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    Techniques for Turning a Breech Baby





    During pregnancy, babies spend their time in various positions.  However, they “should” be heads-down (cephalic or vertex) – and most are (around 95%) – by the time they are ready to be born.  However, some babies are persistently heads-up (breech), even until late in pregnancy.  There are three types of breech – frank (where babies bottom is down & feet are up near their ears), complete (where baby’s knees are flexed & feet are by their bottom – like a crosslegged position), and footling/incomplete (one or both feet are down, lower than the bottom). The most common breech position is frank breech.

     

     

    The determination that baby is heads-up typically isn’t welcome news because it often means, for many women (in this current climate of medicalized childbirth), that a vaginal birth is no longer easily available or an encouraged option for delivery, and a scheduled cesarean section is instead recommended for delivery.

     

    There are studies which indicate that vaginal breech births are safer then breech cesarean deliveries – particularly for the mother.  However, vaginal breech births can present risks for the baby – particularly when the baby is not in the frank breech position – such as cord prolapse, cord compression, and head entrapment. Consideration of these fetal risks, combined with the fact that as c-sections have been more and more routinely recommended for breech delivery – thus resulting in far fewer practitioners who are familiar with the procedure for safely delivering a breech baby vaginally – unfortunately has resulted in vaginal breech delivery being considered the more dangerous mode of breech delivery across the board and not recommended – particularly on an “untested” pelvis (first birth).

     

    "Before a vaginal breech delivery is planned, women should be informed that the risk of peri-natal or neonatal mortality or short-term serious neonatal morbidity may be higher than if a cesarean delivery is planned, and the patient's informed con-sent should be documented."

    See ACOG’s statement on term singleton breech delivery: http://www.ncbi.nlm.nih.gov/pubmed/16816088 At this time, in the United States, over 90% of breech births are delivered by cesarean section; an astounding number. Most women just are not given a choice of vaginal delivery any longer.

     

    There is a recent documentary film called, A Breech In The System about giving women back the choice to birth their breech babies vaginally, instead of via cesarean section. You can view the trailer here: http://www.youtube.com/watch?v=vRjSmR9QmYg&sns=tw

     

    The comparative risk of cesarean section versus vaginal breech delivery is a complex one, and many factors need to be considered, studied, and discussed with your care provider before making a decision. There are several places you can visit to learn about these risks & comparisons of modes of delivery:

    http://emedicine.medscape.com/article/262159-overview

    http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(00)02840-3/fulltext?_eventId=login

    http://www.ncbi.nlm.nih.gov/pubmed/3452635

    http://jeremyscorner-grifter.blogspot.com/2009/03/breech-vaginal-birth-is-not-emergency.html

     
    Regardless of what you decide once baby is about to be born; before baby is at term, there are many things you can do (and that I did as a pregnant mother carrying breech babies – twice) to help your baby to turn, and increase your chances for a safe vaginal delivery. I’ve included every idea that I tried through my two pregnancies, the theory behind the idea, the process & outcome, and my thoughts on each idea.

     

    I recommend talking to your doula, midwife, doctor, or other care provider before trying any of these… just to be safe. :)

     

    Ideas for Encouraging a Breech Baby to Turn

     

    Idea:

    Cold aversion – Take a bag of cold peas, and place on the top of your tummy, near where you believe baby’s head to be.

     

    Theory:

    Baby will move away from the unpleasant coldness, and towards the warmth of your lower abdomen. 

     

    Process & Outcome:

    I tried this only with my first, and only once. Baby didn’t turn.

     

    Thoughts:

    I didn’t like this method – it felt intrusive and not entirely friendly to me.  I “warned” her ahead of time & told her she might not like what was coming up. In all honesty, the coldness probably isn’t that shocking with all the “padding” between me & baby.  But I have a thing about cold, and so I didn’t repeat the experiment.

     

    *****

     

    Idea:

    Music/Sound – Play music or have a deep voice (preferably your partner so that baby will have a better chance at recognizing the voice) at your pelvis. 

     

    Theory:

    Baby will turn to better hear the voice or music.

     

    Process & Outcome:

    My reading had suggested playing classical music, but instead I chose music with a heavier beat & deeper bass – to increase the chance baby would hear it.  Adam also spent many nights talking to my lower abdomen.  Baby didn’t turn.

     

    Thoughts:

    This idea was one of the easiest and least invasive.  It felt very natural to me to talk to baby & play music as an enticement to move.

     

    *****

     

    Idea:

    Light – Shine a flashlight at your lower abdomen.

     

    Theory:

    Baby will notice the light & try to move towards it.

     

    Process & Outcome:

    We tried this several times without luck.

     

    Thoughts:

    I had no problem with trying this one multiple times, but was dubious about the effectiveness due to how dulled the flashlight would actually be shone through so many layers of flesh, muscle, skin, blood, etc.  I would recommend trying this when baby is awake – so drink a glass of OJ first!

     

    *****

     

    Idea:

    Visualization – Picture baby moving downwards into your pelvis; settling into a comfortable heads-down position.

     

    Theory:

    Mind over matter.

     

    Process & Outcome:

    Upon learning of each of my babies’ breech positions, I immediately started thinking of them in a vertex position; birthing vaginally – particularly with my son, after having experienced a long, difficult labor with my first. I knew that positive thinking was so important. I knew my daughter would turn on her own, and she did.  I also felt certain my son would turn as well, but due to circumstances beyond either of our controls, his in-utero environment was simply not conducive to turning.

     

    It is difficult to know for certain if/how visualization helped with turning; but I would like to believe at the very least it improved my outlook.

     

    Thoughts:

    I believe this idea is one of the strongest and least invasive methods, particularly when used consistently and in conjunction with some of the physical suggestions. If nothing else, putting your mind in a positive place when it comes to birth, can only help outcome – even if the outcome is not that which you visualized, I believe knowing you’ve done all you could, will help with coming to terms with the birth you do end up having.

     

    *****

     

    Idea:

    Inversion – putting yourself in various upside-down positions

     

    Theory:

    If baby’s tendency is to be heads-up, moving your own body in the opposite direction (i.e. your pelvis higher than your head) may encourage baby to turn. 

     

    Process & Outcome:

    There are several ways to do inversions with the key point being raising your knees & hips 12 – 20” above your head & shoulders. I was able to achieve this in several ways:

    -          kneeling on the couch, and lowering my torso down onto my folded arms on the floor. 

    -          “elephant walking” – i.e. a downward dog position, but with elbows on the ground, and “walk/crawl” around.

    -          doing a headstand against the wall (note: at the time, I had been actively doing yoga, and was in good physical shape, and familiar with this position – I would not recommend headstands if you’re not already familiar with and comfortable with doing them pre-pregnancy)

    -          lying inverted on an ironing board which was leaned up against the couch – I’d lean the closed board against the couch, straddle the board with feet on the couch for stability, then lay myself out, head-down. I watched a lot of TV upside down. 

    Whichever inversion you choose, hold the position for 5 – 10 minutes.  Make sure that you are supported, comfortable, and won’t fall.

     

    Several of these positions are documented in video/pictures at SpinningBabies.com (a wonderful site for optimal fetal positioning - well worth checking out!): http://spinningbabies.com/techniques/the-inversion

     

    As for outcome, its hard to tell whether my inversions helped or not. I did them every day from about week 34 on with my daughter, and she did turn on her own, so I’d like to believe so.

     

    Thoughts:

    Another good idea, non-invasive, and overall will help stretch your ligaments, and has a good chance of encouraging baby to turn by using gravity. The only issue I had with these positions is that late in pregnancy, they can be uncomfortable to get into, remain in, and get out of, particularly when your center of gravity is off, as well as your sense of balance. I made sure that Adam was close at hand whenever I did any inversions.

     

    *****

     

    Idea:

    Swimming

     

    Theory:

    Submerging yourself in water tends to push your fluids inward, perhaps giving baby a bit more room in which to turn. This theory works with the idea of inversions (above), with the benefit of buoyancy – inversions are much more easily done.

     

    Process & Outcome:

    Swim, flip, and do headstands; anything to help relieve the constant downward-pressure of gravity. Inversions are much simpler to accomplish in the water.

     

    Note: if your bag of waters has ruptured, or you have a slow leak, please consult your care provider before swimming.

     

    Thoughts:

    I went swimming several times per week in late pregnancy – and it was the only time I felt really light, fluid, and graceful in my pregnancy.  Whether or not swimming aided in my daughter’s position change, the benefits of swimming in pregnancy were well worth the effort. I highly recommend this method as it is non-bothersome to baby & mom… and just fun!

     

    *****

     

    Idea:

    Moxibustion

     

    Theory:

    Burning herbs at the acupuncture point (BL67) on the little toe to encourage baby to turn.

     

    Process & Outcome:

    The suggested time is 10 minutes per side, twice a day. I purchased a moxa stick, and used an online guide to locate the correct point, and performed the moxibustion on myself.  Here’s a video guide:

    http://sarah-stewart.blogspot.com/2008/02/using-moxibustion-to-turn-breech-baby.html

     

    I have also read that simply massaging this pressure point may help baby correct her position.

     

    Even after repeated tries at moxibustion, baby did not turn.

     

    Thoughts:

    I was not able to find a practitioner with whom I was comfortable to do this procedure with my first pregnancy, so I attempted it myself. Performing moxibustion on myself was uncomfortable – it isn’t easy to get into the correct position when you have a huge belly – think about tying your shoes for 10 minutes at a time.  I set up a block to hold the moxa stick, which did help, but I still found the heat and the smell rather non-relaxing and off-putting.  Perhaps had I found an experienced practitioner, this method would have had a more positive experience. Overall though, it’s non-invasive to baby, so I’d recommend giving it a try; particularly with a willing partner.

     

    *****

     

    Idea:

    Webster Technique (chiropractic)

     

    Theory:

    By loosening the ligaments holding baby though a chiropractic technique called the Webster Technique, the uterus will have more flexibility and openness, and baby will have more room to move.

     

    Process & Outcome:

    Prior to discovering my first baby was breech, I’d never been to a chiropractor.  I found one certified in Webster Technique (which, I believe is SO important – I used a chiropractor not certified in the technique while pregnant with my son – though she was a prenatal & pediatric chiropractor – and her technique was completely different than the chiropractor who treated me with my daughter).

     

    You can use this search took at the ICPA to find a Webster certified near you: http://icpa4kids.org/Find-a-Chiropractor/

     

    The visit(s) will consist of back, leg, and lower abdomen/pelvic massage and pressure.  The chiropractor will not (and should not) ever attempt to move or even touch baby – the technique is simply about loosening ligaments which may be holding the bottom of the uterus tightly. 

     

    More information on the Webster Technique:

     

    YouTube Video: http://www.youtube.com/watch?v=Et7JuuMrr-Y

    From International Chiropractic Pediatric Association: http://icpa4kids.com/about/webster_technique.htm

     

    As far as outcome goes: I had ONE visit to the chiropractor while pregnant with my daughter – and she turned THAT NIGHT; I felt her move more in the car on the way home, and that evening than I had at any other time in my pregnancy. With my second pregnancy, I had repeated visits to the chiropractor, and my son never budged.  Again though, he was in a previously sectioned uterus, and had very low fluid levels, and my chiropractor was not certified in Webster Technique.

     

    Thoughts:

    My visits to the chiropractor – both with my daughter & my son – were relaxing, rejuvenating, and I always left with a positive outlook. While I wouldn’t go so far as to say its completely non-invasive to mom, because there is a lot of manipulation, it is for the vast majority of the time relaxing non-painful manipulation, so as long as you can tolerate hands-on and lying on your stomach (the appropriate pregnancy pillows are provided), I have nothing but good things to say about the chiropractor.  I highly recommend this method to all women – breech or not – to help optimally position baby.

     

    *****

     

    Idea:

    External Cephalic Version (ECV)

     

    Theory:

    To physically turn the baby through external manipulation of mother’s abdomen. 

     

    Process & Outcome:

    I was checked into the hospital, given a heplock, signed consent forms and warned about the inherent risks to doing an ECV. Once baby’s position had been confirmed again via ultrasound, I was given the option of having pain relief and/or a muscle relaxant, both of which I declined. I was wired with an external fetal heart monitor, and a nurse held a constant ultrasound, and my OB and midwife began the ECV process.  I found the actual process to be very painful, stressful, and unpleasant. The manipulation was extremely forceful – though not blunt – just extreme pressure (my midwife and her OB backup were putting ALL of their muscle into attempting to turn my baby through my contracting uterus) on my sensitive pregnant belly. The first attempt my daughter made it about 3/4s of the way around but would just not move any further, and as soon as they released pressure, she moved herself right back up to breech.  A second attempt was started soon after, which I requested to stop midway through because the pain was too much for me, and I was still not willing to consent to medication. Had I made a different choice in that matter, perhaps the outcome would have been different – that I cannot say for certain.  The outcome was that my daughter did not turn from her breech position, my abdomen was bruised, and I left with a very negative feeling from my midwife (who felt the procedure failed due to my unwillingness to consent to muscle relaxant).

     

    For information on the procedure: 

    http://www.aafp.org/afp/980901ap/coco.html

     

    Thoughts:

    I am torn about this very complex process.  On one hand, having a baby optimally positioned for vaginal labor – heads down, anterior, is what you want. A baby in the “right” position is more likely to move more quickly “down & out”, labor is less trying, painful, and safer for mom.  Less interventions are likely to be requested or necessary, and a baby in the optimal position is less likely to be cesarean sectioned.  On the other hand, the ECV is a highly invasive procedure – and in some hospitals requires an IV, pain medication (even via epidural – which presents its own risks and increased chance of cesarean section), muscle relaxants, and continual fetal monitoring via ultrasound and heart monitor. You are essentially overriding baby’s preferred (for whatever reason) position by force.  It runs counter to how I feel about pregnancy, childbirth, and child-rearing. And yet, if the procedure is successful, certainly it is less invasive than a cesarean section. I will say that had the ECV process been made available to me during my second pregnancy, I would have had to think long & hard before consenting to the procedure again. It was frightening for me, and concerned both Adam and I how it felt to our baby. 

     

    *****

     

    I truly hope that by trying some or all of the techniques, are able to help your baby into a more optimal position for a safe, vaginal birth. 

     

    However, if your baby does not turn, and you & your care provider decide that a cesarean section is the best way to deliver your baby, I would encourage you to read about ways to make your cesarean delivery as comfortable, safe, and satisfying as possible for you, your baby, and your partner. It is my experience that even a c-section delivery can be a wonderful, and even empowering birth experience.  Here are a few links to help you:

     

    Plan a family centered cesarean:

    http://www.ican-online.org/pregnancy/family-centered-cesarean

     

     

    The Natural Caesarean: A woman-centered technique:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2613254/

    Posted: Oct 25 2010, 18:17 by kelly | Comments (12) RSS comment feed |
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    Comments

    Suchada United States said:

    SuchadaWow, very interesting story. Sounds like you really did try every technique. Thanks for all the info -- I'll share with my readers as well!

    # October 25 2010, 19:40

    topsy.com said:

    pingbackPingback from topsy.com

    Twitter Trackbacks for
            
            KellyNaturally.com | Techniques for Turning a Breech Baby
            [kellynaturally.com]
            on Topsy.com

    # October 26 2010, 08:57

    Gauri United States said:

    GauriWow, this is powerful and beautiful stuff. Thank you. Kind of wish I had read this before having my (breech) baby... Then again kind of glad I didn't. I tried ALL the techniques on here (plus a few) and baby did not turn. So I moved heaven and Earth to get seen at UCSF, which I am told is the only hospital on the West Coast that will do vaginal breech deliveries. We got in... but DD decided she wanted to come into the world on New Year's Eve at 9pm so of the five doctors who *can* oversee this kind of birth, none of them were available at this time - most were away on vacation, one was at a party. They tried. They tried really hard for us but it just wasn't meant to be, alas. Oh well. My beautiful baby is here and her birth was triumphant, even as a cesarean.

    This info is great though. May it help others.

    # March 31 2011, 03:07

    lovingearthmama.com said:

    pingbackPingback from lovingearthmama.com

    Turning a Breech Baby (and Empowering an Expecting Mother) « Loving Earth Mama

    # March 31 2011, 03:15

    kelly @kellynaturally United States said:

    kelly @kellynaturally@Guari - thank you for sharing your birth story! ALL births are beautiful, and every mother should feel triumphant and at peace with their birth experience.

    Thank you SO much for linking my post on your site! :D

    # March 31 2011, 10:14

    Gauri United States said:

    GauriI agree. It was just a little bit of a journey (pre-birth, luckily) for me to come to remember this truth: all births are beautiful.

    Thank you!

    # March 31 2011, 15:00

    KellyNaturally.com said:

    trackbackTop Posts

    Top Posts

    # August 02 2011, 08:58

    babyandbump.momtastic.com said:

    pingbackPingback from babyandbump.momtastic.com

    Ladies in the UK - Page 2 - BabyandBump

    # October 15 2012, 17:13

    Catriona Ireland said:

    Catriona Thank you for all this information. Currently my first pregnancy is in a breech position and I am in my 37th week. I don`t fancy the thought of re-positioning for outside by Dr., or the cold peas trick, which seems cruel!

    I swim and will also now try the inversion excercise. If they to now work, then whatever is to be must be. Of course I was hoping to experience a natural birth. I am hoping that i can !!

    Anyway, thanks again

    # January 24 2013, 06:21

    KellyNaturally.com said:

    trackbackThe Secret. And a bit of a birth story.

    The Secret. And a bit of a birth story.

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