The Empowered Breech Birth Series

Part 2: Natural ways to turn a 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. So learning natural ways to turn your breech baby can be an empowering next step in your journey.

 

While medical interventions like external cephalic version (ECV) and cesarean section are commonly recommended for breech babies, there are holistic and natural approaches that can first be explored to turn a baby head down.

Recently there has been discussion in the birth-work world about whether we should be attempting to turn breech babies at all, or if we should accept the baby’s choice to be born in the position they are in. Breech babies can be born vaginally, but mothers are often pressured into an elective c-section instead.

Ultimately, the mother should always decide what is right for her and her baby, but as a doula and bodyworker, clients have come to me for years wanting support to get their babies head down for birth, to avoid being ‘risked out’ of care with a homebirth midwife, or due to threats of an unwanted c-section in the hospital system.

 This article will delve into the techniques I have used to turn breech babies, including pelvic and uterine ligament alignment, pelvic floor release, rebozo, Spinning Babies positions and Optimal Maternal Positioning techniques, as effective methods for encouraging a breech baby to turn head-down, ultimately supporting the mother’s wishes for a natural vaginal birth.

Pelvic and Uterine Ligament Alignment

Optimal alignment of the pelvis and uterine ligaments plays a crucial role in creating a supportive environment for a breech baby to spin.Misalignments and imbalances in the pelvis and uterine ligaments are common, and can be caused by injury and trauma, or develop gradually over time from imbalanced positions such as extensive sitting, reclining, wearing high heels, carrying a baby or baskets of washing on one hip, or regularly standing with the body’s weight to one side. These actions create tightness, restriction and pulling on one side of the pelvis resulting in misalignment which can restrict the baby’s movement and prevent them from settling into an optimal head-down position.

Skilled prenatal bodyworkers can align the pelvis and release tension in the uterine and pelvic ligaments, using gentle and safe techniques to restore balance in the pelvis and create more space for the baby to move freely.

These techniques can include:

 

Prenatal Bodywork

I use a combination of massage and physical prenatal bodywork techniques to manually release soft tissues and enable more mobility and flow of motion. This approach is helpful for maintaining and restoring balance in the mother’s body whether baby is breech, transverse or in any other less than optimal position for birth, or to ease discomfort at any time during the second and third trimesters of pregnancy.   

Rebozo

The rebozo is hand woven fabric tool traditionally used by Mexican midwives as an extension of the arms to support mothers in pregnancy, birth and postpartum.  Rebozo should only be used by a trained practitioner and its use has become increasingly more common among western doulas and holistic birthworkers. 

The rebozo can be used to support turning a breech baby with a variety of manoeuvres including sacral jiggling techniques that promote pelvic floor relaxation, reversing manoeuvres and also tying of the rebozo as a belt to support holding a baby once it has flipped. 

Spinning Babies®

The Spinning Babies® approach, developed by midwife Gail Tully, focuses on improving foetal position through maternal movements. The techniques include a range of positions and exercises that encourage your baby to move into an LOA or head-down position, with the back of the baby’s head to the mother’s left side. Some commonly recommended Spinning Babies positions for correcting breech babies include:

a. Forward-Leaning Inversion: This position should only be carried out with supervision and support of a second person or trained Spinning Babies® Aware practitioner.

This position involves kneeling on the edge of a couch, and then one by one, lowering the hands to the floor, and coming to rest on the forearms, with strong shoulders, elbows out and hands close. Let the head hang but keep the chin tucked. Knees should stay close to the edge of the couch with bottom held high, belly loose, and keep the lower back flat to create an A shape with your body. Hold the position for at least three breaths, working up to longer periods with more practice. Walk the hands back to the couch, pushing up into a high kneeling position. Take a few breaths before sitting back on the heels, allowing ligaments to settle into a symmetrical position. Repeat 5 – 7 times a day, until baby turns.

b. Breech Tilt: This position should only be used when a breech position is confirmed beyond 32 weeks, and with the support of a trained Spinning Babies® Aware practitioner.

Using a sturdy plank, such as a shelf or an ironing board, create a strong service on an angle against a couch or chair, so that the highest end is approximate 38-55cm above the floor. Pillows or cushions can be placed around the base to help prevent tipping. The mother is then supported to lay on her back on the board, with her head down and feet up, resting on either side of the board on the couch. Pillows can be used for neck support.  The mother remains on the board for up to 20 minutes, between 1-3 times a day. This position should be used alongside other techniques for maximum effectiveness.

c. Open-Knee-Chest: This position should only be used in a confirmed breech presenting baby or as part of a stalled labour protocol, with the support of a training Spinning Babies® Aware practitioner.

The mother gets into a supported kneeling position on the floor, before moving even lower to the floor, with knees, chest and face resting on the floor. The mother is supported to move her chest and shoulders further forward, while the knees stay in place. A pillow can be placed under the chest. From here, a trained practitioner can use a rebozo wrapped across the mother’s upper thighs, and pull back, taking some of the weight of the mother’s body during the Open-Knee Chest position. A helper can also sit in such a way that the mother can rest her shoulders on their ankles. This position should only be practiced with a trained practitioner, and only as part of a protocol of techniques for spinning a breech baby.

Optimal Maternal Positioning

Optimal Maternal Positioning (OMP) techniques primarily focus on maintaining balanced posture and daily activities throughout pregnancy to optimise uterine and pelvic alignment, thereby creating space for baby to assume an optimal position. This includes avoiding positions that compress the pelvis, such as reclining in soft couches or chairs, and promoting positions that encourage the baby to move into a head-down position. Some OMP techniques that can be beneficial for breech presentation include:

a) OMP Reversing Protocol: This combination of positions is designed to reverse, align and mobilise. OMP creator Ginny Phang recommends using the combination of Forward Leaning Inversion and Pelvic Floor Relaxer or the Open Knee Chest with Pelvic Floor Relaxer, for a total ‘down-time’ of 15-30 minutes during pregnancy, before attempting the OMP Pelvic Alignment Protocols.

b) OMP Pelvic Alignment Protocols: Following the Reversing Protocol, the standard suite of OMP pelvic alignment techniques can be used, focus on untwisting the hot air balloon in order for gravity to take over and flip a breech baby head down.

During a Pelvic Alignment and Mobility session with me, you will receive a tailored combination of these and other alignment techniques specific to your body and baby. I also provide personalised guidance on daily stretches and positions to practice at home throughout pregnancy to optimise your baby’s positioning, and bring mindfulness to the way you position your body during movement and at rest.  For many people, relaxation and rejuvenation can also be key to releasing held tension in the body, making my Massage and Pelvic Alignment session a great option.

Internal Pelvic Floor Release

The pelvic floor muscles are a key component in creating an open and flexible birthing pathway for your baby.

When these muscles are overly tense, injured or imbalanced, they can also restrict the baby’s ability to move into the desired position.

Internal pelvic floor release bodywork, in conjunction with personalised home exercises and gentle stretches, can help relax and release tension in the pelvic floor and restore healthy pelvic floor function.

This approach focuses on releasing tension and restrictions within the muscles, ligaments, and fascia of the pelvic floor region, which can help create a more favorable environment for the baby to move into the optimal head-down position.

• Relaxing Pelvic Floor Muscles: Tense or tight pelvic floor muscles can restrict the baby’s movement and hinder their ability to turn head-down. Through internal pelvic floor release techniques, your therapist can identify areas of tension or imbalance and apply gentle pressure or massage to release the tightness, allowing the pelvic floor muscles to relax and elongate. This relaxation can create more space and freedom of movement for the baby to shift position.

• Releasing Ligament Restrictions: The ligaments supporting the uterus, such as the uterosacral and round ligaments, can sometimes contribute to a breech presentation when they are tight or misaligned. Internal pelvic floor release techniques can target these ligaments, releasing any restrictions or adhesions that may be impeding the baby’s ability to rotate. By optimising the ligamentous support around the uterus, the baby may be encouraged to turn head-down.

• Balancing Pelvic Structures: Internal pelvic floor release also aims to restore balance and alignment within the pelvic structures. Through gentle manual manipulation, your therapist can address any asymmetries, imbalances, or restrictions within the pelvic joints, bones, and soft tissues. A balanced pelvis provides a more favorable environment for the baby to navigate and align themselves in the head-down position.

I provide this bodywork during my Internal Pelvic Floor Release consultation or the more comprehensive Pelvic Preparation for Birth session which includes internal and external release, mapping of the pelvic bones and guidance on specific exercises that promote pelvic floor health.

 Other methods for turning a breech baby include:

• Webster Technique practiced by Chiropractors

• Hypnosis for Breech

• Breech Relaxation Tracks

• Therapies that encourage emotional and fear releases

• Acupuncture

• Moxibustion 

• External Cephalic Version (ECV) – a medical procedure performed by an experienced Obstetrician or Midwife to manually turn the baby head down

While medical interventions are sometimes necessary, most parents will have time to consider and try holistic and natural approaches to turn their breech baby before opting for more invasive procedures.

The combination of pelvic and uterine ligament alignment, bodywork, rebozo, internal pelvic floor release, Spinning Babies positions, and Optimal Maternal Positioning techniques can create an optimal environment for a breech baby to turn head-down.

Sometimes a baby will turn after one session, or a combination of these techniques. It is important to consult with trained practitioners and seek guidance when utilising these techniques. With patience, persistence, and a well-rounded approach, many breech babies can be successfully repositioned, increasing the likelihood of a smoother and more satisfying natural birth experience.

In Part 3 of the Empowered Breech Birth series, we will take a deeper look at what the evidence really says about the risk of vaginal breech birth vs c-section. 

In case you missed it, Part 1 of the Empowered Breech Birth series provides guidance on making informed decisions about your breech baby.

References:

1. Tully, G. (2019). Spinning Babies: Approaches to Optimal Fetal Positioning. Journal of Prenatal and Perinatal Psychology and Health, 33(3), 177-192.

2. Kwasnicki, R. M., Bohacek, I., & van den Berg, M. (2019). Understanding and Treating Breech Presentation: A Guide for Acupuncturists and Traditional Chinese Medicine Practitioners. The Journal of Alternative and Complementary Medicine, 25(9), 875-879.

3. Latka, A., & Dąbrowska, M. (2021). The Effect of Prenatal Yoga on Pregnancy Outcomes: A Systematic Review with Meta-Analysis. International Journal of Environmental Research and Public Health, 18(2), 656.