I like to think that my daughter needed help turning from head-up (breech) to head-down (vertex) because she was ready for life outside the womb, where people don’t walk around with their bottoms in the air. Or maybe it was that she wanted to be close to my heartbeat. Whatever it was, it made for an interesting roller-coaster ride at the end of my pregnancy.
At my 30-week checkup, the midwives told me not to worry, that she could flip around on her own. But by the time my 34-week checkup had come and gone, and my little yogi was still sitting happily head-up (with her legs crossed, we would later learn from ultrasound), I decided to take action. I was a woman on a mission; after the heartbreak of learning that my little girl would need major orthopedic surgery before her second birthday, I had been counting on giving her a gentle entry into the world. I was excited that the perinatalogists we’d been seeing had given us their blessing for birth with midwives in the birthing center (a separate wing of the hospital), and I wanted to have this opportunity.
Meeting this challenge became a nearly full-time job. Below you will see the list of strategies that we employed to encourage turning. In the end, my baby turned during an external version in the hospital, and we got our gentle vaginal birth. Even if the version had not been successful, it would have been easier for me to reconcile myself to a c-section knowing that I had exhausted all other alternatives.
C-Section vs. Vaginal Breech Birth
The vast majority of doctors and midwives practicing in hospitals in the U.S. today believe that the risks of vaginal breech birth outweigh the risks of cesarean birth. Data to support this position can be found in the Term Breech Trial and follow-up study, published in The Lancet in 2000 and 2004, respectively. Some practitioners, such as Ina May Gaskin in Ina May’s Guide to Childbirth, argue convincingly that poorer outcomes for vaginal breech births are the result of inadequately-trained doctors. Henci Goer also mounts research in support of vaginal breech birth in The Thinking Woman’s Guide to a Better Birth. Regardless, "breech" is a catch-all category for several different positions, and even Gaskin and Goer would agree that only one position, "frank breech," qualifies for vaginal birth when planned cesarean birth is an option. Although I take the risks of c-sections for both mother and baby very seriously, I felt at peace with the idea of having a cesarean birth if my baby did not turn. Review the literature for yourself and make an informed decision.
Self-Care Strategies
- Visualizations and self-hypnosis. Use visualizations and self-hypnosis to encourage the baby to turn. See Self-Hypnosis by Brian Alman and Peter Lambrou. You can also see my self-hypnosis script.
- Breech tilt. The breech tilt is a simple exercise that harnesses the power of gravity. It involves putting your hips and legs up above your head, with pillows, a board, the wall, or in a yoga shoulder-stand against the wall. I found it quite uncomfortable. It should be done multiple times daily.
- Underwater handstands. Visit a pool and do underwater handstands. This achieves the same result as the breech tilt, but with a lot less discomfort.
- Music and talking. Play music and talk to the baby from the bottom of your belly (this is easier to do with help!).
- Warm and cold. Place a warm pack at the bottom of your belly and a cold pack (ice pack, frozen veggies) at the top of your belly for a few minutes. Be cautious about overheating.
- Flashlight. Shine a flashlight on your belly, starting at the top and moving down toward your pubic bone.
- Belly massage. Use massage oil and rub your belly in a circular motion in the direction you want the baby to turn. Have your midwife or OB teach you to feel for the body parts (back, bottom, legs, etc.) so that you will be able to figure out which way to rub.
Alternative Medicine
- Acupuncture and Moxibustion. See an acupuncturist for moxibustion and acupuncture. Find someone who has experience with turning breech babies. You will also want to get instructions for burning moxa at home. Moxibustion for breech presentation is recognized as clinically effective for turning breech babies in a study by Cardini and Weixin in the Journal of the American Medical Association, Volume 280(18), 11 November 1998, pp 1580-1584 (please email me if you would benefit from seeing the full study and you do not have ready access to a medical library). Acupuncture is wonderful for relaxation during pregnancy, anyway!
- Chiropractic. See a chiropractor trained in the Webster Technique, a special adjustment specifically for the purpose of turning a breech baby
- Osteopathic manipulation. Find an osteopathic doctor (D.O.) trained in osteopathic manipulation. This soothing, gentle technique will make you more comfy, and can address common pregnancy aches and pains like sciatica. A related modality is Craniosacral Therapy, which utilizes the same principles of osteopathic medicine, though practitioners do not have the same full medical training as a D.O.
External Version
If none of the above strategies help your baby to turn, you might consider an external version (also known as external cephalic version) in the hospital. In this procedure, an obstetrician will use her or his hands to turn your baby while another doctor monitors your baby’s heart rate with ultrasound. Versions are usually performed in the c-section operating room with an anesthesiologist standing by. A sudden drop in the baby’s heart rate could signal compression of the umbilical cord, requiring an immediate birth by cesarean. For this reason, versions are not typically attempted until a baby is full term (at least 37 weeks) since the risks of prematurity outweigh the risks of a full-term cesarean birth.
If You’ve Tried Everything and Your Baby Won’t Turn…
Remember that breech presentation is not always random. Sometimes babies need to be breech for a medical reason, such as cord position. If your baby doesn't turn, there is probably a good reason. Trust that your baby knows what she needs and that your body and your baby will work together for the best possible outcome.
If you will be having a planned cesarean birth, it might be helpful to make a birth plan and ask your obstrician or midwife what you can do to make your cesarean more of a birth experience than an operation. For example, can you select some music to play in the operating room? Can they dim the lights? Can your partner watch the birth? Can you bring a doula or another support person with you to take pictures? Can the baby be brought to you to nurse as soon as possible in recovery?
When to Start With Breech Turning Strategies
30-32 Weeks: Your doctor or midwife may not be too alarmed, since there is still ample room in your uterus for the baby to turn around. However, I recommend doing some legwork now to ensure that you have the resources and providers that you need on hand, should your baby decide to stay breech. For example, it can take a few weeks to find an obstetrician with the willingness, skills and experience necessary to do a successful version.
33-37 Weeks: If this is your first baby, you may want to begin some of the breech turning strategies as early as 33 Weeks. Cardini’s study of moxibustion took place between Weeks 33-35; 33 Weeks is also the point at which the chance of turning is only 15.5% for women who have not had a baby before (or for women who’ve had at least one prior pregnancy with a breech baby at 37 weeks). Whether or not you’re a first-time mom, you might want to use the model of going from “less invasive to more invasive”: start with self-care and leave yourself time to try alternative medicine modalities before progressing on to a version and then, as a last resort, a c-section.
37-39 Weeks: Your baby is now considered “full term,” and you may now be a candidate for a version. If you or your obstetrician/midwife is concerned about the risks of a version, you can choose to continue with alternative modalities and hope for the best. The earlier a version is attempted in this window, the higher likelihood of success, since the baby is smaller. However, if there is any chance that your due date could be too early, you would want to avoid a version at 37 Weeks, since there is a risk of fetal distress necessitating immediate birth by cesarean, as well as some risk of premature rupture of membranes leading to labor induction.
Resources
- One article I found very helpful was "Baby is Breech, Now What?" by Mother Care Canadian Birth Professionals. It elaborates a little more on all of the turning strategies. It includes a discussion of homeopathy and vaginal breech birth.
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