If you’ve read my birth story, you’ll know that I chose to have a vaginal breech delivery. Few obstetricians today are performing vaginal breech deliveries, and sadly it is a skill that is being lost. In 2009, the Society of Obstetricians and Gynaecologists of Canada released guidelines stating that breech cases that meet certain criteria where labour is managed can be comparable in safety to elective caesarean section with reports showing excellent neonatal outcomes (read the guidelines here: http://sogc.org/guidelines/vaginal-delivery-of-breech-presentation/).
I was referred by my midwife to one of only a handful of doctors that do breech deliveries in Toronto. Not all breech babies may be considered for vaginal delivery though, as it may depend on the position of the baby. For example, a baby can be “footling breech”, meaning feet down, or “frank breech” which is buttocks down (there are 3 types of breech position: frank, complete and footling). My own daughter Ava was a frank breech baby, so she was determined to be in a favorable position for a vaginal delivery. Her position was monitored by frequent ultrasounds during the third trimester of my pregnancy. When planning for a vaginal breech delivery, there are many factors to consider, such as the type of interventions involved (the birth of my own baby required induction and epidural), the health care provider’s routine methods of delivery for breech births, and potential risks. Ask lots of questions and know your options!
Turning a Breech Baby
A health care provider may suggest using methods to help turn a breech baby between 32 and 37 weeks of pregnancy. Listed below are methods used for turning a breech baby – some techniques are easier and require less effort than others. Check with your health care provider first to ensure it is safe for both you and your baby before trying any of the following:
1) Inverted positions such as the “breech tilt”, “open knee chest”, and “forward leaning inversion” have all been used. Inverted poses use gravity to move the baby’s bottom end up and out of the mother’s pelvis, creating space and therefore encouraging her to turn. Generally babies want to move head down because the baby’s head is the heaviest so it is inclined to move downwards into the mother’s pelvis. Most babies will be head down in the uterus by 32 weeks, so don’t panic if baby is still breech before that time. Some babies even turn late in pregnancy or in labor. Babies are in a breech presentation in only about 3-4% of all deliveries. You can read more about breech and positioning here: http://spinningbabies.com/baby-positions/breech-bottoms-up/what-to-do-about-breech and here: http://spinningbabies.com/more-info/for-pregnancy/daily-activities. There is currently insufficient evidence on the effectiveness of postural techniques alone, but some success when used with moxibustion.
2) The “Webster Technique” is a chiropractic technique to help address any misalignments in the mother’s pelvis or tension in the ligaments that could create asymmetry of her pelvis and uterus, which is thought to be another cause of breech positioning.
3) Moxibustion is a technique from Chinese Medicine that uses heat on specific acupuncture points on the mother. There is some evidence that the practice of positioning and exercises in addition to acupuncture has shown positive results. You can receive this treatment from a qualified acupuncturist, who may also teach you to do moxibustion on yourself, as you may be advised to repeat the treatment more than 1x/day. You can read more about moxibustion for breech babies here: https://www.scienceandsensibility.org/p/bl/et/blogid=2&blogaid=660
4) An ECV or external cephalic version. An ECV is a procedure where the practitioner (OB or midwife) places their hands on the mother’s abdomen and lifts the baby up and away her the pelvis and gradually turns the baby from a head up, to a head down presentation. The baby’s heart rate is monitored, and fetal ultrasound may also be used. If done in the hospital, the mother may have access to pain relief in the form of an epidural. Not all OBs or midwives perform ECVs, and skill and expertise with this technique also varies. Consideration for an ECV involves a number of factors, such as whether or not there is enough amniotic fluid around the baby to safely do the procedure. If a baby doesn’t turn, even after you try to encourage her to do so, there is usually a good reason. They are in that position because it is the best and most comfortable place to be (the baby’s size, a short umbilical cord, the cord wrapped around the baby, the shape of the mother’s uterus or pelvic bones, amount of amniotic fluid and room available to move in the uterus can influence the baby’s position and cause a baby to be breech).
Evidence on postural techniques
Moxibustion/postural techniques for breech
The Society of Obstetricians and Gynaecologists of Canada
Evidence for ECV
International Chiropractic Pediatric Association (for Webster technique)