Breech, Now What?

What is breech?

Breech presentation is defined by a baby who is presenting with the buttocks or feet closest to the cervix. At 28 weeks about 40% of all babies are breech, however, only 3-4% of all babies will still be in a breech presentation at the time of birth. This means that approximately 96-97% of all babies will present head first or cephalic at the time of birth.

There are three types of breech presentation

• Frank breech: the baby is butt first, hips flexed, and knees extended in a pike-like position. 50-70% of all breech babies are in this position.
• Complete breech: the baby is in a cannonball position with hips flexed, knees flexed. Only 5-10% of all breech babies are in this position.
• Footling or incomplete: one or both hips extended and a single foot presenting. This potion makes up about 10-30% of all breech positions.

There are several known or common reasons why a baby is breech.

• Breech babies are more common in women who have had multiple pregnancies due to relaxed abdominal tone and diastasis recti.
• If you have polyhydramnios or excessive amounts of amniotic fluid.
• If the baby has any abnormalities.
• If the mother has any growths, such as fibroids, or uterine abnormalities.
• If the placenta is low lying or has been diagnosed with placenta previa.
• Other reasons I have noted over time include women who persistently wear high heels. I believe that when the pelvis is not tucked due to the heels it is harder for the baby to flip its head down.

Natural methods to facilitate the baby to turn

Even though most babies are head down by 32-34 weeks, 4% will still be breech for delivery.  There are many strategies to facilitate a vertex or head-down baby.  Most of these are the most successful if started at 32 weeks or as soon as you find out your baby is breech.

• Acupuncture is the most successful when started early, before 34 weeks.
• Chiropractic care is highly effective for breech at any time in pregnancy but is also effective throughout pregnancy for common discomforts as well.
• Do the tilt from spinning babies
• Try water inversions and swimming for both relaxation and to support alignment.
• Homeopathic pulsatilla can be used in conjunction with any of the options above with great success.
• Aromatherapy has been effective with massage to help a baby find their way head down. Peppermint oil diluted and massaged into the belly clockwise has been effective.
• Some babies will flip head down when light or music is present near the vaginal opening.
• Other babies just need to be ‘talked to’, welcomed, and emotionally encouraged to flip head down. I have seen babies flip as soon as the crib is set up.
• Finally, once the baby flip head down to the vertex position wearing a belly binder like this one will help them to tuck into your pelvis and prevent them from flipping around again.

 

Medical methods to turn a breech baby

When natural methods do not work or if you do not have access to trusted alternative care providers, it can become necessary to work with your OB team. They may offer you a procedure called an ECV (External Cephalic Version).

An ECV is usually done at 37-39 weeks in a hospital setting with detailed monitoring and portable ultrasound.  Many providers will also encourage the mother to use IV medications or an epidural to further relax the uterine muscles allowing for a higher success rate.

Here is a video of a successful ECV procedure.

 

Still breech?

Sometimes despite everything that is tried the baby is still breech.  Most breech babies in the US are being born via cesarean.  However, not all breech babies need to be born via a cesarean.  There are a few homebirth midwives and doctors who are highly trained and will deliver breech babies. Also, some hospital providers will deliver a breech baby vaginally as long as you meet their criteria.

The criteria for a local hospital here in the Washington DC area:

• You have had at least one baby vaginally before
• The current baby is not especially large and there are no other known risk factors
• The baby is ideally in a frank breech position
• Labor unfolds spontaneously and without any variations
• A team can be called in who is trained in breech delivery

If you do not meet these criteria or if a team cannot be called in then chances are your baby will be born via cesarean.  By working with your provider, you may be able to make requests for a family-centered cesarean, however.

Final thoughts

Birth is a partnership between mother and child. Neither one can birth without the other.

By understanding there is a partnership my clients find it easier to work as a team and make strategic choices for the best possible outcome for the two of them.  Case in point, I remember one baby in particular who just loved his toes, and despite everything, the mother tried he would not stop holding on to them.  He loved them so much that when he was delivered via cesarean he was born holding on to his foot and sucking his toes!