Article by Jane Palmer Though most breech babies will turn naturally before their due date, some remain in the breech position. It is then that the woman and her partner will be faced with choices on what to do regarding trying to turn the baby and what is the best way to give birth.
Breech babies present with their bottoms down and their heads up. When a woman is 28 weeks pregnant, her baby has a 25% chance of being in the breech position. As the pregnancy progresses, the likelihood of a baby staying in the breech position gets smaller. At 33 weeks of pregnancy there is around a 5% chance of a breech presentation. At full-term around 3-4% of babies remain in the breech position. There are different types of breech babies and they are described by the position that they are in. There is the ‘complete breech’ which is where the baby sits cross legged. The “frank breech” where the baby’s legs are straight and held flat against his/her body. There is the rare ‘footling breech’ where the baby’s foot or feet are coming first (before their bottom). There is the very rare ‘kneeling breech’ where the baby is in a kneeling position.
Sometimes there are contributing reasons for the baby being in a breech position. Reasons like when the baby is born premature (remember the earlier the pregnancy, the more likely a baby is to be in the breech position.) Some women have a septum in their uterus. A septum is a structure that can divide the uterus. A septum makes it more difficult for the baby to settle into a head down position. If a woman has a growth in her pelvis such as a tumour or fibroid, this may also prevent the baby from turning to a head down position. Other reasons that increase the likelihood of a breech baby include: An abnormality of the baby, placenta praevia, multiple pregnancy, excessive amniotic fluid, unusual shape of a woman’s pelvis or if the woman has very week or very tight abdominal muscles. However a breech baby can occur in a healthy woman with a healthy baby. In these cases a baby simply likes being the other way around.
A midwife or doctor can usually diagnose a breech baby during pregnancy, although occasionally it is not found until a woman is in labour. The midwife or doctor usually can feel the soft bottom near the pelvis and the baby’s head somewhere in the upper abdomen. Often women who have a breech baby report that they feel a hard ball or a very sore spot under their ribs.
Though most breech babies will turn naturally before their due date, some remain in the breech position. It is then that the woman and her partner will be faced with choices on what to do regarding trying to turn the baby and what is the best way to give birth.
What is the best way for a breech baby to be born? A study called the Term Breech Trial endeavoured to answer this very question. The conclusion of the study reported that overall it was safer for full-term babies in the breech position to be born by a caesarean birth. While the study design has some serious flaws it resulted in many doctors recommending a caesarean for breech babies.
Since the results of the Term Breech trial were published the level of skill for midwives and doctors in assisting breech births has declined greatly. If you chose to have a vaginal breech birth you will need to seek a skilled birth attendant (and such a person may be difficult to find). You will also need to find out what type of breech is it? A complete breech has far less complications than a footling breech for example.
It is important to remember that both vaginal breech births and caesarean births carry risks. There is plenty of information both in books and on the internet about breech babies and breech births. There is a lot to consider when choosing the right option for birth and it is important to discuss the issues with the health professional providing your care.
The procedure where a doctor attempts to turn a breech baby to head down position is called an ‘external cephalic version’. Research clearly supports that external cephalic version substantially reduces the number of babies who remain in the breech position. The research also says that an external cephalic version should not be done until the baby is full-term (at least 37 weeks). This helps reduce the number of babies who turn back to the breech position. During an external cephalic version a doctor manipulates the baby externally, through the woman’s abdominal wall, to make the baby roll forwards or backwards. The doctor uses minimal force. Sometimes medication is given to help relax the woman’s uterus. External cephalic version is not without risks. There is an increased risk of fetal distress, spontaneous rupture of membranes and problems with the placenta. The risks and benefits should be discussed with a doctor or midwife.
Acupuncture has been used successfully to turn breech babies. I have seen two well controlled research studies supporting its use. They found that acupuncture can successfully turn up to 70% of breech babies. Treatment can be commenced as early as 32 weeks. The most common treatments used by acupuncturists are moxibustion alone or moxibustion in combination with acupuncture. Moxibustion is a method of applying heat to an acupuncture point using a cigar-like stick of the dried herb moxa (Fursland, 1992). The acupuncture point used to turn breech babies is located just near the little toe. If choosing this method it is important to consult a qualified acupuncturist.
There are a number of alternative methods which have been used to assist the breech baby to turn. Pulsatilla, a homoeopathic remedy, has been claimed to be successful by some practitioners. Pulsatilla can be given as a single dose and helps stimulate the baby to move. To obtain Pulsatilla you would need to consult a qualified homoeopath.
Positioning has been recommended by some as a method to encourage the breech baby to turn. Balaskas (1989) recommend walking an hour a day. The theory behind this is that the baby’s head is the heaviest part of the baby’s body and will move down because of gravity. Another positioning technique that has been used is one that has the woman’s bottom higher than her head. This type of position discourages the baby’s bottom from settling into the pelvis. One way of doing this is by getting onto the floor in the hands and knees position and then place your head on the ground (known as the knee chest position). Try this exercise three times per day for 15 minutes at a time. There has been some uncontrolled studies that indicate this last method has a high incidence of breech babies turning. Further research on positioning techniques is needed, so we know if they are effective or not. Remember before commencing any treatment it is important to consult a qualified health professional.
(updated 27th January 2010)