uterine ligaments Broad Ligament UteroSacral Ligament Round Ligament Williams Obstetrics Chapter 19
4	Uterosacral Ligaments Each uterosacral ligament extends from an attachment posteriorlaterally to the supravaginal portion of the cervix to encircle the rectum and then insert into the fascia of the second and third sacral vertebrae. The uterosacral ligaments are comprised of connective tissue and some smooth muscle and are covered by peritoneum. Posterior subluxation of the sacrum may result in tightening and torsion of the uterosacral ligament contributing to an imbalance in the uterus leading to intrauterine constraint. Williams Obstetrics 21^st Eddition
5	Round Ligaments The round ligament extends from the lateral portion of the uterus, arising somewhat below and anterior to that of the origin of the oviducts. Each round ligament is located in a fold of peritoneum that is continuous with the broad ligament and extends outward and downward to the inguinal canal, through which it passes to terminate in the upper portion of the labia majoris. It joins with the inguinal ligament approximately half way on its inferior course. During pregnancy, the round ligaments undergo considerable hypertrophy and increase appreciably in both length and diameter. It too has smooth muscle.
6	Complications anticipated from breech presentation: Perinatal morbidity and mortality from difficult delivery Low birth weight from preterm delivery, growth retardation or both Prolapsed cord Placenta previa Fetal, neonatal and infant anomalies Uterine abnormalities Operative intervention, especially c-sections (Williams Obstetrics 21^st edition, Chapter 18)
7	Accepted ways to turn a breech: External Cephalic Versions Webster’s breech turning technique
8	E.C.V.’s: External Cephalic Versions Usually scheduled between two to three weeks prior to delivery. The success rate of the ECV has been documented to range between 41-77 % (Hans Jr. JW: Am Journal OB/Gyn, 1990) Complications of ECV’s include: Fetalmaternal bleeds, placental separation, ruptured membranes, and even fetal death. (Williams Obstetrics 21^st ed. P.531) Most breech presentations with an unsuccessful ECV will result in a c-section. Most c-sections will result in subsequent c-sections.
9	Webster Technique Defined: The Webster Technique is a specific chiropractic analysis and adjustment that 1. Reduces interference to the nervous system. 2. Balances the pelvic muscles and ligaments Which in turn… 3. Reduces torsion to the uterus and intrauterine constraint to the fetus 4. Allows the baby to get into the best possible position for birth.
10	Five Major steps in Webster’s Technique: 1. Check for Piriformis contraction 2. Check for Sacral Plexus subluxation 3. Adjusting Sacrum 4. Locating Round Ligament 5. Round Ligament contact
11	1: Piriformis muscle analysis Piriformis muscle will be tight on side of sacral posteriority Muscular contact will be made gently to equalize pull on both sides of the sacrum.
12	2.Checking for Sacral Subluxation Analyze for a resistance as we push each foot toward each buttock The side of resistance will be the side of posteriority of sacrum
13	3.Adjusting the Posterior Sacrum Very gentle impulse from posterior to anterior on the side of sacral posteriority.
14	4.Locate the round ligament
15	5.Thumb Contact of Round Ligament Sustained Contact Pressure is equal the resistance of the ligament Contact is sustained for 1-3 minutes on average Fetal movement if often felt when uterine constraint is released.
16	Our Success rate: Over 100 breech presentations in the last 5 year 97-98 % success rate at vertex position with 2 weeks
17	Some Testimonials… “Thank you, Thank you, Thank you Dr. McWilliams for helping my baby turn” K H “I would have never imagined it would be such a comfortable procedure” J B “I cant believe we turned my baby with so little effort. Thank you so much for a wonderful experience” T B “I would recommend Dr. McWilliams to anyone with a breech baby. Within three treatments my baby turned” J A “I was really nervous at first but Dr. McWilliams was so comforting and the procedure was absolutely painless. Thank you!” K C
18