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The History

The first description of the technique dates back to Italy in the mid 1700s. The image below is from a publication: La Commare o riccoglitrice (The Midwife, 1601 edition) by Italian monk turned surgeon Scipion Mercurio.

The technique is now know and named after Gustav Adolf Walcher, who was born September 21, 1856 and was from East Württemberg, Germany, where he was the Director of the Württenburg School for Midwives in Stuttgart.

The position was praised in an obstetric review in 1897 as it helped to reduce high forcep use, which commonly lead to severe birth trauma and often death due to infection, as hygeine practices were poor back then, but it was then lost to American Obstetric literature. Gail Tully of Spinning Babies redescribed the technique in an article in Midwifery Today in 2011.

Midwife assisting a woman in labour from La Commare o riccoglitrice (The Midwife, 1601 edition) by Scipion Mercurio

How Walcher's Works

In this position, the legs are used as a long lever into hip extension (moving back relative to the body). This causes an anterior rotation (forward tipping of the top) of the pelvis relative to the extended spine (arching of the low back). This opens the space between the pubic symphysis at the front of the pelvis and the sacral promontary at the back. Opening the front to back space in the pelvic inlet. If the legs cannot hang freely you can place pillows, rolled up towels, etc under the top of the femur to allow for the required movement.

Walchers should only be used when the baby is high and struggling to get into the inlet of the pelvis. It should also only be used when there are active and strong contractions. It is best to only use Walchers when other techniques for helping at the inlet have failed. This position can be held for three contractions with close support and reassurance of the birthing person, as it creates an intense and uncomfortable arch in the lumbar spine (low back). There are alternatives to this techniques that are less extreme and things that you can try BEFORE using this technique. If you would like to know more about helping at the inlet, or how to know if a baby is stuck at the inlet, you can find out in my Bitesize Birth Lecture - Helping at the Inlet.

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