By Hayley Oakes LM, CPM ~
One of the most common questions we are asked by prospective clients is, “What happens if my baby is breech?” The short answer is we don’t deliver breech (‘bum’ down versus head down) babies at the birth center. We are an accredited birth center (via the American Association of Birth Centers) with Certified Nurse Midwives on staff; therefore, it is out of our scope of practice.
The safest mode of delivery for a breech presentation has long been a debate in obstetrics.
The risk with delivering a breech baby vaginally is fetal head entrapment. This means the legs and lower body are born but the head (and possibly one or both arms) is stuck causing asphyxia. Today most babies who are breech are delivered via cesarean section. However, a cesarean is not risk-free as it is major abdominal surgery and there are higher risks to the mother including infection, bleeding, or injury to internal organs.
“So what can I do if my baby is breech?”
Well, most babies are breech at some point in the pregnancy. Babies are small so they can flip, swim and turn in the womb and that’s normal. Only 3-4% of babies will persist in a breech position at birth. That means that most babies will turn head down by 36 weeks. So this might be a worry that naturally resolves itself by the time you are due to give birth.
“Is there a medical reason why my baby is breech?”
Some factors that predispose a mother to carrying a breech baby include uterine malformations or fibroids, polyhydramnios (too much amniotic fluid), placenta previa (the edge of the placenta partially or fully covers the cervix), fetal abnormalities, and multiple gestations. Otherwise, might just be a structural preference for the baby.
“How do you know if my baby is breech?”
At the birth center we make sure your baby is head down by 34 weeks gestation. We wait until 34 weeks because a baby is still quite small at this point so we want to give the baby enough time before initiating the discussion of interventions, however, it still leaves a few weeks to try and help the baby turn before we start talking about breech birth options.
Throughout your care with us we assess the baby’s size and position with our hands via Leopold’s maneuvers. This helps the midwife become familiar with your baby’s constitution, position, and growth. At 26-28 weeks, most babies start to move in a head down position. At this time, the baby’s head becomes the largest and heaviest part of the body and naturally with the mother’s upright nature and with the help of gravity, a baby’s head is guided into the mother’s pelvis.
If the baby is not head down by 32-34 weeks, or we are not 100% convinced of the baby’s position, we have a small ultrasound machine at the birth center to visually see the baby’s position. Why we don’t use an ultrasound 100% of the time is because it’s not medically indicated to do so up to this point, it can be expensive, and we try to limit the amount of ultrasound exposure to babies unless necessary.
“What can I do to try and turn my baby?”
If a baby is still not head down at this time, we advise the mother to start getting bodywork and engaging in specific positions and exercises multiple times a week. This can help encourage the baby to turn naturally.
Acupuncture has been used for centuries in China to turn breech babies.
Additionally, the use of moxibustion (a treatment involving the Chinese herb, Moxa, that is burned by the acupuncture points on the foot) has been shown to be very successful. Some practitioners have an 80-90% success rate in turning breech babies with only this modality. The treatment is said to release hormones that both stimulate the uterus to contract and the baby’s heart rate to increase, which facilitates fetal movement.
Chiropractic care specifically the Webster technique is helpful in releasing tight round ligaments that could possibly be preventing a baby’s mobility.
Spinning Babies techniques i.e. inversions off the couch and hand stands in the pool can help turn a baby head down. This along with ‘belly sifting’ – an exercise that uses a rebozo (a Mexican shawl but you can use any fabric that can easily wrap around the mother’s abdomen) – to support the mother’s abdomen can be very helpful to soften the round ligaments.
“Go away from the cold and towards the party”. Babies respond to external temperature changes, light, darkness and sound. You can apply an ice pack under your ribs, by the baby’s head as well as shine a flashlight and play music (or have your partner talk to the baby) down by your pubic bone. This can encourage the baby to go towards the warmth and familiar sounds and away from the cold.
Emotionally and the more ‘woo-woo, hippie-dippie’ reason for a baby turning breech is that a baby wants to be closer to the mother’s heart. This could be because it has been a stressful pregnancy physically, emotionally, or financially (or all of the above). Or the baby wants to get the mother’s attention if she has not been able to make the health of her pregnancy a priority. This happens with unexpected pregnancies and apprehensive feelings about being a mother; a woman with a full time job, or a mother with other children to care for.
Hypnosis guided visualizations and affirmations can be great for this. It only takes a couple of minutes and can be done as one is lying in bed. Otherwise, try to set an alarm on your phone every day to remind you to stop, take deep breaths, and talk to the baby. Not only will this bring down your blood pressure and pulse but also decrease the levels of adrenaline and other stress hormones coursing through your body, placenta and baby
“What if my baby is still breech after all this?”
If all of these natural measures don’t work, then around 36-37 weeks, one can try an external cephalic version. This is an attempt to turn the baby manually to a head down position. This is usually performed by an OB-GYN in a hospital setting for the in-case scenario that a baby doesn’t tolerate the procedure well and needs to be born ASAP. While it’s not a highly successful intervention (50% success rate), it can be one last thing to try before discussing how and where to deliver your breech baby.
If your baby turns head down then you continue care with us at the birth center. If not, then we talk about your breech birth options: seek out one of the three care providers who offer vaginal breech (in the Los Angeles County) or schedule a cesarean. If you’re interested in vaginal breech, here is a great video of a home breech birth with an Ob-gyn and midwife present.
“Why are there such limited options?”
This is in part due to the higher risks associated with breech delivery (the ultimate risk is if the head becomes trapped in the mother’s pelvis), as well as the simple fact that it’s just not practiced anymore due to liability and higher malpractice premiums. Most importantly it’s no longer taught in medical school so a lot of care providers just don’t know how to deliver a vaginal breech baby. This can be frustrating for mothers as it leaves them with very little options.
In navigating this tricky system, it’s important to remember that you can only do your best. If your baby still presents breech and that means you have to let go of the birth center or vaginal birth you hoped for, then know that it is not personal, something you did wrong or a sign that you are failing at motherhood. There are wise and difficult teachings around being a mother and raising a child, but the biggest one is to ‘control what you can and then surrender to the rest’. We often forget there are two peoples’ wishes during the pregnancy and birth (and especially afterwards) and sometimes the baby’s doesn’t match that of the mother’s. So grant yourself a lot of grace, patience and trust with whatever outcome as those will be your best tools in your journey of motherhood.