Is your baby breech?

by | May 11, 2023 | News

The Empowered Breech Birth Series

Part 1: Making informed decisions about your breech baby

In this three part Empowered Breech Birth series, I dive deeper into the fascinating topic of the breech baby, including why breech positions occur, natural ways to prevent and correct breech positioning and what the evidence really says about the risks of vaginal vs caesarean birth for breech babies.

Most babies will position themselves head down in preparation for birth. But sometimes, a baby will remain in a breech position at full term, presenting bottom or feet first. Most breech babies are now born by caesarean section due to the loss of breech birth skills in the medical community and restrictive hospital policies. Learning your baby is in a breech position can be confusing and stressful, especially if you were planning a vaginal birth and can’t find a provider to support your wishes. My hope is the information in this article series can support you to make informed decisions about your breech baby journey.

What is a breech baby?

Breech position is when a baby is positioned bottom or feet first in the uterus at full term. This occurs in approximately 3-5% of all pregnancies and is considered a variation of normal.

In a head-down position, the baby is considered to be in the ideal position for birth, and this is referred to as the cephalic presentation. Most babies will settle into a cephalic or head down position between 32 and 36 weeks. When the baby remains in bottom or foot presenting position beyond this time, it is considered to be in a breech position.

There are types of breech presentation including frank breech, complete breech, and incomplete breech.

Frank breech: Baby has both hips flexed with legs straight and feet near their face, in a pike position.

Complete breech: Baby is sitting with both hips flexed and both legs tucked.

Incomplete breech: Any combination of one or both hips extended, also known as a footling breech when one leg is extended or double footling breech where both legs are extended.

Breech baby positioning can present additional challenges during labour and birth, and there may be potential for increased risk of complications for both mother and baby. Most breech babies are now born by caesarean which also carries risk, however, a breech baby can be born safely vaginally, and you have the right to seek out a provider who can support vaginal breech birth, if that is what you would prefer for you and your baby.

Why does breech position occur?

The exact cause of breech presentation is not entirely understood, but several factors have been associated with an increased likelihood of breech presentation(1), including:

  • Premature birth: babies who are born before their due date have a higher risk of being in a breech position.
  • Multiples: mothers who are carrying more than one baby have a higher risk of having a breech baby.
  • Previous pregnancies: breech is more common in repeat pregnancies, which is thought to be due to increased laxity in uterine ligaments.
  • Low amniotic fluid levels: when there is less amniotic fluid in the uterus, the baby may have reduced ability to move into a head down position.
  • Abnormalities in the uterus: certain uterine abnormalities, such as fibroids or a bicornuate uterus, can increase the risk of breech presentation.
  • Pelvic injuries and misalignment: past trauma or injuries to the pelvis and hip area, or misalignment of interal pelvic and uterine ligaments can influence the space and shape of the uterus, potentially leading to breech positioning of the baby.

What can be done to prevent a breech baby?

Because the positioning and alignment of the mother’s body can influence the positioning and alignment of the baby, sometimes steps can be taken to reduce the likelihood of breech positioning from occuring.

These include:

  • Pelvic alignment: using alignment techniques such as Optimal Maternal Positioning and Spinning Babies during pregnancy can encourage baby into a head-down position
  • Bodywork: receiving bodywork from a practitioner trained in pelvic alignment throughout pregnancy can support alignment
  • Avoiding misalignment: non optimal positioning of the baby can occur if the mother is spending prolonged periods of time with misalignment in the pelvis, such as slouching backwards on chairs, extended periods of sitting, wearing high heels, placing uneven pressure on the hips such as leaning on one leg or putting all your weight on one leg while getting in and out of a car or bed.
  • Chiropractic care: some chiropractors specialise in pregnancy care and can assist with gentle alignment of the maternal spine to create adequate space for baby to turn.
  • Acupuncture: there is some evidence that acupuncture may help to encourage the baby to move into a head-down position.

What can be done to correct breech position?

When a baby is already in a breech position, there is a range of options that can be explored to encourage the baby to move into a head-down position before birth.

These include:

  • External cephalic version (ECV): this is a medical procedure which involves a trained healthcare provider using their hands to manually manouvre the baby into a head-down position from the outside of the mother’s abdomen. This procedure is performed in a hospital setting, with close monitoring of the mother and baby, due to the risks of premature rupture of membranes, changes in baby’s heart rate, blood loss, and cord prolapse. A Cochrane review of 31 randomized controlled trials found that ECV was successful in turning the fetus in 58% of cases. 
  • Pelvic alignment: Creating alignment in the uterus and pelvis through bodywork and practicing breech-specific techniques like Spinning Babies and Optimal Maternal Positioning may help to gently and safely encourage a breech baby to turn head down.
  • Moxibustion: a traditional Chinese Medicine technique which involves burning the herb mugwort near specific acupuncture points. One study found that moxibustion may be effective in helping to turn a breech baby. In this study, 53% of the fetuses in the moxibustion group turned head-down, compared to 36% in the control group. (2)
  • Chiropractic care: some chiropractors will support pregnant clients late in pregnancy with adjustments at regular intervals to encourage a breech baby to turn and stay head down.
  • Acupuncture: there is some evidence that acupuncture may help to encourage the baby to move into a head-down position.

Options for birthing a breech baby:

If your baby remains in a breech position at full term, you still have options.

Unfortunately, many maternity care providers in Australia no longer have the skills, experience or permission to support a planned vaginal breech birth, and you may need to seek out a provider who is skilled and capable of supporting a breech birth.

  • Vaginal breech birth: this involves birthing the baby vaginally while the baby is in a breech position. This option usually requires monitoring and a skilled healthcare provider who is experienced in supporting breech birth. It is generally only recommended in certain situations where the baby is in a favorable breech position and there are no other complications.
  • Caesarean section: most breech babies now have a caesarean birth due to hospital policies surrounding the perceived risks of vaginal breech birth. However, it is important to note that ceasarean also carries risks, including longer recovery times and a higher risk of surgical complications. (3)

If you’ve learnt you have a breech baby, these are just some of the options to consider to help you achieve an empowering breech birth on your terms.

In Part II of the Breech Baby series, we take a deeper look at natural tools and techniques to prevent and correct breech baby positioning.

References:
  1. Barrett JF. Breech presentation before the onset of labor. UpToDate. Updated December 9, 2021. Accessed February 28, 2022. https://www.uptodate.com/contents/breech-presentation-before-the-onset-of-labor
  2. Coyle ME, Smith CA, Peat B. Cephalic version by moxibustion for breech presentation. Cochrane Database Syst Rev. 2012;5(5):CD003928. doi: 10.1002/14651858.CD003928.pub3
  3. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 161: External Cephalic Version. Obstet Gynecol. 2016;127(2):e54-e61. doi: 10.1097/AOG.0000000000001200

As a doula, prenatal bodyworker and birth educator, my role is to support birthing families in making informed and empowered decisions about their birth. As part of this process, I want to share the latest evidence-based information and statistics on a wide range of interventions that are now so common, but not always necessary, in the Australian maternity system. And breech baby positioning is just one scenario where I often see the cascade of interventions begin. If you’d like support with turning your breech baby in Cairns and Far North Queensland using Spinning Babies, Optimal Maternal Positioning, pelvic alignment and pelvic floor bodywork, or you’d like to discuss your options for an empowered and informed breech birth, you can book a Pelvic Alignment for Birth Package or Private Prenatal Consultation with me.

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