As I approached the 9th month of my second pregnancy knowing that my daughter was still in a breech position, I began doing a lot of research. Almost everyone I encountered (family, friends, co-workers) assumed that I would automatically need (and want) a cesarean section. Most obstetricians today recommend a planned cesarean section for breech babies and it may actually be difficult to find a provider who is experienced and comfortable with vaginal breech births. Fortunately, the founders of Atlanta Birth Center (the midwives and physician team members at Intown Midwifery), support vaginal breech births in cases that meet specific safety criteria (which most babies in breech presentation at term do). The following information gives an overview on breech presentation, ways to turn a breech baby, and what to expect if your baby is breech during labor.
So what exactly does “breech” mean?
The typical delivery position is “vertex”, which means the head delivers first and the feet last. When the baby is in the opposite position, it is called “breech.” According to the American Pregnancy Association, breech births occur in approximately 1 out of every 25 full-term deliveries.
There are three different breech presentations (click here for a visualization):
Frank breech: The baby is basically bent in half – the baby’s buttocks are near the bottom of your uterus with the head up, legs in front of the body and the feet near (or extending over) the baby’s head. In a vaginal delivery, the baby’s buttocks deliver first and the head last.
Footling breech: The baby has one or both feet near the bottom of the uterus. In a vaginal delivery, the baby’s feet would deliver first and the head last.
Complete breech: The baby is basically sitting cross-legged inside the womb. The buttocks are at the bottom of the uterus with the knees bent and feet near the buttocks.
Are there ways to turn the baby into the vertex position before delivery?
There are a couple of different techniques used to help turn a breech baby:
- Webster Breech Technique: This technique is done by trained chiropractors to help relax the uterus and surrounding ligaments. The painless technique is often successful because the relaxation and re-alignment of the spine, muscles, and ligaments in the mother’s pelvis creates an optimal environment for the baby, making the baby more likely to turn naturally on his/her own. Research has shown that the Webster Technique is most successful during the 8th month of pregnancy and has an 82% success rate, although getting regular adjustments can help optimal fetal positioning from the beginning. The Webster Technique is recommended by the midwives at Intown Midwifery and you can find a chiropractor certified in this technique at this website. Some that Intown Midwifery works with often in all parts of the metro area include Dr. Danielle Drobbin, Dr. Liliana Warner, Dr. Laura Scheiner, Dr. Linda Mullin, Dr. Pamela Stone and many others!
- Acupuncture and Moxibustion: a traditional Chinese medicine, mugwort, is burned on a stick near an acupuncture point on the outside of the little toe – done by an acupuncturist and is most successful around 34 weeks. In the Atlanta area, you can contact Caroline Friedlander at Morningside Acupuncture and Natural Medicine, Decatur Acupuncture, or Intown Acupuncture
- External Cephalic Version (ECV): This technique is done in a hospital. Your provider will give you an IV medication to relax your uterus. While monitoring your baby’s position through ultrasound and his/her heart rate, the provider(s) will physically turn your baby from the outside by manipulating your abdomen. The success rate of ECV varies by provider, some with much higher success rates, but has an overall 58% success rate. ECV is most successful around the 36th week of pregnancy. ECV can be quite uncomfortable, or even painful for some mothers and carries some risks to your baby. Read about risks and get more information by clicking here. If you are a client of Intown Midwifery and choose this option, your physician will do the procedure with assistance from your midwife in the hospital after you are full-term. Both obstetricians and perinatologits are trained in this procedure.
In addition to Webster’s Technique, acupuncture, and ECV, there are some easy, effective (and even fun) things you can do at home to encourage your baby to turn into a vertex position:
- Pelvic tilt exercises – position yourself with your hips higher than your chest. (i.e. place pillows under your hips or get on all fours with your elbows on the ground and your bottom in the air and relax your abdomen and lower back)
- Massage your abdomen in a circular motion several times a day or try Maya abdominal massage from a skilled provider
- Put a set of headphones with music playing near the bottom of your abdomen – some babies may turn to be closer to the noise
- Put an ice pack (or frozen bag of peas) on the top of your abdomen near your baby’s head – your baby may want to wiggle away from the cooler temperature (or put a heat pack near the bottom of your abdomen to attract your baby to the warmth)
- Visualize your baby turning and keep in mind most babies turn spontaneously
- Go for a swim
- Ask your midwife or health care provider trained in homeopathy about homeopathic remedies that can help turn breech babies, for example, Pulsatilla
Every woman’s body and situation are unique; however, a vaginal breech birth may be contraindicated in the following situations:
- Macrosomia – the average newborn baby weighs 7 lbs. According to the American College of Obsetricians and Gynecologists, macrosomia refers to babies estimated to be larger than 4500 grams, or about 9 pounds 15 oz. Clinical guidelines for breech births from the Society of OBGYNs of Canada include a fetal weight between 2500g and 4000g (~5lbs 8oz and 8lbs 13 oz) as ideal.
- A cord presentation- meaning that the umbilical cord is presenting in front of the baby’s buttocks.
- Though it may be possible deliver a baby in the footling or complete breech positions, a frank breech position is considered the safest and is more likely to be successful.
- The most reassuring sign that a vaginal breech birth is a safe choice is smooth progress during a spontaneous labor.
- A consideration, although not a contraindication is a 1st pregnancy (or first vaginal birth). A previous vaginal birth stretches and loosens the pelvis and results in the woman having a “proven pelvis.” This is very helpful in breech births since more maneuvering of the baby may be required when compared to a traditional vertex position. However, if all criteria for safe vaginal breech birth are met, the fact that it is a woman’s first vaginal birth is not usually a contraindication.
Just as with a planned cesarean section, there are risks and benefits to a vaginal breech birth. The most significant considerations with a breech baby involve the position of the umbilical cord, and facilitating birth of the baby’s head. For these reasons, all breech births should be attended in a hospital, by practitioners experienced and comfortable with breech. It can be reassuring to note that good research suggests that “Long-term neurological infant outcomes do not differ by planned mode of delivery even in the presence of short-term complications” You should have a thorough consultation with a physician about your particular situation, and choose together what the safest birth option would be.
If you are planning a vaginal breech birth with your midwife from Intown Midwifery, here are some things to expect:
- You will have a combination of continuous and intermittent fetal monitoring throughout labor. You will be free to move around in different positions, use a birthing ball, the shower, etc. At this time, hospital policies do not allow you to labor in the water or have a waterbirth with a breech baby.
- You are not required to have epidural analgesia or deliver in an operating room. Breech is a variant of normal, and can be safely treated as such, under trained and careful supervision.
- Both your on-call midwife and physician will attend the birth.
- Your midwife and physician will pay close attention to your progress of labor, and watch for signs that your breech baby is coming easily and normally. When breech births work, they work!
- Your midwife will direct you gently through the pushing phase, as you guide your baby, rump first into the world.
- If at any point during your labor, your midwife or physician see signs that your baby would be safer being born by cesarean, you will be offered a Family Centered Cesarean birth.
- In case of a Cesarean, your physician will perform the procedure. Your midwife will be with you behind the curtain (near your head) and continue to support you, as needed. In non-emergent surgery, the Cesarean section will be “family-centered”, meaning that your baby will be placed on your chest immediately after delivery, you can allow the umbilical cord to pulsate for an extended time before your partner (or whoever you choose) cuts the cord. Your baby will not be separated from you (unless medically necessary), which means that the baby will stay with you in the OR, preferably skin to skin, and the recovery room. Your midwife will also assist you in initiating breastfeeding in the OR or the recovery room. According to Anjli Aurora Hinman, CNM, some interesting trends have been observed with Intown Midwifery clients who have had family-centered Cesareans such as quicker recoveries, less pain after birth, higher rates of successful breastfeeding, high rates of positive cesarean birth experiences, and less bleeding and post-operative complications. Currently, Intown Midwifery is one of the few practices in the state that offers such a birth experience with cesarean births. Stay tuned for a future blog post on Family Centered Cesareans!
- Due to an increased risk for a Cesarean and safety concerns, vaginal breech births will be attended by your midwife and doctor at the hospital, instead of Atlanta Birth Center. Situations like these are why the midwives at Atlanta Birth Center will continue to hold hospital delivery privileges, and all prenatal and postpartum care will remain at Atlanta Birth Center.
As I gathered the above information and talked with my husband, we decided that we wanted to try a vaginal breech birth. Women have had babies in breech positions for thousands of years. It hasn’t been until the last couple of decades that the practice of vaginal breech births has declined as c-section rates have risen. Although medicine has changed and advanced, women’s bodies are still the same. Though we were still hopeful that our daughter would turn before her delivery, we placed trust in the ability and design of my body no matter what position she was in. I started seeing Dr. Drobbin for the Webster Technique around 35 weeks and doing some of the home methods mentioned above to encourage our baby to turn. At my 38-week appointment with my midwife, we discovered that she had indeed turned head down. My hopes of having another waterbirth were restored and the “planner” part of my personality was able to relax a bit, knowing that I would be having a child the same way I had done previously.
But a part of me was a little sad. Although I was worried about the unknown, I wanted to be a “pioneer” for the women in my life who discouraged me from a vaginal breech birth. As women, we need to support and encourage one another in birth choices. A woman shouldn’t feel ostracized or fearful, but rather hopeful and supported by a community of women. I am grateful for a husband and midwives who were able to give me that hope and support. Although it doesn’t look like I will be having a breech birth this time around, I hope that those of you who will have a vaginal breech birth find yourselves more informed, uplifted, and encouraged after reading this blog post. Even if you aren’t pregnant, you can still make a difference to a woman whose baby is breech by avoiding fearful language or “oh, I hope he/she turns” types of comments, and instead offer words of encouragement and support. Together, we can all restore the views of birth being a natural, healthy process, and do our part to “bring birth back.”
- American Pregnancy Association
- External Cephalic Version for Breech Position
- 18 Ways to Turn a Breech Baby
- Birth International: If your baby is breech
- Society of Obstetricians and Gynecologists of Canada Clinical Practice Guideline for Vaginal Delivery of Breech Presentation
Image by Oana Hogrefe Photography