The Bagnell System for Breech Presentation
By Dr. Karen Bagnell
The Bagnell System for Breech Presentation was designed with the breech baby in mind, but has also been used very effectively for transverse, oblique and posterior presentations as well.
I started using Webster’s technique when I was still a student at Life more than 10 years ago, but was left wanting more from that particular technique. It was then that I realized I need to know how and why a baby malpresents. As a result, the quest for a new technique began.
The only technique that vaguely resembles our own is in fact Webster’s. This resemblance lies in the fact that both techniques address the breech baby and that neither claims to turn babies, but that is where the similarities end. While Webster’s technique places emphasis on the round ligament, The Bagnell Technique places emphasis on the alignment of the pubic symphasis. In Webster’s technique, sacral posteriority is key, however, The Bagnell Technique has uncovered that sacral rotation plays a much more significant role than posteriority alone. The Bagnell Technique also incorporates the importance of C2, coccyx and the sacrotuberous ligaments.
More than a decade and hundreds of pregnant women later, we have a highly effective technique to present to our profession. In the following paragraphs you will learn why this technique is so effective and yet why it is not 100 percent effective. You will learn how and why a baby malpresents and how to determine if a pregnant woman can benefit from The Bagnell Technique for Breech Presentation.
How this technique was developed.
When we used Webster’s technique with mediocre results, we started to wonder why. What are we missing? Why do some women have a posterior sacrum and some do not? Why do some women’s round ligaments present with tautness while others’ never do? What do we do if the Webster indicators do not show up during exam?
This is when we started to really investigate the mechanisms of the female pelvis especially during pregnancy. We spent hours at local and college libraries reading and studying the biomechanical aspects of the female pregnant pelvis. We found a green book written by Harry Vedder in 1923 called “Chiropractic Gynecology” at a local book sale and bought it for $2. This was the start of it all. The following diagram made it clear to us why a baby malpresents and how to correct it through chiropractic.
When we started to see more and more women who carried mal-presented babies we knew we had to uncover why this is happening and so we started our research. The following theories came about from over 10 years of research.
Bagnell Technique Theories
The uterus is suspended by eight ligaments and a node called the perineal body. These suspensory ligaments must all function properly and not have tension or spasms in order for the uterus to be suspended properly and itself, be without spasm. Some of the ligaments attach directly to the pelvis and others attach indirectly to it, as you can see in the illustrations.
Subluxation to pelvic region including coccyx causes an unstable environment due to an abnormal pelvis, (we have found a huge correlation between the coccyx and the female reproductive system). A distorted pelvis causes distortion to its contents especially the uterus.
If the round ligament is taut it causes a restriction of the uterine (broad) ligament that surrounds the fetus.
Subluxation of the sacrum causes confusion in the nervous system and a distortion of the pelvis and pelvic opening itself.
Misalignment of the Pubis symphysis plays a huge role in our technique. We believe this to be the corner stone of the Bagnell Technique. In fact, this is one of the criteria that sets us apart from the other techniques. Both round ligaments attach into the tissue of the labia majora. Due to this attachment we have found a relationship between the round ligament and the pubic bones. A taut round is always on the side of pubic bone superiority. Unless this superiority is corrected, the round ligament will continue to spasm. We have yet to see an exception to this.
What we know so far
We have found with our experience, it is much more effective to adjust ALL subluxations present on every visit. This includes the sacrum and any ligaments found to be taught. We know this goes against what some techniques teach, but this is what works here.
Sacrum is almost always involved in some way. If you are not getting a clear “picture,” check the occiput (Lovett Brother to Sacrum). After adjusting the occiput, a sacral “listing” will almost always appear, as will a pubic bone subluxation.
Almost always, when pubic bone superiority is corrected, the round ligament relaxes.
C2 must not be ignored. Its Lovett Brother is L4. L4 is significant in the female reproductive system. On many occasions, we have found and adjusted only C2 with fantastic results.
Bagnell Technique Protocol
Obviously, a thorough case history and exam is required.
Ask specifically about trauma to the coccyx; we were surprised how many women who had breech presentations had this in common.
You must have a way to care for the pregnant woman when she is in the prone position. We use a table with a tilt up pelvic piece. You may also use a table with a drop away lumbar piece. We have also used with great results pregnancy cushions. These cushions can be used on any chiropractic table, bench or bed (for house/hospital calls). We check for sacral apex rotation using Thompson Technique, but this can be very technique specific as many other techniques check for sacral rotation, and we recommend you use the technique that best serves your clinical experience and expertise.
It is not so much the posteriority of the sacrum as it is the rotation of the apex. This almost always has to be adjusted first, and then the posteriority component can be addressed if still present.
Always adjust the superiority of the pubic bone before you address the round ligament contraction. Very often, by just adjusting the pubic bone the round ligament will “let go.”
Make sure to address the sacrotuberous ligament especially if there is sacral involvement. As with the occiput, the sacrotuberous ligament often must be addressed before any sacral subluxations can be detected. There are a variety of techniques such as SOT, Network, Logan Basic, etc. that address the sacrotuberous ligament spasm. Personally, the technique that we choose in our office is a combination of SOT and Logan whereby we hold a contact on the tight ligament until the spasm releases. Again, though, use the technique that best serves your clinical experience and expertise.
Step by step instructions for the Bagnell Technique
