The following information is extracted from a previous article by Margaret and is additional to the entry in our ebook “From Bump to Birth” . You will also find more information elsewhere on our website about both Breech and Optimal Foetal Positioning on the page "Tips for Bump" .
N.B: The information and any of our suggestions are not intended as a substitute for medical diagnosis or treatment by a health care professional, and do not take into account any of your personal risk factors or pregnancy complications. Your first stop with any concerns, questions or symptoms should be your own doctor or midwife.
MIDWIVES’ TIPS ON BREECH BABIES
Breech babies present with their bottoms down and their heads up. Most babies are born headfirst, but at the end of pregnancy, around 3% to 4% are found to be breech. Before 37 weeks of pregnancy, breech presentation is much more common - about 20% of babies at 28 weeks are breech, presentation and 15% at 32 weeks. Before term, which is defined as 37 weeks, it doesn't matter if the baby is breech, as there is always a good chance that she/he will turn spontaneously. Some babies do turn by themselves after this time, but it is much less likely, and some preparations should be made to decide how delivery is going to take place. About 10% of breech babies are discovered for the first time late in labour!
There are different types of breech babies and they are described by the position that they are in
- Footing breech - feet first
- Complete breech - baby sitting on heels (Buddha style)
- Extended/Frank breech - bottom first, with feet up by head
- The very rare ‘kneeling breech’ where the baby is in a kneeling position.
Sometimes there are contributing reasons for the baby being in a breech position. These include premature labour (remember the earlier the pregnancy, the more likely a baby is to be in the breech position.) Some women, meanwhile, have a septum in their uterus. A septum is a structure that can divide the uterus. If a woman has a fibroid in her pelvis, this may also prevent the baby from turning to a head down position.
Other reasons that increase the likelihood of a breech presentation include: placenta praevia, multiple pregnancy, excessive amniotic fluid, unusual shape of a woman’s pelvis or if the woman has very weak or very tight abdominal muscles. However the majority of breech baby’s can occur in a healthy woman with a healthy baby. In these cases a baby simply likes being the other way around.
A midwife or doctor can usually diagnose a breech baby during pregnancy (though about 10% of breech babies are discovered for the first time late in labour) The midwife or doctor can feel the soft bottom near the pelvis and the baby’s head somewhere in the upper abdomen when you are palpated. Often women who have a breech baby report that they feel a hard ball or a very sore spot under their ribs.
Though most breech babies will turn naturally before their due date, some remain in the breech position. It is then that the woman and her partner will be faced with choices on what to do regarding trying to turn the baby and what is the best way to give birth
External Cephalic Version (ECV):
The procedure where a doctor attempts to turn a breech baby to head down position is called an ‘External Cephalic Version’. Research clearly supports that external cephalic version substantially reduces the number of babies who remain in the breech position.
It is possible to manoeuvre the baby from breech to a head-first position. This is done after 37 weeks and the success rate is around 50%, though some doctors are successful as often as 70% of the time. It is useful in that it definitely reduces the number of breech and caesarean births. Around 2.5% of babies flip back to breech after a successful ECV. Women not having their first baby have a higher success rate of turning, as the muscle tone are less light.
A scan is usually performed first to assess the size and position of the baby, and the amount of fluid around the baby. The doctor places her hands on the abdomen, and guides the baby through a forward somersault - often the baby seems to get the idea and his kicking helps to complete the turn. It may be quite uncomfortable during the turn, but shouldn't be excessively painful. The baby's heartbeat is monitored before and after ECV.
It is a safe procedure for the baby, but on the rare occasion the baby becomes distressed a caesarean delivery will be necessary at that time. If an ECV is unsuccessful, it is still possible to have a normal breech birth.
This technique has been practised by doctors for thousands of years and a lot of research has been carried out to test its safety. The results have been so positive that the Royal College of Obstetricians now recommends that: 'All women with an uncomplicated breech pregnancy at term (37-42 weeks) should be offered ECV.'
ECV is generally carried out when you are close to your due date. You will not need to have a general anaesthetic. The procedure will be carried out in hospital, where there is equipment to monitor your baby's heartbeat and ultrasound. If you are rhesus negative, you will have an injection of anti-D.
ECV is more likely to be successful if: This is not your first baby; There is plenty of water round the baby; Your baby has not yet descended into your pelvi
Other methods to help a breech baby to turn
Acupuncture has been used successfully to turn breech babies. Two well controlled research studies support its use. They found that acupuncture can successfully turn up to 70% of breech babies. Treatment can be commenced as early as 32 weeks.
The most common treatments used by acupuncturists are moxibustion alone or moxibustion in combination with acupuncture.
The heat from burning moxa sticks can be used to stimulate the baby's movements and encourage it to turn. These sticks, shaped like cigars, are available from herbalists, Chinese medicine stockists and some acupuncturists (who use moxa sticks for other purposes) and they contain tightly rolled dried leaves of the mugwort plant. They are very inexpensive and two sticks will be needed - they can be used several times.
If you are unable to attend a qualified acupuncturist the following "do it yourself" technique has a proven high success rate A randomised controlled trial indicates that approximately 70% of breech babies will turn using this method.
This simple treatment is best done just before bed, starting at 34 - 36 weeks. It takes several hours for the baby to turn, and this will be easier if you are lying down, because the baby will not be sitting as firmly into the pelvis. Continue over several nights, or until the baby has turned itself.
Sit on a chair and place each foot on a book with your little toes hanging over the edge. Place each stick on another book with the tip in the gap.
Light the sticks (they burn with no flame but an intense heat and pungent smell) and position the hot tip as close as possible to the outside of each little toe, with the heat directed at the point just above the toe nail. Leave in place for 20 minutes. Be careful not to touch the skin as you will burn yourself. The heat should be as strong as you can tolerate, for the best effect.
After a few minutes, you will notice the baby begin to kick and move. The primary aim of the moxibustion treatment is to encourage the baby to move around and thus increase the effect of gravity which will help the heaviest part of the baby (its head) to turn over and enter into the pelvis.
Turning techniques you can do at home are collectively referred to as spontaneous cephalic version. Some trials have been conducted to determine the effectiveness of these various methods, but more study is required. In one study of 71 breech babies, 65 turned when their mother adopted the knee-chest position. To do this:
Kneel on your bed with your bottom in the air and your hips flexed at slightly more than 90 degrees (don't let your thighs press against your bump). Try to keep your head, shoulders, and upper chest flat on your mattress. Maintain this position for 15 minutes every two waking hours for five consecutive days.
One method often recommended by midwives is the Knee-to-Chest position combined with crawling.. Get onto the floor in the hands and knees position and then place your head on the ground After a few minute in this position try crawling slowly. With your head leading, take one small step forward on diagonally opposite limbs (for example on your right hand and left knee). You will notice that when you start each step (leading with the head) your body’s weight shifts to the limbs that were in front and are now stationary. After each step, your weight should again be evenly distributed between all fours. Do not rush. Pause. Breathe out gently through an open mouth. As you crawl slowly, don’t lift your knee off the floor. The leg will be dragged gently along the floor, pulled forward by the rest of your body After you have crawled for about ten minutes, bring yourself from kneeling on all fours to the knee–chest position again: lean forward from your hips and lower your head down to the floor; spread your knees slightly further apart; allow your elbows to bend until one cheek and both forearms rest on the floor, your hands flat next to your head, and your elbows in line with your shoulders. You may find it more comfortable if you place cushions under your knees.) Rest in the knee–chest position for a few more minutes; you may occasionally turn your head from side to side. Then get up again on all fours and carefully rise up to standing.
Alternatively, try lying on your back with your hips slightly elevated and your hips and knees flexed. Gently roll from side to side for 10 minutes and repeat this manoeuvre three times a day. If you have had any backache, pelvic pain or hip pain during your pregnancy, do talk to your midwife or physiotherapist before you try this.
Or lie on your back, with your bottom away from the wall. Place the feet high on the wall, and using it for support, lift your hips high. Have pillows or a firmly rolled towel ready to slip behind your back for support. Your hips need to be higher than your shoulders.
Pulsatilla, a homoeopathic remedy, has been claimed to be successful by some practitioners. Pulsatilla can be given as a single dose and helps stimulate the baby to move. To obtain Pulsatilla you would need to consult a qualified homoeopath.
These are some less conventional ways of turning a breech baby. There is little research to show they work but they may be worth trying.. They include:
- Visualising the baby moving down with the head very deep in your pelvis, several times a day; especially in conjunction with positions and exercises above.
- Swimming as often as possible. This keeps your body and pelvis loose and relaxed. Do in conjunction with headstand below if you have help.
- Headstand - with assistance and in a pool as frequently as possible.
- Breech Tilt - begin at 32-35 weeks gestation. Do 3 times daily for 10-15 minutes each time, when you have an empty stomach, and the baby is active. Prop one end of an ironing board securely on a sofa or chair 12 to 18 inches high (or may use slant board). Lie down, bend knees but keep feet flat on board. Relax, breathe deeply, and avoid tensing. May also use pillows on a flat surface to raise hips 12-18" above shoulders. Gravity pushes the baby's head into the fundus, and baby can then do a somersault to a vertex position.
- CD/iPod headphones - place them inside mother's pants toward her pubic bone and play classical music for 10 minutes 6-8 times a day.
- Flashlight - try moving slowly down from the top of the uterus toward your pubic bone while you are in a breech tilt position.
- Massage - start with your left hand at the bottom of the abdomen and your right hand just above it. Move your hands clockwise around the right side of your tummy. As your right hand reaches the top of your abdomen, slide the left one over your right and move it down the left side of your tummy. Your left hand leads as you come full circle, continuing clockwise. Massage gently as you would to apply lotion. Massage for ten minutes or more up to several times each day.
- Glass of orange or other juice - follow this with a side-lying position, with your hips positioned higher than your feet. Babies move more after a sugar high!
- Pelvic Tilt. Lie on your back on the floor with knees flexed and feet on the floor with three large pillows placed under your buttocks. Place an ice pack on the top of your tummy . Try this for 10 minutes twice a day on an empty stomach. Try it in conjunction with headphones and visualisation.
- Cat stretch - start with all fours, then lay your head and chest flat on the floor with your buttocks in the air, as you round your back and return to all fours.
- Belly Relaxing followed by Inversion - Partner places a shawl, sheet, or towel under mom's hips as she lies on the floor. Lift up on the corners of the cloth and shimmy her from side to side moving your hands up and down to wiggle her belly from side to side. These should be very small movements which mom should find very relaxing. Do this for about 5 minutes. Then mother kneels on the stairway landing. Walk your hands down 2 or 3 stairs into an all fours position; have your partner support your shoulders to balance you. Remain in this position for about 5-10 minutes or as long as comfortable. Also do this on an empty stomach.
At the end of the day it might be that your baby prefers to lie in the breech position. But if this is the case it does not mean you are automatically in line for a caesarean section. Discuss the possibility of having a normal delivery with your midwife and obstetrician.
What is the best way for a breech baby to be born?
A study called the Term Breech Trial endeavoured to answer this very question. The conclusion of the study reported that overall it was safer for full-term babies in the breech position to be born by a caesarean birth. Although there has been some controversy in the way this study was carried out, most doctors now recommend a caesarean section for breech babies.
Since the results of the Term Breech trial were published the level of skill for midwives and doctors in assisting breech births has declined greatly due to high C-Section rates. If you chose to have a vaginal breech birth you will need a skilled birth attendant. You will also need to find out what type of breech is it? A complete breech has far less complications than a footling breech for example.
It is important to remember that both vaginal breech births and caesarean births carry risks. Read all you can about breech births as there is a lot to consider when choosing the right option for birth, and it is important to discuss the issues with the health professional providing your care.
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Banks, M. (1998). Breech birth: Woman-Wise. Birthspirit
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Cardini, F., & Wiexin, H. (1998) Moxibustion for correction of breech presentation. The Journal of the American Medical Association, 280 (18), 1580-1584.
Charlish, A. (1995) Your natural pregnancy. Australia:
Enkin, M., Keirse, M. J. N. C., Renfrew, M., & Neilson, J. (1995). A guide to effective care in pregnancy and childbirth (2nd ed.). Oxford: Oxford University Press.
Hannah, M. E., Hannah, W. J., Hewson, S. A., Hodnett, E. D., Saigal, S. & Willan, A. R. (2000). Planned caesarean section versus planned vaginal birth for breech presentation at term: A randomised multicentre trial. The Lancet, 256: 1375-1383.