A childbirth educator and doula wondered why the doctor of a mom she is helping wasn't 100% sure about the signs of a breech baby. He suggested an Ultrasound (sonogram). Was he stretching to find a reason to do an ultrasound (sonogram)? Or is it really that hard to tell?

Keep reading for tips on discerning a breech position and see pictures of palpation. 

Ultrasound is justified if your care will change based upon what was found by an Ultrasound examination. Jane Evans of the United Kingdom raises a unique question around ultrasound and breech. Since babies often cover their faces in response to ultrasound, can an ultrasound exam be the cause of the complication of extended arms (drawing, right). This is a very clever question and could be compared as long as no one is touching the breech baby during the entire birth process, because touch is another cause of extended arms. 

There is another way to tell baby's position, and that is by palpation, or feeling the baby through the abdomen.Palpation is not as reliable as Ultrasound. Not all women are easy to palpate. It takes less skill to interpret an Ultrasound image of a breech baby than palpate the baby's position accurately, especially in women that aren't easy to palpate..

Avoiding Ultrasound imaging during fetal life prevents exposure to sound waves that cavitate fluids in and between the baby's cells. Recent Ultrasound studies, like older studies, suspect that certain childhood diseases are caused by Ultrasound exposure during fetal development.  Finding out that the baby is breech can definitely change birth plans, one way or another.

Breech is often more difficult to tell with palpation (feeling the abdomen with the hands) and other times be easy to tell. Even if the doctor is sure, s/he'll recommend an ultrasound (sonogram) to get hard data to put in the file. Most doctors now recommend a cesarean for a breech baby. So doing an ultrasound will help prevent a cesarean for a head down baby that was thought to be breech. Likewise, a doctor doesn't want to miss an undetected breech only to discover thick meconium emerging from a squeezed bottom once the mom starts pushing.

Here are some pictures of palpation and the drawings done on a Sunday, when baby was breech, and the next day, Monday, when we found out the baby had flipped head down.

 "I had one child, breech vaginally.  I would not let them do an ultrasound so I escaped the knife." -Dr. Lucia Lein, DC about her own birth.

There can be some benefits of a sonogram/ultrasound if the parents desire a vaginal breech birth. A sonogram can locate the placenta, check for head flexion and inform the parents and physician what type of breech it is. Some physicians and midwives could tell these things with their hands, and perhaps, with the help of a fetoscope (stethoscope for pregnancy). Even some ultrasound technicians are not accurate at telling the finer details of fetal position, so parents should ask, if they decide on an ultrasound, to have the baby's position explained to them in detail.

Of interest are:

    * Location of the placenta
    * Amount of head flexion (how much and which way the neck is bent)  * What type of breech position the baby is in

To help tell what position the baby is in, the parents may look at the four breech types.

    1.  Frank, or bottom first with legs extended towards baby's trunk

    2.  Complete, or legs folded so that feet are very close to the buttocks,

    3.  Footling, One or more feet coming into the pelvis first-the bottom is above the brim and the feet are below, at 37 weeks the knees may be bent so that the baby seems to be sitting on the top of the pelvis dipping his feet into the pelvic tunnel.

    and

    4.  Kneeling, both knees are coming first, the feet are folded up behind the baby's thighs.

Location of the heart beat is not a reliable indicator.

Sometimes the heart beat can be heard far from the heart when the physician or midwife uses a doppler. A doppler is a hand held monitor that uses ultrasound (sonogram) to detect the heartbeat. A firm tummy allows the heart rate to be heard a distance away from the baby. So does ample amniotic fluid. Water carries sound.

Belly Map of a Breech Baby

 The drawings here begin with the four quadrants of a Belly Map. A simple circle can be drawn on a piece of paper. Then draw two crossing lines; the lines cross at the navel.

Next, the bumps and wiggles that the mother with a breech might feel are drawn.

 Finally, we see the breech baby drawn in for this Belly Map. This particular breech baby is in the complete breech position. He or she is a bit oblique, not unusual at 32 weeks gestation, but less common, and certainly less favorable at 40 weeks gestation.

Details that will help you think about what you are feeling:

When the feet are folded near the baby's buttocks the pelvis and feet together make a hard ball.

Feeling the folded feet and hips of the baby through the abdominal muscles and uterus can, at times, feel much like a head.

The head however, tilts on the neck when moved by hand. Grasping and tipping the buttocks will move the entire trunk of the baby.

Sometimes the uterus over the fetal head in the fundus (top of uterus) feels warm and tender.

 When the baby is stretching a leg away from his body, the hips will have a cylinder shape emerging from it-the thigh. The head doesn't have a cylinder coming out of it.

There may, at times, be a cylinder shape overlapping the head, when the baby has their arm up. Sometimes fingers can be felt near the face.

Lower in the pelvis, the foot movement of a breech is quite memorable. One mother said, "The baby has made a treadmill of my bladder." Compare that to the Frank breech position the legs are up towards the tummy and chest and there is little movement.

A transverse baby will lay sideways. Nothing will be in the pelvis. Limbs will cross the belly, high or low or right across, depending on how the baby is lying. The limbs might even be towards the back which would make the baby seem less active. The bottom and head will still slide against the mother's abdomen on a regular basis, reassuring everyone with the baby's wellbeing.

When a breech position is suspected using the maternal forward leaning inversion and breech tilt exercise can help the baby flip head down.

 Learn how and why to do the maternal inversion on the Spinning Babies blog at http://spinningbabies.blogspot.com/2007/02/how-to-do-inversion.html

Read more about what to do for a breech baby in pregnancy in  The Timeline for Breech Concerns. For a lot about breech read  About Breech

Click here to go to a YouTube video of a midwife attended, hands off breech birth in water. YouTube Breech birth. I don't know the midwife or the mother. The birth is inspiring. I don't know that I would have had the patience to let the head wait that long for birth, as the body is arching away from baby's chin. Later the baby's body floats back to a better position for chin flexing and the contraction brings the head out suddenly.