When is breech an issue?

Many home birth midwives suggest interacting with a baby at 30-34 weeks to encourage a head down position (vertex). After 32-34 weeks, chiropractic adjustments are suggested. The later in pregnancy a baby is breech, the more difficult it is for the baby to flip head down. The baby’s size grows in relation to the uterus and there is a smaller percentage of amniotic fluid for the baby to move freely in. Read more by clicking the link here.

When should you be concerned about a breech birth?

Email from Wed, Feb 11, 2009:

…I’m 30 weeks and the baby is what I’d describe as oblique breech – his head is on my right side next to my belly button, his hips/butt are in my pelvis on the lower left side (my left) and his feet are in front of his face. I think he’s facing forward – towards my belly button. I’ve known this for weeks just because his big head is so hard I always bump that spot on accident.

…. my first son was 9 lbs and born posterior, so I’m really hoping this baby is in the ideal position for delivery… so both of these things make me nervous that he won’t move. He has been in this position for a few weeks now. …

Anyway, just wondering if I should worry and what, if anything, I can do to help him move now. My Midwife suggested a Chiropractor that can do some adjustments. I’d like to do the couch inversion too. Would it help for me to walk more? Also, should I sleep more on one side than the other? Thanks for your help! Great site!

Gail’s reply:

Hi….It is common for babies to be breech at 30 weeks. However, now is a good time to take action, not so much that your baby is breech, but because your first baby was OP. You see, a pelvic misalignment and/or round ligament spasms (they often go together) can result in either a breech or a posterior fetal position. So, a breech will often flip to a posterior position and may stay that way unless you resolve the underlying issue.

Maternal positioning is often not enough by itself to correct a posterior fetal position when there is a history of previous posterior or breech babies. While certainly, most breech babies flip head down, it’s beneficial to help correct the symmetry of your uterine ligaments now, while the baby is still small enough to have plenty of room to flip head down once the reason for the previous posterior position is remedied.

See some things a Chiropractor can do for breech and posterior by reading Profession Help.

 

The timeline for breech concerns

Before 30 weeks

Routine good posture with walking and exercise will help most babies be head down as the third trimester gets under way.

A 30-second inversion is good practice for everyone. Unless you have a medical reason not to, please consider the Forward-Leaning Inversion.

If you have a history of a car accident, falls, an uncomfortable pregnancy, hormonal imbalance or a previous breech or posterior baby, then begin the Inversion and body work before pregnancy or in early pregnancy.

Between 30-35 weeks

Use of maternal positions that put the mother upside down can help a baby use gravity to flip. The breech tilt, other inversions or use of an inversion table are all possible options. The Open-Knee Chest extends the mother’s chin and I’ve changed my mind about that position. I like inversion positions that allow the mother to tuck her own chin. Myofascial workers tell me this relaxes her pelvis whereas extending the chin tightens the pelvis. This matches what we know about open-throated vowels sounds in labor (sounding or moaning in labor).

There is often enough amniotic fluid for an easy flip before 35 weeks. Gentle methods used in alternative maternity care will not force the baby. A few midwives recommend version (manually turning the breech baby to head down) at 30 –31 weeks. They find that there is less resistance from the uterus because there is more fluid and the baby is yet small. See my notes on version safety in this section. Body work is suggested for first-time moms or women who had a difficult time with their first birth. If a previous baby remained either breech or posterior until birth, I suggest body work throughout this pregnancy. Diligent use of maternal position is also more effective now than later in pregnancy, in my opinion.

Between 35 and 36 weeks

If you baby is breech during this time your doctor or midwife will begin to talk about how to help baby flip head down and possibly about scheduling a manual version for 36-37 weeks.

Getting body work and having acupuncture or homeopathy will help soften the ligaments and a tense uterus to either help the baby flip spontaneously or to allow more success in an attempt at a version.

36-37 weeks

During this time, you can continue with the suggestions in the “Professional Help” page. Also, an obstetrician may suggest manually flipping the baby to a head down position at this time. (A few midwives will also offer this, perhaps earlier, at 30-34 weeks. But don’t let someone manually flip your baby without using careful monitoring of the baby’s heart beat. Accidents can occur even when their is good intention. The baby must be listened to and the version stopped immediately if the heart rate drops.)

Cephalic Version

You may also agree to go through with a cephalic version (the doctor manually turns the baby head down through your abdominal wall). I suggest getting chiropractic, myofascial and acupuncture, homeopathy or moxibustion (or all) before the version. Financially this may not be possible, I realize. The Forward-Leaning Inversion when done repeatedly and correctly over time may possibly help align the pelvis by correcting the utero-sacral ligament and its pull on the sacrum (one of several benefits of the Forward-leaning Inversion). 

38-40 weeks

Sometimes a woman and her caregivers don’t know the baby is breech until this late. Rarely a baby flips breech this late in pregnancy. It may be the bio-physical ultrasound exam that discovers the baby is breech.

A External Cephalic Version may yet be tried and, depending on the fluid level and the flexibility of the uterus, baby’s head position and location, a uterine septum, where the placenta is, etc. the version may yet succeed.

After the birth

While the concern about breech position is during the birthing, when the baby is breech for most of the third trimester, their skull bones become shaped by the inside of the upper womb (the fundus).  Craniosacral therapy can gently reshape baby’s head, ideally during the month or two after birth, without using force.

Here is a note from a pregnant mother to her yoga teacher who referred her to use the Forward-Leaning Inversion. Doing the inversion helped bring the baby’s bottom out of the pelvis and the doctor was able to flip the baby manually:

Hey Jenni!

Just wanted to thank you again for all of your support and insight –

And to let you know that we had the version yesterday at the hospital and it worked!!!  We are so excited – and the procedure was really not that bad at all…

Just wanted to share the good news.

If the doctor can’t get the baby head down by doing a cephalic version, a cesarean may be scheduled.

Some women will seek help for a vaginal birth. One of the factors in assessing the safety of breech vaginal birth is a baby that is born between 32 and 40 weeks. Of course, before 36 weeks the baby is too premature to be born other than at a hospital with a special care nursery.

 

Postdates with a breech (after your due date)

By 41 weeks the baby’s skull bones are setting up more firmly and a vaginal birth is less favorable. Besides, I would wonder why a mom with a breech wasn’t going into labor if she had been getting regular bodywork for weeks now.

After 41 weeks

For a head down baby, 41 weeks and 1 day is a common time for labor to begin on its own. With a breech, going all the way to 42 weeks may or may not be more of an issue. In a mother who has birthed before in a straight-forward manner, a vaginal breech birth may still be safe. For a mother with a “sloshy” metabolism, I am inclined to transfer care to a kind hospital provider at about 41 1/2 weeks. This is the mom who is a little overweight, slow metabolism, with little get-up-and-go. This might be a classic, low-thyroid body type. On the other hand, many of the women who birth spontaneously have a classic lean look, does this indicate good or even hyper thyroid function? It would be interesting to know.