Breech babies

While it is not common, only 1 in 25 babies present this way at birth, we wanted to talk a bit about breech babies today and ways to encourage optimal fetal positioning during pregnancy.  Most babies will move to a head-down position in the weeks prior to birth, although not all.  Breech presentation is when the baby, instead of being positioned head-down, presents with his or her buttocks (and sometimes knees or feet) first, closest to the birth canal.Though many babies have been safely delivered from the breech position throughout time, this type of birth scenario is considered out of the scope of birth center practice.  In cases of breech birth at the birth center, we transfer to the care of a hospital-based team.  However, there are many ways to encourage baby to move into a more optimal position if they are breech and ways to lower the risk of breech presentation before it occurs.

Reasons for breech presentation

Many believe that babies will get into the best position possible given the space they occupy in the womb.  This space can be affected by mom’s pelvic alignment and ligament length.  For example a twist, or torsion, of the pelvic joints can throw the uterine ligaments out of balance.  Broad ligaments may also be too tight and can hold a baby in a breech position.  Uterine tone can affect fetal positioning, as can the amount of amniotic fluid present.  Mom’s physical and emotional experiences can also affect baby’s position in the uterus (such as a car ride, or emotions such a fear, grief, or a sense of safety).

Fortunately, many babies that are presenting breech late in pregnancy flip before labor begins.  In these cases, they are often aided by the increased relaxin hormone levels made by mom’s body at the very end of pregnancy, which can relax her ligaments and uterus enough to allow baby room to shift.

In some cases, the natural shape of mom’s uterus, which may have a center membrane (septum) or a heart shape (bicornate) may contribute to breech presentation.

Evidence also indicates that women with a history of breech presentation in their personal or family history may have a greater chance of breech.

The location of the placenta, such as with placenta previa (placenta covers part or all of mom’s cervix), can also increase the likelihood of a breech presentation.

A short or wrapped cord may also be preventing a baby from getting into optimal position.  (This scenario is rare and doesn’t necessarily indicate an impending danger during birth.)

Lastly, premature birth also increases the risk that a baby will be born breech.  However, only 3 to 4 % of babies born between 37 and 42 weeks present in the breech position.

Types of Breech Positions

There are four ways a baby can present breech:

• Frank breech: the buttocks presents first with legs extended towards baby's trunk
• Complete breech: the buttocks presents first with the legs folded so feet are close to the buttocks
• Footling: one or both feet present first
• Kneeling: when both knees present first, with the feet folded up behind baby's thighs.

Oblique (diagonal) and transverse (lying sideways) positions are not considered breech presentations, although these positions carry their own risks.

Natural ways to help a breech baby turn

Before 30 weeks many babies are breech and it is generally not a concern at this time, as most of these babies will get into position in plenty of time before birth.  Midwives are trained and experienced at feeling for fetal position at every visit in the later months of pregnancy.  Breeches are often addressed between 32 and 37 weeks of pregnancy.

It is important to manage situations of breech presentation with the guidance of an experienced care provider.  Together, mom and care provider can talk about the options and what actions might be most appropriate, safe and beneficial to you.  Many factors, such as gestational age, known or suspected cause of breech, mom’s physiological health, and positioning may affect the course of action with a breech baby.

Homeopathy, chiropractic, craniosacral therapy, and Traditional Chinese Medicine (including acupuncture and moxibustion) can all assist in cases of breech.  In fact, many of these treatments utilized throughout pregnancy can help prevent any of the pelvic conditions that may contribute to breech.  A particular technique of chiropractic care known as the Webster technique has high success rates in turning breech babies.

Mayan abdominal therapy is another modality in which women have experienced success in turning a breech baby.  Massage, particularly myofascial release, can also be helpful in preventing or addressing breech.

Mothers can use certain positions to help turn a breech baby or prevent a baby from becoming breech in the first place.  This includes what is called the forward-leaning inversion.  Spinning babies is a great resource for more information about this.

In cases where low amniotic fluid is the case, women can increase their fluid intake and modify their diet (again with support from an experienced care provider) in addition to receiving bodywork.

You may also been seen by an OB for an External Cephalic Version (ECV) in which a doctor manually turns the baby head down through the abdominal wall.  This may be a good choice for some women after other options have been explored.

If you have questions about breech babies, please feel free to speak with us at an upcoming appointment.