The opera singer and the baby whisperer: A gentle birth technique has a hard time
Cesarean section? "Please not!" This thought went through Julia Novikova's head when she learned that the baby in her womb was in a breech position: its head up instead of down as usual. Julia Novikova is an opera singer. "A cesarean section damages the abdominal muscles," she says. A terrible thought: she has already sung the Queen of the Night, the aria from Mozart's "Magic Flute," in Berlin and Vienna, in large venues in front of large audiences – would the 41-year-old soprano still be able to do it?
A coincidence led her to the solution: Larry Hinkson, a doctor at the Charité hospital in Berlin . A friend mentioned a YouTube video. In it, Hinkson turned a baby: He stroked the mother's stomach, touching it here and there, triggering reflexes in the unborn child so that it moved in the desired direction of its own accord. "A gentle external version," says Julia Novikova. That's how she would give birth to her daughter, she thought at the time: "At the baby whisperer." But things turned out differently. While it wasn't a cesarean section, it wasn't a birth using the very same method known as "Soft Touch Tap" either.
That happened a good six months ago, but for Julia Novikova, this story is still relevant. It tells of a healthcare system that operates in its established ways and is based on guidelines. Sometimes it's difficult to take new approaches, even if they're good for patients, have few side effects, are uncomplicated, and have been tried and tested for years.
"From my perspective, it seems as if the system lacks the will to innovate," says Novikova. She refuses to accept this. "I want to ensure that women who find themselves in the same situation as I did have access to this gentle method."
She had tried to get an appointment with Larry Hinkson. "I called a phone number that was shown in the video. I explained why I wanted to give birth using the gentle method." On the other end of the line, a Charité employee explained that she would have to be registered for delivery at the university hospital to be considered. Novikova was registered at St. Joseph's Hospital in Tempelhof, where she had had a very positive experience with the birth of her first child. "At that point, I couldn't have known that she would be in a breech position."
The woman on the phone said she should try again later. But whenever Novikova called in the following days, the answer was always the same. "They said it wasn't possible due to high demand."
Only about five percent of pregnant women are affected by a breech presentation. Nevertheless, the capacity at Hinkson's clinic is far from sufficient to accommodate all interested women. The appointment crunch is also due to the fact that external cephalic version is only possible within a narrow time frame. Normally, the fetus turns head-down on its own by the 37th week of pregnancy. If the procedure is performed prematurely, there is a risk of premature birth.
Hinkson offers a breech presentation consultation, which takes place two to three times a week. "The women come from other hospitals in Berlin, from other German cities, and from other European countries," reports the senior physician. He has even received inquiries from the USA, but he has declined them.
He has been practicing his method since 2012. In 2018, he described the mechanism in a scientific publication. He came up with it in a pediatrician's office, where he saw a poster depicting an infant. It featured points that trigger reflexes when touched. "There are more than 20 such reflexes in newborns," says Hinkson. "I thought, 'Hey, I learned that in medical school.'" Why shouldn't these trigger points also work in the uterus? "The next day, a woman with a breech presentation came into the clinic." Hinkson and his team used ultrasound to search for the crucial points. "The child moved into the correct position in the mother's womb almost on its own. It was like a eureka moment," says the doctor. "No one had done that before."
It didn't stop at just one time. The idea became a system. A recent study at the Charité with more than 100 participants found a success rate of 72 percent. However, there are exclusion criteria. "Soft Touch Tap" cannot be used if a pregnant woman has too little amniotic fluid or if the placenta is in an unfavorable position. The umbilical cord must also be positioned in such a way that it does not strangle or otherwise injure the unborn child if it twists. "If all of these things are present, we always attempt a gentle turn," says Hinkson.
He too used the traditional method in the past to avoid a cesarean section, but did so after studying in England. This involves trying to position the baby mechanically by applying strong pressure with the hands on the mother's abdomen. "This often took place in an operating room. A surgical team was on standby in case complications arose and a cesarean section became necessary." While medication is not used for the gentle turn, says the doctor, the pregnant woman is given a labor inhibitor for the traditional method. "The medication is supposed to improve the success rate, but can cause side effects in the mother such as palpitations, nausea or falling blood pressure," says Hinkson.
For Julia Novikova, the labor inhibitor made her heart pound. "It was like I was running a marathon." She gave birth at St. Joseph's Hospital, where she was registered. During the prenatal consultation, she mentioned "Soft Touch Tap" and also referred to Hinkson's video, which was well-known. The external version was done the traditional way. "The attending physician was very caring," she says. "She said she would try as long as I could bear the pain. The baby was sufficiently protected." Julia Novikova persevered. "However, my stomach felt like I had a hematoma for five days."
Larry Hinkson shares his experiences with colleaguesMichael Abou-Dakn is chief physician at St. Joseph's Hospital. He says he has been familiar with the gentle external version for some time and reports that he first used it himself in the late 1980s. "Larry Hinkson deserves great credit for explaining how the method works: how to trigger a reflex arc and thus help the child turn." His senior physicians at Tempelhof Hospital, says Abou-Dakn, "mostly start with the gentle external version. If it doesn't work, they switch to the classic method."
The professor hopes that obstetrics will increasingly rely on this more gentle procedure, provided patients meet the requirements. "We try to make the turning situation as calm and gentle as possible, because a less tense pregnant woman makes it easier for her child to turn into the cephalic position."
Larry Hinkson is doing his part to ensure that his discovery can become standard practice, not only in Germany. He has already shared his practical experience with many colleagues. A team from Innsbruck, for example, recently had a demonstration of how "Soft Touch Tap" works. A visitor from Switzerland spent a week at the Charité Hospital. Hinkson participated in a soft tap in the US via video conference, guiding them remotely. "I post explanatory videos on YouTube." They are viewed thousands of times.
Hinkson doesn't know of any clinic that fundamentally rejects gentle ectopics. "But I do know of doctors who are afraid to perform them." Among them are several general practitioners. "They're afraid it might be painful for the women. That the babies might be exposed to stress. That an emergency situation might arise." However, the risks associated with this type of procedure are extremely low, and the time savings are an advantage for the patients. "We offer gentle external ectopics in our outpatient clinic. We perform an ultrasound examination and conduct an informed consent session with the mothers. If the procedure goes well, they can leave after one or two hours of observation."
Julia Novikova is grateful that the doctors at St. Joseph's Hospital delivered her baby without complications in December, but she wants to advocate for the gentle turn to become more widespread in obstetric care. It's no longer for her personal benefit; she has two children, including a daughter and a six-year-old son. She's committed to helping others in the same situation. "How is it possible," asks Julia Novikova, "that this proven approach isn't offered as part of mainstream care?"
She asked the German Society for Gynecology and Obstetrics a similar question. She described her situation and concerns in writing, in detail, and in considered terms. The society thanked her for the email and responded with a three-line statement: "Below you will find some papers on external turning that address the method and its application in everyday clinical practice and may provide further information." Below was a link leading to a guideline.
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