“Breech” is a term describing your baby as head-up rather than the optimal head-down position.  Breech position is not uncommon in the middle of pregnancy and most babies turn head down toward the end.  Some turn during labour.  A baby coming bottom first can have more difficulty being born and while a caesarean birth may be suggested, there are many doctors willing to catch breech babies.  For now let’s focus on turning the baby.   The best time to turn the baby is around 35 weeks.

Your midwife or doctor can usually tell the baby’s position by palpating your abdomen, as is done at every prenatal visit.  If a breech is suspected, then an ultrasound will be ordered to confirm.  During labour they can often tell if the baby’s breech or not during an internal examination.

The overall rate of breech babies at term is 4% (Healthwise, 2010).  Premature and low birth-weight babies are more likely to be breech.

Risk Factors

Although many breech-babies occur with no risk factors, the following increase the chances:

  • Issue of uterine / abdominal muscles – very tight or loose
  • Placenta covering the cervix
  • Multiples – twins, triplets
  • Pelvic or uterine issues such as obstruction (e.g. fibroid) or unusual anatomy
  • Prematurity
  • First pregnancy
  • Babies who are smaller than expected for their “age”
  • Unusually high or low amount of amniotic fluid
  • Tight cord around baby
  • Short cord
  • Fetal abnormality
  • Emotional issues – fear of birth or parenting, not paying attention to pregnancy, family history of breech, relationship issues, financial concerns, stress (Frye, 1998)

Tricks for Turning a Breech Baby to a Head-down Position

Sometimes there’s a reason (that we don’t know about) for baby to be breech and nothing will turn her or him.  But in many cases a baby can be turned.  Please ask for details or referrals.

  • Visualization and “talking” to your baby. Focus on letting the baby know it’s easier to get out head first.  This works especially well if combined with changing your emotional environment e.g. dealing with fears, prepping for birth.
  • Look at a picture of baby in proper position (e.g. Fig. 1), or have it drawn on your belly!
  • Webster Technique with a chiropractor certified in its use. Pistolese (2002) cites an 82% rate of success in relieving the musculoskeletal causes of intrauterine constraint.  It’s beneficial to perform the Webster Technique starting at 35-36 weeks.
  • Prenatal massage therapy with a practitioner trained and experienced in malpositioned foetuses.
  • Hypnotherapy
  • Inversion (do this with empty stomach) – hips 22-30cm higher than head, 3-6x daily for 20min each, beginning at 30weeks. An ironing board can be used.
    • At 32-35wks progress to a 30-45cm slant.
    • If baby turns then immediately get up and walk around or do several squats.
  • Inversion machines are generally contraindicated in pregnancy.  However they’re great for breech; easy to get into and out of, secure, no sliding around, and can lie at any angle.
  • Homeopathic Pulsatilla 200CH, 1 dose every 3 days.
  • Moxibustion – see a Traditional Doctor of Chinese Medicine or an acupuncturist who specializes in women’s and pregnancy care. There are no needles and you can do it yourself at home once shown how.  The reported success rate is 85% after 34 weeks gestation (A. Ewies, 2002).
  • Deal with fears around childbirth and parenting.  Hypnotherapy can be quite helpful.
  • Postural management – check out spinningbabies.com for some excellent postures and exercises that encourage babies to assume optimal positions for birth.
  • External cephalic version (see External Cephalic Version Consent and Waiver for further details)
    • Reported success rates vary. Bogner et al. (2012) reports 49% with a spontaneous re-inversion rate of 8%; HealthLink BC (2010) reports 58%; Hutton et al. report only 30%.
    • (This is an invasive procedure with risks and benefits. Please get informed before proceeding.)

 

References

A. Ewies, K. (2002). Moxibustion in breech version – a descriptive review. Acupunctrue in Medicine , 20 (1), 26-29.

Bogner, G., & al. (2012). Single-institute experience, management, success rate, and outcome after external cephalic version at term. International Journal of Gynecology & Obstetrics , 116 (2), 134-137.

Coyle, M.; Smith, C.; Peat, B. (2005, Feb). Cephalic version by moxibustion for breech presentation. The Cochrane Library: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003928.pub2/pdf/standard

Frye, A. (1998). Holistic Midwifery, Vol 1, Care During Pregnancy. Portland, OR: Labrys

Healthwise. (2010, June). Breech Position and Breech Birth. Retrieved Jan 2012, from MyHealth.Alberta.ca: https://myhealth.alberta.ca/health/pages/conditions.aspx?hwid=hw179937&

HealthLinkBC. (2010, June). External Cepahlic Version (Version) for Breech Position. Health Link British Columbia: http://www.healthlinkbc.ca/kb/content/otherdetail/hw180146.html

Hutton, D. E., & al. (2008). Factors Associated With a Successful External Cephalic Version in the Early ECV Trial. J Obstet Gynaecol Can , 30 (1), 23-28.

Pistolese, R. (2002). The Webster Technique: A chiropractic technique with obstetril implications. Journal of Manipulative and Physiological Therapeutics , 25 (6), E1-E9.

Tayler, R. (2000). Homeopathy for Pregnancy and Childbirth. Ottawa: Ottawa School of Homeopathy.