A breech presentation is one in which the baby’s bottom is coming down the birth canal first, followed by the shoulders and head. The breech birth is considered a more complex presentation for natural delivery through the vagina because the head and shoulders are wider than the baby’s bottom. Instead of the head opening up the birth canal, with smaller parts of the body to follow, the broadest aspect of the baby’s anatomy comes at the very end of delivery.
In the past, midwives and physicians understood that approximately 3 to 5% of all women will carry a baby in a breech presentation. They developed the skills necessary to assist women in labor who were giving birth to a baby in a breech position..
However with the advent of cesarean surgery as the default procedure used anytime the baby is in a breech position, many doctors and midwives have lost this expertise. If your baby is in a breech position after 30 – 32 weeks you may want to look for a care provider who is knowledgeable and comfortable with breech birth.
Turning the Baby
It should be noted that it is perfectly normal for the baby to periodically be in a breech position throughout the pregnancy up to 30 weeks.
After 30 weeks, when a baby is in breech position , the ideal or preferred solution is for the baby to turn, reversing its alignment to head first.
There are a number of things a woman can do that have some degree of success at turning the baby. Sometimes women will try several things to help increase their chances of getting the baby to turn. I know one woman who’s baby turned on the day that she went into labor. She named him “Turner”, so never give up! Deborah Flowers, CPM
Get your thyroid checked
This is best done early in your pregnancy, but it may not be too late to get your thyroid checked. One study showed that when women have low thyroid function, their baby may not be as active and this could lead to the baby being in a poor position at the time of birth. https://www.endocrinology.org/press/pressreleases/2009-12-23_Thyroid%20and%20foetal%20position.pdf
Exercises to Turn a Breech Baby
The Breech Tilt is an exercise that has been used by women to help a breech baby flip to a head-down position with a great degree of success.
You will need to do this exercise 1-3 times a day if you are told your baby is breech. You can start as early as 30-32 weeks and continue through to the time that you know that your baby is head down. As soon as your baby turns, you want to stop doing the breech tilt and go for a walk to allow your baby to settle into the pelvis. one good thing about the Breech Tilt is that it is not invasive. Ask your care provider if there is any medical reason not to do a Breech Tilt before you start doing this exercise.
For more info about doing this exercise go to: http://spinningbabies.com/learn-more/techniques/other-techniques/breech-tilt/ .
This is a chiropractic adjustment that has a high success rate for turning breech babies. Look for a chiropractor who has experience with this method. The reason this method works is because there may be an imbalance in her pelvis preventing the baby from being able to turn to a head down position. The SI joints or the symphysis pubis may be out of alignment, as well.
Acupuncture can also we very beneficial for turning the breech baby.
“As a midwife, I love it when I hear that a pregnant women in my care is going to a chiropractor or acupuncturist during their pregnancy. This is because they may have a much easier delivery because their baby will most likely be in a better position.” Deborah Flowers, CPM
Talk to your baby and explain that birth will be easier if baby gets in a favorable position. This is head down with babies back on your left side. Visualize your baby doing this. You can start visualization around 30 weeks of pregnancy.
External Cephalic Version (ECV)
When encouraging the baby to turn on its own through exercise positions is unsuccessful, your midwife or doctor may attempt to turn the baby manually, physically maneuvering the baby’s body with their hands, a procedure known as external cephalic version (ECV) or more commonly simply called “version.” The care provider will place their hands on the mother’s belly, applying pressure to push the baby and turn it around.
If your baby does not want to turn with ECV or exercise, then keep in mind that it may be wise to trust that the baby is breech for a good reason. The cord may be short or around the babies neck several times. Ultrasound may be useful it determining if a version is a safe option. The bottom line is, if trying to turn the breech is difficult, do not force it!
There are varying opinions about when is the best time to attempt a version. Some care providers believe that it may be more successful if attempted early, between 32 and 36 weeks. At this time the baby may be smaller and surrounded by a greater amount or amniotic fluid, allowing it to rotate more easily. Doctors will also often administer a drug which loosens or relaxes the muscle walls of the uterus. This method of turning the baby usually works best with women who are having their second or third baby.
If this procedure is going to be successful, then the baby will usually move relatively quickly and with minimal to moderate effort or pressure. If there is a significant resistance, the likelihood of success is rather small.
Because you are putting physical pressure on the baby, the baby’s heartbeat is closely monitored so that any sign of distress can be addressed immediately
There is also no guarantee that a baby which has been turned will not go back to a breech position. It is estimated that this maneuver will be successful in approximately 1/3 of all attempts. For this reason, some practitioners would rather wait until closer to the mothers due date to do ECV.
For more information about ECV go to: http://evidencebasedbirth.com/what-is-the-evidence-for-using-an-external-cephalic-version-to-turn-a-breech-baby/
Use sound to encourage your baby to turn. There are a couple of different methods of sound use, both relying on the baby turning towards the sound and thus into the proper position.
- One popular option is to play music for the baby by positioning headphones on the lower part of your belly. You can download music made especially for unborn and newborn babies online — whether it’s soft classical music or lullaby versions of your favorite lullaby tunes.
- Alternatively, you could have your partner place their mouth on your lower abdomen and talk to the baby, encouraging him or her to move towards the sound of there voice. This is also a good way for your partner to bond with the baby.
Use hot and cold packs. Something cold applied to the top of the uterus and/or something warm to the bottom of the uterus may encourage your baby to move away from the cold sensation and towards the warm one, flipping into the correct position.
- To do this, place an ice pack or a packet of frozen veggies on top of your belly, near the baby’s head. Hopefully, the baby will shy away from the coldness and turn in order to find a warmer, more comfortable position.
- Using the ice pack in a bathtub, with the lower half of your belly submerged in hot water, is a good way to use this technique, as the baby will gravitate towards the warmth. Alternatively, you can place a warm pack or hot water bottle on the lower half of you belly.
- This hot and cold technique is completely safe, so it can be done for as long and as often as you like. Many women choose to use hot and cold packs on their bellies while performing the breech tilt.
Consider a vaginal breech birth. Delivering breech babies through vaginal birth is no longer considered to be as dangerous as it once was.
- In fact, in 2006 the American College of Obstetricians and Gynecologists (ACOG) stated that delivering breech babies vaginally is safe and reasonable in certain patients under specific conditions.
Upright breech birth movement
Many care providers have found that when they keep their hands off the breech that labor progresses with fewer complications. Also when the mother is in an upright position or on her hands and knees, that 70% of the time the baby will be born without needing any help. If you choose a vaginal birth with a breech baby, share this info with your care provider. http://breechbirth.org.uk/2013/05/mechanisms-of-upright-breech-birth/
Breech delivery in the all fours position: a prospective observational comparative study with classic assistance. RESULTS: Deliveries in the all fours position successfully took place without obstetric intervention in 70.7% of deliveries PMID:25204214
For some amazing pictures of a breech birth done in the upright or hand and knees position: http://karynloftesnessphotography.com/vaginal-breech-birth/