Flip A Breech

How can you help your breech baby turn head down?

Here are self-care exercises and explanations of how a professional might help if baby is still breech after 30 or 32 weeks gestation. Combine this list with those on the Daily Activities page for the most comprehensive approach. As you expand your options, you increase the chance baby will flip head down.

Your midwife or doctor may also have advice.

Please work with an experienced midwife or doctor whose hands know your belly and your situation. Together you can find a way that empowers you for a safe resolution.  You may print this page and give a copy to your doctor, midwife and chiropractor for discussion. Ask your doctor if there is a medical reason you couldn’t try some of these suggestions.

Is one or both of your twins breech? Also, check out my article on Twins.

Things to keep in mind:

  • Trust your baby; trust your body
  • Breech fetal position is normal before 30 weeks and often OK at 32 weeks
  • You can begin general balancing activities without knowing fetal position (but not Breech Tilt and Open-Knee-Chest without knowing baby is breech!)
  • Put yourself in the position you want your baby to be in! Head down!
  • Share your plan with your caregiver before you begin
  • When your womb is in balance, the baby is likely to flip head down spontaneously
  • If the baby is still breech at 37 weeks or later, you may get medical advice to have a external cephalic version (ECV)
  • Doing balancing activities before the ECV might help it be more successful
  • Talk to your baby, heart to heart, and tell your baby what you want – and ask your baby what she/he needs in this situation, too.

Specific activities to try:

These are the things I’m currently recommending but there are more on the web and in practice around the world that I could add to this list. My feeling is to do more rather than fewer. Don’t stress about them, but create a new rhythm of balance and balancing techniques to do often, 3-4 times a day after 34 weeks.

NOTE: These exercises may not work:

  • When breech runs in the family
  • When the womb has a septum or unusual shape
  • When the baby is wrapped in a particular way by the cord
  • When the other twin blocks the flipping movement of the breech twin
  • When the torsion that may be causing the reduced space in the lower uterine segment was not overcome or corrected by the woman’s selected activities
  • When the torsion that may be causing the reduced space in the lower uterine segment was not corrected by the bodyworker’s selected techniques

Whether or not the exercises work is not an indication of whether the vaginal breech birth will go smoothly or not. In other words, having found these exercises not to work may increase emotional stress about having a breech birth. Regardless, do not judge the safety of a breech birth by the fact baby didn’t turn. You have other indicators of whether breech birth or breech delivery might be safe for you. See some of the articles in Breech Birth for Providers.

If a term breech mom is considering trying the techniques but worries about doing them alone, how frequently to do them, and how to tell if baby flips, I suggest going carefully and using help to get into the Forward-Leaning Inversion and the Breech Tilt, until feeling secure. Do this 3-4 times a day at 37+ weeks. Add body work such as craniosacral release with myofascial release, chiropractic, Maya Massage; all with practitioners who the community recognizes as those to go to in pregnancy (It’s important that the practitioner not only see pregnant women, but that they see dozens/hundreds of them). Walk long and briskly every day. You might tell if the breech flips by feeling feet kick where the head had been before.

In summary, inversions are effective as long as there is enough amniotic fluid and uterine ligaments are not super tight. If the ligaments are that tight, professional bodywork can release them and give the baby a more flexible home to move around in. If the ligaments are too loose, wearing a pregnancy belt can give your lower belly the slope baby needs to correct their position. When the baby flips, you may or may not notice the baby flipping.

 

Forward-Leaning Inversion

We want to let the lower uterine segment (the lower, narrower part of the pear-shaped uterus) expand to make room for baby’s head. Do the Forward-Leaning Inversion for 30 seconds first and follow up with the Breech Tilt. They achieve different goals, so both are indicated.

Tuck your chin, which will release the tension in your fascia that could keep the baby from going head down.

Inversions for 30 seconds can be done by all pregnant women (See Forward-Leaning Inversion to learn about when NOT to do it). Repeating the Forward-Leaning Inversion frequently is better than doing it fewer and for longer periods of time (Start out with fewer seconds if it’s hard). You will find this position more comfortable with repeated use.

Two of the benefits of either the Forward-Leaning Inversion or the Breech Tilt are:

  1. Helping the baby stay out of the pelvis, and
  2. Helping the baby to tuck his or her chin so that baby is able to make the flip.

In a steep Forward-Leaning Inversion, the mother’s neck is free to move, helping the fascia over the pelvis be more free to move.

What about the yoga position called Down Dog?

I do think that Downward Dog and the Forward-Leaning Inversion are different and accomplish different things. Both are good, but I think the Forward-Leaning Inversion is better for releasing torsion in the uterosacral ligament when the uterus hangs freely from this posterior ligament. Down Dog, especially with straight knees, doesn’t allow for the fascia to reposition itself on the sacrum, nor does down dog let the uterus hang freely.

Down Dog just doesn’t seem specific to fetal repositioning. But let me know what you are finding! If you see a pattern that Down Dog is helping fetal position, share it. We all want to know!

After the baby flips

If your baby was breech and is now head down you can stop the inversions for a few days. Now walk briskly for a mile, or more, every day for three days.

What if I think my breech baby has flipped head down but I’m not sure?

If you think the baby may have flipped head down, but you aren’t sure, you can either cease doing inversions until you know for sure, or simply hold the Forward-Leaning Inversion position for only 30 seconds, or 3 long breaths.

If baby is head down, will baby flip breech if I do a Forward-Leaning Inversion?

It is super unlikely that your baby will flip breech, if you keep your Forward-Leaning Inversion short and do it only once a day. Don’t do the Breech Tilt if you think baby may have gotten head down.

If you have a lot of amniotic fluid around your baby, so that a doctor needs to see you often, you should do other balancing activities like the Sidelying Release. Whether the baby flips on their own, or with the help of an experienced midwife or doctor, the newly head-down baby is often in the right occiput posterior position. A daily Forward-leaning Inversion can continue to help the baby get into an even better position for the start of labor. Remember, head down is only half the story!

 

Breech Tilt

The Breech Tilt is well known.

We want to let the baby’s head flex, so the baby can put his/her chin on his/her chest. This is called flexion. Flexion is the first step before flipping. Just like the gymnast, the baby tuck’s his/her chin before rolling.

Get a broad plank of wood, like an ironing board. Prop it at an angle against the couch or a chair. A few pillows stuffed around the base will help prevent tipping. Another pillow goes under your neck. Next, lie on the board with your head down and feet resting on either side of the board on the couch. Try it a couple times to get it right.

Remain on the board for up to 20 minutes, 3 times a day.

After you’ve got this down and you can relax inverted like this, put a bag of frozen veggies, wrapped in a thin towel, behind baby’s head, and a very warm “hot pack” in front of the baby near your pubic bone. Put the warm pack on the same side of your belly as the baby’s hands and feet are on, but close to your pubic bone.

Other times, place a paper towel tube in the same spot and have family members speak through it or play Beethoven. When you think or know your baby is head down, walk a good long walk each day for a couple days.

Integrate your Breech Tilt and other activities with the Daily Activities for an Optimal Fetal Position.

Can you get in a deep, warm pool and stand on your head?

Repeat a few times in the pool.

Loose ligaments are supported by wearing a pregnancy belt. Baby can get angled in a way that gives baby a better advantage to improve fetal positioning.

 

Open-Knee Chest

Some sources suggest Open-Knee-Chest for breech, but I don’t think it is as effective without the other inversions. The mother’s neck is restricted from movement which in turn restricts the fascia at the pelvis from free mobility. This technique promotes rotation and progress for a posterior or asynclitic baby in labor. This may work, but try the others, too. A friend of mine did this for two hours and then plopped over on her bed to sleep. Her baby flipped right then.

 

Moxibustion

At 34-35 weeks, Moxibustion has been shown to be very helpful for flipping a breech. You can do moxibustion at other weeks gestation also, but the studies that showed the most success were done during the 34th week. Moxibustion is also helpful for rotating a posterior baby towards the anterior. The mugwort herb in the sticks makes a lot of smoke. You can do this outside or buy “smokeless” moxa.

Let’s do some gentle things to help baby be head down before labor! Maternal positioning, journaling, emotional exploration and using professionals to help with pelvic adjustments, abdominal and sacral releases, homeopathy, acupressure and acupuncture, hypnosis and moxibustion have been show to be effective.

 

Standing Sacral Release

This “releases” the sacrum, the triangle bone between your spine and your tailbone (considered part of the spine).

The pressure of the helpers hands is almost anti-pressure! Go get a medium-sized coin (such as a nickel) and feel the weight of it. When you are applying pressure on the mother’s sacrum, don’t press any more than the weight of the coin in your hand.

If your ligaments are loose it may be wild to see and funny to feel. If your ligaments are tight it may be uncomfortable and may cause a few contractions (check contractions out with your midwife/doctor if you get 6 in one hour, especially if you are less than 37 weeks). If you are asleep the movements may wake you, but usually they don’t wake you. Work closely with your doctor and midwife to monitor the baby.

 

How to tell when baby flips

You may notice a difference in where you feel kicking after baby flips. USUALLY, the strongest kicks are from the legs not the arms, and will be high in the womb when the head is low. An anterior placenta (one that is in the front of the womb) can block the baby’s limb movement and confuse people who are trying to tell the baby’s position. More often, a mother will notice a difference in how she is carrying the baby.

Notice where your baby is kicking. If that is quite different, and is now strong at the top of your womb, you may want to stop measures to flip baby. If the same, you may want to continue your Breech Tilt or inversion until you can get the midwife or doctor to verify the position. Once head down, take a mile long, brisk walk each day to get the head into your pelvis.

This technique might be done by a professional or by a friend who has been shown what to do.

 

Professional Help for Flipping a Breech Baby

Professional help may include:

  • Chiropractic Webster Maneuver
  • Chiropractic Adjustment
  • Homeopathy
  • Acupuncture
  • Myofascial
  • Craniosacral
  • Maya Massage
  • Hypnosis

Many chiropractors can loosen the ligaments by doing the Webster Technique.

Adjusting the sacrum, for both a vertical twist or a buckled (horizontal wrinkle) sacrum will let the baby put their head down more readily because the bones won’t be in the way.

Here is a YouTube video showing the Chiropractic Webster Maneuver for resolving a breech position:

Chiropractor adjustments could include:

  • The sacral ala is corrected vertically (SI joints) from any twist,
  • The sacrum is checked for a buckle (wrinkle) that a sacral release will undo (below)
  • The pubis symphysis is adjusted
  • Any other alignment necessary, such as the neck and jaw, to help the pelvis and SI joints stabilize.

Homeopathy

Seek a homeopath to select the right remedy and the right dose for you and to monitor for side effects, if any.

Acupuncture

Look for experience and high-level education. There are simple points that might work for some, given by the certified. Other women will need someone with advanced skills. This is another way towards balance. The thyroid can be helped through this modality, too.

Myofascial Release

Muscles and fascia are released in this technique. Depending on the background and style of the practitioner, this may be subtle, gentle or vigorous and rough. You can seek out what works best for you. The Standing Sacral Release described above is an example.

Craniosacral Therapy

This is a very gentle and subtle “release” of the fascia supporting the skull and pelvis. Again, when the mother is in balance the baby will move into the most ideal position possible.

Maya Massage

Traditionally, the Central American Maya midwives give pregnant women a massage and do sifting with the Rebozo (Manteado y Sabada) every 15 days in pregnancy. The abdomen is wrapped with a long, thin strip of linen to support the lower abdominal wall when walking and traveling about. Breech was extremely rare when Anthropologist Brigitte Jordan was interviewing midwives there in the last century.

Hypnosis

Hypnosis has been useful for many women to help flip their breech baby to head down.

Phyllis Klaus, one of the founders of DONA International doula organization has used hypnosis to help women figure out why or what happened that their babies went breech. This starts the release that often leads to the baby flipping.

A Hypnobabies member shares the benefits of Hypnobabies hypnosis for fetal positioning at InexplicableWays.com.

Kerry Tuschhoff, developer of Hypnobabies, has a MP3 download, Turn Your Breech Baby, Yes, You Can on her site. Here’s what she says:

Hypnosis is excellent for turning a breech, since the baby is registered by the inner mind as part of the mother! In this deep hypnosis Turn Your Breech Baby audio track, you are allowed to relax the muscles and any constriction all around your baby and use effective hypnotic suggestions for turning baby to the vertex, (head down) position, if that is the safest way for baby to be positioned. Baby will let you know! Excellent for midwives to keep for their home birth and birth center mothers, as well as *anyone* whose baby has turned to Breech presentation in late pregnancy or labor.

Carole Thorpe [from Hypnobabies] adds:

…Since the baby and the mother’s physiology, hormones and brain chemicals are so intimately connected during gestation, what impacts the mother impacts her baby.

It is not a huge leap to think that a mother’s emotional state could impact the baby’s positioning. The verbal and non-verbal communication between a mother and her care provider impact the mother’s beliefs about herself and her abilities, impacts her emotions, brain chemicals and physiology and absolutely can impact her physical circumstances. The mind-body connection has everything to do with how a mother and her baby travel through childbirth.

Babies feel what their mothers feel…experience the emotions she experiences because they get a ‘dose’ of her hormones and brain chemicals while being bathed in the amniotic fluid she replenishes every 3 hours. This is what APPPAH researches and teaches about and it’s fascinating (http://birthpsychology.com/).

An example of how the mother’s thoughts…emotions and brain chemicals and hormones can be affected through hypnotic suggestion/positive, encouraging words to change a breech babies lie, here’s a study:

“Hypnotherapy [suggestions/words that impact a mother’s mental and emotional state] may help pregnant women turn their breech baby around to the normal head-first, or vertex, position. A researcher at the University of Vermont, Burlington, used hypnosis with one hundred pregnant women whose fetuses were in the breech (feet-first) position between the thirty-seventh and fortieth week of gestation.

The intervention group received hypnosis with suggestions for general relaxation and release of fear and anxiety. While under hypnosis, the women were also asked why their baby was in the breech position.

The study, which appeared in the Archives of Family Medicine, reported that 81 percent of the fetuses in the hypnosis group moved to the vertex position, compared with 48 percent of the control group. Not surprisingly, hypnosis was most effective for the women motivated to use the technique.” [Natural Health magazine, November-December 1995]

These techniques work for most babies, but not all. Some women will choose an external cephalic version (ECV). Babies death rate from ECV makes it a technique that should be done only by skilled practitioners (for whom that rate is taken from) who know how to listen to babies before, during and after. Again, trust your gut to whether this is a choice you want to take. It can be an easy and simple procedure or, rarely, it can be heartbreaking.

Thanks, Carole!

 

If baby doesn’t flip

Balancing techniques could help a vaginal breech birth go more smoothly. Always use physiologic breech birth practices (Knee-elbow or hands-and-knees maternal position, hands-off the breech, natural childbirth).

Otherwise, a cesarean after labor begins gives the baby a bit of labor hormones to help transition into life outside the womb. Discuss these options with your midwife or doctor. There is currently better data in obstetrics to support physiological breech vaginal birth.

Please go over all the recommendations including body work. Consider that another week of healthy gestation, to 40 weeks, has nothing but benefits for your baby. If you or baby are not healthy or if there is a prolapsed cord, you need medical help. But a prolapse cord is a different issue with a breech than a head-down baby and getting bottoms up and riding to the hospital is likely to lead to an excellent outcome.

Keep reading, keep balancing and keep talking about what is beneficial for you and your baby with your provider.

 

True Story: “I just found out my baby is breech.”

I received this email from a woman who found out her baby is breech. You can read my response to her below. Her story:

I recently found out my baby is breech.  This is a 2nd baby.  My first was a very calm baby and was always head down.  This one is QUITE active and apparently flipped in the 4 days between my midwife appointment and an ultrasound (they thought my placenta was low… it’s ok).

I exercise 3-5 times a week.  I eat well and am in good shape.  I am seeing a chiropractor …   Initially, saw her for “shifty hips” that would pop out of joint… hasn’t happened since.

My only pregnancy problem (with both) is uterine irritability… I’ve tried cramp bark tea for this but usually the only solution is to sit down.  If I don’t nip it in the bud, it progresses to quite strong contractions where I vomit.  My uterus is often quite tight for hours on end when I am walking around or at work (I’m a nurse).  I was much worse with my son (they kept thinking it was preterm labor but my cervix never opened).  Of note, he was a very quick and easy labor/ birth (less than 4 hours)– maybe from all the uterine toning?

Here’s my questions:

  1. The Chiropractor did a Webster Maneuver once; usually she is cracking my back and neck and hips and such.  Should she be doing Webster every week?  What should I be expecting from her?  I’ve never seen a Chiro before.  I haven’t seen her yet since the baby flipped.
  2. How does my uterine irritability play into all this?  My midwife said I had very good abdominal tone also.  Is this hurting things?
  3. I’m being more diligent about my posture now and I’ll start some tilts/ inversions (already doing pelvic rocks).  I’ll see if my husband can try the Rebozo sifting on me– would a Maya wrap sling work OK for a scarf?
  4. I plan a homebirth/ waterbirth with a CNM.  I know she won’t do breech births at home.  I’d be willing to give it a go if there was a practitioner.  My mom and grandma were both easy birthers and I’m shaped like my grandma who popped 10 kids out on the farm :)
  5. Any other thoughts/ suggestions?  Thank you so much for your time!  I better go do my pelvic rocks– the baby is dancing around in there!

 

Gail’s reply:

“Your contraction symptoms and baby’s breech position seem to match the picture of asymmetrical ligaments.

The Webster Maneuver would help the round ligaments.

  • The Inversion will help the cervical ligaments first and then help the broad and round somewhat.
  • Pelvic adjustment releases any possible pulls on the ligaments supporting the womb from even a slight misalignment of the pelvic joints.
  • Get the abdomen ligaments relaxed and then supported. A pregnancy belt may help the looseness that makes it hard for the baby to have a toned slope to settle head down on.
  • When a baby is breech the first action is to relax a twist in the womb using the above methods.
Question 1) The Chiropractor may have to adjust the pelvis in three ways.

Suggest your chiropractor check:

  • The sacrum vertically (SI joints) for a twist at the ala,
  • The sacrum horizontally for a buckle (wrinkle) that a sacral release will undo
  • The pubis symphysis.

The Webster Maneuver is a gentle press on the round ligaments in a specific direction to soften the ligament. It takes a just a few moments and will soften a cramp, spasm or even “good tone” to allow the baby to flip past the ligaments into a head-down position. Releasing a kink or tightness in the round ligaments also helps the uterus become more symmetrical, which also helps baby into an ideal starting position for labor.

The Webster can be done repeatedly, weekly or bi-weekly if in the last month or two. It is one step in helping a breech baby flip. Sometimes it is the only step needed, especially if repeated about 3-4 times. But sometimes you need more body work or self care to flip a breech baby.

Question 2) Pelvic alignment and ligament release will help uterine irritability, especially getting the sacrum “unbuckled”.

After a sacral release, you may wear a belt as much as possible to support a loose abdominal wall. There are other ways to help uterine “irritability” as well (scroll down on this page!). Good tone may be good tone or too tight a broad ligament. We use that phrase a little loosely in our desire to say positive things, and in ignorance of the myofascial clues among those of us untrained in this type of bodywork. It would take training to tell the difference, I think. A tight broad ligament often goes along with an asymmetry in the round ligaments. Releasing it helps the baby turn past it.

Carol Phillips, DC, my link to the myofascial world, says that premature contractions are often solved by a sacral release (standing sacral release). The moms that I have referred to have this type of bodywork done have found it to work. I also suggest a high protein, whole foods diet with plenty of leafy greens, yellow veggies, Omega 3s, liquids and salt-to-taste (Brewer Diet and then some).

Question 3) Posture, Inversions, Rebozo.

Using the Rest Smart positions will be helpful, of course. But probably not enough to help baby flip on his or her own after 32-34 weeks. But you have a clear idea of several things you yourself can do, and the body work that will help.

Continue with the Inversion. I suggest the method of getting upside down shown in the inversion video on my blog.

A sling for a Rebozo helps relax the broad ligament if you can relax your belly into it like a hammock and your partner can lift the weight of the baby off your spine without scrunching the baby into your spine. And then start slowly to do short jiggles until your involuntary muscles can relax. About 3 minutes. Repeat daily as possible. Using a sling, sheet or any long, broad woven material can be substituted for a Rebozo.

Question 4) Finding an attendant for a vaginal breech birth.

Your clarity on your ability to birth a breech baby is one of several aspects of safety for breech vaginal birth. Important physical assessment will help determine if a vaginal breech birth might be safe in your situation. Searching out an experienced midwife or physician in breech birth is a challenge, but a necessary one if you decide to have your baby naturally at home or in the hospital.

You will have to ask at midwifery circles, homebirth support groups, cesarean prevention groups, and teaching hospitals for referrals. Having an experienced person reduces the risk to breech birth but doesn’t eliminate the risk, of course. Finding someone who can sit on their hands for the first half of the birth is a good start.

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.

Question 5) Besides Chiropractic and Myofascial care for uterine “irritability” I suggest:
  • 3-4 cups of bulk red raspberry leaf tea daily. If you don’t have sensitivities to dried herbs, that is. The bags of RRL are too old and lack oil. The bulk herb is more effective, go to a co-op, though, for “fresher” dried herbs. Use 2 TBSP in a wire mesh strainer and fill a quart jar with ALMOST boiling water to steep for 5-6 minutes only. Remove herb and drink hot or cold, straight or with a splash of apple juice, or other herbal teas (There’s no caffeine in bulk RRL).
  • Eat plenty of protein, but watch the peanut butter! It’s hard for a pregnant liver to process.
  • Drinking a total of 3 quarts or more is almost always necessary for pregnant women’s health.
  • Check for a calcium magnesium supplement that is easy to absorb.
  • Wear a snug pregnancy belt.

If your baby isn’t head down and you are later than 32 weeks, you may like to try the methods you can use at home, the Rebozo, the Inversion as well as the Rest Smart positions in Pregnancy Posture.

Some mothers wait to try these techniques until they are 34 weeks. They still may work that late if you have plenty of amniotic fluid. Talk to your midwife about these suggestions to help your baby flip.

You are doing everything right.

Its just a matter of finding what your womb needs for your baby to flip, or to find what your baby is telling us if he/she can’t flip.”