Breech
Page Contents:
Breech Babies: Breech Birth, Written by, Jane Palmer, Midwife - Australia
Encouraging a Breech Baby to Turn, Written by Donna Broderick, Midwife - Maine, USA
BREECH BABIES: BREECH BIRTH
Jane Palmer
(Updated 26th February 2006)
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.
My doctor said that he would prefer to do a caesarean as my baby is breech. I would like to avoid a caesarean if at all possible. What can I do?
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. There has been some controversy since this study in the way it was carried out, however most doctors now recommend 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 choose 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.
I have heard about a procedure where a doctor tries to turn the baby into a head down position. Can you provide me with further information?
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.
Is acupuncture successful in turning breech babies into the head down position?
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.
Are there any natural methods of helping a breech baby to turn?
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.
Reference list
Balaskas, J. (1989). New active birth: A concise guide to New active birth: A concise guide to natural childbirth. London: Unwin Paperbacks.
Banks, M. (1998). Breech birth: Woman-Wise. Birthspirit
Beal, M. W. (1998) Women’s use of complementary and alternative therapies in reproductive health care. Journal of Nurse-Midwifery, 43 (3), 224-234.
Cardini, F., & Wiexin, H. (1998) Moxibustion for correction of breech presentation. The Journal of the American Medical Association, 280 (18), 1580-1584.
Charlish, A. (1995) Your natural pregnancy. Australia:
Enkin, M., Keirse, M. J. N. C., Renfrew, M., & Neilson, J. (1995). A guide to effective care in pregnancy and childbirth (2nd ed.). Oxford: Oxford University Press.
Fursland, E. (1992) How to do a baby a good turn.
Hannah, M. E., Hannah, W. J., Hewson, S. A., Hodnett, E. D., Saigal, S. & Willan, A. R. (2000). Planned caesarean section versus planned vaginal birth for breech presentation at term: A randomised multicentre trial. The Lancet, 256: 1375-1383.
Mehl, L. E. (1996). Hypnosis and conversion of the breech to the vertex presentation. MIDIRS , 6, 52.
Jane Palmer, Midwife - Australia
Website: www.pregnancy.com.au
back to the top
ENCOURAGING A BREECH BABY TO TURN
Written by Donna Broderick, CPM, Doula and Childbirth Educator – Maine, USA
At twenty eight weeks gestation 75% of babies will have turned into a head down position. By thirty four weeks, only 5% of these babies will remain in a head up, or breech position. At term, 3-4% of babies will be in a breech position and remain so for birth.
Because so few practitioners these days are trained and willing to attend breech births, we have become quite skilled at encouraging our breech babies to turn head down. All of the following measures have been successful at accomplishing this, especially when attempted early on, when the baby still has ample room to rotate, and before the presenting part has entered the woman’s pelvis. Many of these methods are non-interventive and can be done by the mother-to-be in her own home.
One of the most common methods of turning a breech is using “breech tilt exercises”. These exercises use gravity to try and help the baby’s head to float to the top of a woman’s uterus. Basically, the woman will lie with her hips higher than her head. This can be accomplished by placing pillows under her hips to raise them 30cm off the floor when she is lying on her back. She could also use an ironing board propped at a 45% angle, then lie on it head down. For these first two positions the woman should lie on her back. The other possibility for women who are uncomfortable on their backs is to kneel on her bed, or other flat surface, and bring her chest down to the floor. Any of these exercises should be performed three times each day for a 15 minute period.
A method similar to the “breech tilt” is accomplished by entering the weightless environment of a swimming pool. A woman can do hand stands or walk on her hands in a pool. The water needs to be deep enough to cover her bottom when she is upside down. She should not however stay under for long periods but come up regularly for breaths. While this sounds funny and may cause spectators to be amazed, there is anecdotal evidence that it has been successful in turning breeches.
There are a number of simple techniques that a woman can use hand-in-hand with these exercises. It is beneficial for women to spend time visualizing and seeing her baby turned into a head down position. Sometimes women hang pictures of babies in head down positions on the wall of their bedroom to continue reinforcing the image of a vertex baby. Women can also spend time talking with their baby, either out loud or just through their silent connection. Women can do some of their first mothering by telling their baby how to turn into a head down position. Also, women can use music and light. Woman can place a radio over the lower abdomen for about 10-15 minutes at a time. The music should be melodic but lively and at an easy listening volume. This same technique can be used with a bright light shone low on the abdomen to encourage a baby to turn towards it.
A very interesting correlation has been made through diet and an increased incidence of breech presentations. The intake of yin foods can cause the baby’s head to become too yin to assume its natural downward position for birth. Therefore, it is necessary to create a more yang condition. Cigarette smoking, stress and an over busy life contribute to an excessively yin state. Excessive yin foods include fruit juices, tropical fruits, ice cream, sugars, oil, coffee, sweeteners, drugs and chemicals.
More yang foods include the animal proteins of fish, poultry, eggs, red meats, dairy products and also miso which can be taken as a soup or tea.
Another method that many midwives use to help women’s babies turn from breech positions is homeopathy. The homeopathic remedy Pulsatilla can be used in the 35th week of pregnancy. This is especially valuable if the breech baby’s position is stress related. Your midwife or homeopath would suggest potency and frequency of your treatment.
Some women have great success turning breeches by visiting an acupuncturist, who can treat her either with acupuncture, acupressure, or moxibustion. The acupuncture point (Bladder 67) to turn a breech baby is on the outer aspect of the little toe nail at the nail bed. This point can either be needled, have pressure applied to it, or have cones of moxa burned on it. These procedures should only be performed by a professional trained in acupuncture.
Another practitioner that some women are drawn to for help turning their breech babies is a chiropractor. There is an adjustment called the Webster’s technique, which ensures correct alignment of the woman’s spine and pelvis. It has been reported to be successful when everything else has failed to work. This too should be performed only by a skilled practitioner.
One of the more interventive, and last methods to try is what is known as external cephalic version. This is done through a series of movements which encourage the breech baby to turn into a head down position. Most practitioners recommend turning a breech baby before thirty six weeks. This can be done by a midwife in the home or a woman can schedule an ECV in the hospital and even receive muscle relaxants to help a woman not tense up during the procedure. The actual procedure usually takes approximately two or three minutes. The majority of babies are turned easily by this procedure, though few are “stubborn” and remain in the breech position.
Women are highly encouraged to turn their breech babies into a head down, or cephalic position. There remain a few practitioners in Maine (and most US states) who attend breech births. Unfortunately, many women are required to travel long distances, labor in operating rooms, or labor within very limited parameters due to their “high risk” category. However, some babies are not successfully able to turn into a cephalic presentation. In these cases, each mother must find the point where she accepts that the baby’s intention is to remain in a breech presentation. Each woman will reach her own end point for deciding when that is. Then, she will begin the adventure of finding out where and with whom to give birth to her breech baby.
Donna Broderick, CPM, Doula and Childbirth Educator – Maine, USA
Website: www.morningstarmidwifery.com
Email: dl_broderick@hotmail.com
back to the top
Breech Babies: Breech Birth, Written by, Jane Palmer, Midwife - Australia
Encouraging a Breech Baby to Turn, Written by Donna Broderick, Midwife - Maine, USA
BREECH BABIES: BREECH BIRTH
Jane Palmer
(Updated 26th February 2006)
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.
My doctor said that he would prefer to do a caesarean as my baby is breech. I would like to avoid a caesarean if at all possible. What can I do?
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. There has been some controversy since this study in the way it was carried out, however most doctors now recommend 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 choose 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.
I have heard about a procedure where a doctor tries to turn the baby into a head down position. Can you provide me with further information?
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.
Is acupuncture successful in turning breech babies into the head down position?
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.
Are there any natural methods of helping a breech baby to turn?
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.
Reference list
Balaskas, J. (1989). New active birth: A concise guide to New active birth: A concise guide to natural childbirth. London: Unwin Paperbacks.
Banks, M. (1998). Breech birth: Woman-Wise. Birthspirit
Beal, M. W. (1998) Women’s use of complementary and alternative therapies in reproductive health care. Journal of Nurse-Midwifery, 43 (3), 224-234.
Cardini, F., & Wiexin, H. (1998) Moxibustion for correction of breech presentation. The Journal of the American Medical Association, 280 (18), 1580-1584.
Charlish, A. (1995) Your natural pregnancy. Australia:
Enkin, M., Keirse, M. J. N. C., Renfrew, M., & Neilson, J. (1995). A guide to effective care in pregnancy and childbirth (2nd ed.). Oxford: Oxford University Press.
Fursland, E. (1992) How to do a baby a good turn.
Hannah, M. E., Hannah, W. J., Hewson, S. A., Hodnett, E. D., Saigal, S. & Willan, A. R. (2000). Planned caesarean section versus planned vaginal birth for breech presentation at term: A randomised multicentre trial. The Lancet, 256: 1375-1383.
Mehl, L. E. (1996). Hypnosis and conversion of the breech to the vertex presentation. MIDIRS , 6, 52.
Jane Palmer, Midwife - Australia
Website: www.pregnancy.com.au
back to the top
ENCOURAGING A BREECH BABY TO TURN
Written by Donna Broderick, CPM, Doula and Childbirth Educator – Maine, USA
At twenty eight weeks gestation 75% of babies will have turned into a head down position. By thirty four weeks, only 5% of these babies will remain in a head up, or breech position. At term, 3-4% of babies will be in a breech position and remain so for birth.
Because so few practitioners these days are trained and willing to attend breech births, we have become quite skilled at encouraging our breech babies to turn head down. All of the following measures have been successful at accomplishing this, especially when attempted early on, when the baby still has ample room to rotate, and before the presenting part has entered the woman’s pelvis. Many of these methods are non-interventive and can be done by the mother-to-be in her own home.
One of the most common methods of turning a breech is using “breech tilt exercises”. These exercises use gravity to try and help the baby’s head to float to the top of a woman’s uterus. Basically, the woman will lie with her hips higher than her head. This can be accomplished by placing pillows under her hips to raise them 30cm off the floor when she is lying on her back. She could also use an ironing board propped at a 45% angle, then lie on it head down. For these first two positions the woman should lie on her back. The other possibility for women who are uncomfortable on their backs is to kneel on her bed, or other flat surface, and bring her chest down to the floor. Any of these exercises should be performed three times each day for a 15 minute period.
A method similar to the “breech tilt” is accomplished by entering the weightless environment of a swimming pool. A woman can do hand stands or walk on her hands in a pool. The water needs to be deep enough to cover her bottom when she is upside down. She should not however stay under for long periods but come up regularly for breaths. While this sounds funny and may cause spectators to be amazed, there is anecdotal evidence that it has been successful in turning breeches.
There are a number of simple techniques that a woman can use hand-in-hand with these exercises. It is beneficial for women to spend time visualizing and seeing her baby turned into a head down position. Sometimes women hang pictures of babies in head down positions on the wall of their bedroom to continue reinforcing the image of a vertex baby. Women can also spend time talking with their baby, either out loud or just through their silent connection. Women can do some of their first mothering by telling their baby how to turn into a head down position. Also, women can use music and light. Woman can place a radio over the lower abdomen for about 10-15 minutes at a time. The music should be melodic but lively and at an easy listening volume. This same technique can be used with a bright light shone low on the abdomen to encourage a baby to turn towards it.
A very interesting correlation has been made through diet and an increased incidence of breech presentations. The intake of yin foods can cause the baby’s head to become too yin to assume its natural downward position for birth. Therefore, it is necessary to create a more yang condition. Cigarette smoking, stress and an over busy life contribute to an excessively yin state. Excessive yin foods include fruit juices, tropical fruits, ice cream, sugars, oil, coffee, sweeteners, drugs and chemicals.
More yang foods include the animal proteins of fish, poultry, eggs, red meats, dairy products and also miso which can be taken as a soup or tea.
Another method that many midwives use to help women’s babies turn from breech positions is homeopathy. The homeopathic remedy Pulsatilla can be used in the 35th week of pregnancy. This is especially valuable if the breech baby’s position is stress related. Your midwife or homeopath would suggest potency and frequency of your treatment.
Some women have great success turning breeches by visiting an acupuncturist, who can treat her either with acupuncture, acupressure, or moxibustion. The acupuncture point (Bladder 67) to turn a breech baby is on the outer aspect of the little toe nail at the nail bed. This point can either be needled, have pressure applied to it, or have cones of moxa burned on it. These procedures should only be performed by a professional trained in acupuncture.
Another practitioner that some women are drawn to for help turning their breech babies is a chiropractor. There is an adjustment called the Webster’s technique, which ensures correct alignment of the woman’s spine and pelvis. It has been reported to be successful when everything else has failed to work. This too should be performed only by a skilled practitioner.
One of the more interventive, and last methods to try is what is known as external cephalic version. This is done through a series of movements which encourage the breech baby to turn into a head down position. Most practitioners recommend turning a breech baby before thirty six weeks. This can be done by a midwife in the home or a woman can schedule an ECV in the hospital and even receive muscle relaxants to help a woman not tense up during the procedure. The actual procedure usually takes approximately two or three minutes. The majority of babies are turned easily by this procedure, though few are “stubborn” and remain in the breech position.
Women are highly encouraged to turn their breech babies into a head down, or cephalic position. There remain a few practitioners in Maine (and most US states) who attend breech births. Unfortunately, many women are required to travel long distances, labor in operating rooms, or labor within very limited parameters due to their “high risk” category. However, some babies are not successfully able to turn into a cephalic presentation. In these cases, each mother must find the point where she accepts that the baby’s intention is to remain in a breech presentation. Each woman will reach her own end point for deciding when that is. Then, she will begin the adventure of finding out where and with whom to give birth to her breech baby.
Donna Broderick, CPM, Doula and Childbirth Educator – Maine, USA
Website: www.morningstarmidwifery.com
Email: dl_broderick@hotmail.com
back to the top
