When is breech an issue?

This is a timeline of what to do when to help a breech baby move head down.

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.

The more complicated past births were due to fetal position the earlier I suggest starting to get your muscles unwound and your pelvis aligned. If a previous baby remained either breech or posterior until birth, I suggest body work throughout this pregnancy.

 

So, when should I be concerned about a breech position?

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

10-24 Weeks Gestation

This is the time fetal position is generally determined even though the baby’s final position isn’t typically set before 34 weeks gestation. Then how can this be? The body has a habit, so to speak, of how the soft tissues, ligaments, muscles, and alignment of the pelvis and whole body is set. The baby follows this basic pattern.

By adding body balancing now, the baby has an increased chance of ideal positioning for labor at 34 weeks and beyond.

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.

30-34 Weeks Gestation

By 32-34 weeks, chiropractic adjustments are suggested. Read more by clicking the link here.

The best time to flip a breech is now. Oxorn and Foote recommend external version at 34 weeks, but most doctors want to wait for baby’s lungs and suck reflex to be more developed in case the maneuver goes wrong and starts labor or pulls the placenta off the uterine wall.

There is often enough amniotic fluid for an easy flip before 35 weeks.

Inversion

Use of maternal positions that put the mother upside down may help a baby use gravity to flip. Get into the position you want your baby to be in. Head down.

Showing your baby your head down position isn’t the only purpose here, though let’s not rule that out too quickly.
Inversions give a static stretch to uterine ligaments which, when followed by a swing back up to sitting tall over a neutral pelvis helps realign cervical ligaments and may make more room for the baby’s head.

Forward Leaning Inversion

Start with a 30-second to 2 minute Forward Leaning Inversion.

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.

Follow the FLI with the Breech Tilt for 10-20 minutes

Dad's the hero in this "over the top" support to help his mate do a Breech Tilt in the comfort of bed!
Dad’s the hero in this “over the top” support to help his mate do a Breech Tilt in the comfort of bed!

The Breech Tilt, or the Open-Knee Chest

The first allows you to tuck your chin while upside down on a similar slanted surface. Use an ironing board against the couch, for instance.

The second, Open-knee Chest has been studied and shown to help breeches flip. It does, however, extend the mother’s chin.

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).

 

Start now with Professional Body work

Chinese Medicine is Acupuncture and Moxibustion. Both have good statistics for flipping breeches over doing nothing.

Therapeutic Massage

Muscle/fascia attachments at base of skull, respiratory diaphragm, inguinal ligament, hip sockets – oh so many more places than expected! We are whole organisms, not machines with reproductive parts.

Chiropractic

The list includes

  • The sacrum, both vertically (SI joints) and horizontally (for a buckled sacrum)
  • The symphysis pubis
  • The neck (Logan Basic is so helpful)

Neck adjustments do improve pelvic alignment, especially if accompanied by myofascial release. Not all Chiropractors are trained in Myofascial Release.BodyBSimilar holistic body awareness approaches are gaining in popularity.

Diligent use of maternal position is also more effective now than later in pregnancy, in my opinion.

 

All these techniques are listed in more detail elsewhere on SpinningBabies.com

Follow the links or look in “Flip a Breech”

 

 

Manual External Cephalic Version earlier than later?

A few midwives recommend version (manually turning the breech baby to head down) at 30 –31 weeks. Anne Frye, Author of Holistic Midwifery herself, reported a very low incidence of breech at term when her midwifery group manually rotated babies during this gestational age.

Attempting to turn the baby now is over a month before the medical model of turning breeches. Utmost gentleness must be the protective factor. If forcing a baby to turn harms baby or placenta, the baby is too young to be cared for outside of the Neonatal Intensive Care Unit. Midwives who turn babies now believe there is less chance of hurting a baby and proceed very carefully, stopping at once if there is resistance.

Typically, there is less resistance from the uterus because there is more fluid and the baby is yet small. Body work is suggested before attempting this, especially for first-time moms or women who had a difficult time with their first birth. There are risks to a manual version (manually turning the baby through the abdomen), so the baby should be monitored closely in between each 10-30 degrees of rotation. To monitor at every 10 degrees might take continuous monitoring.

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 may 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.

 Moxibustion has its highest success rate this week.

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.)

External Cephalic Version near the end of pregnancy

You may also agree to go through with a cephalic version (the doctor manually turns the baby head down through your abdominal wall). The baby is in the womb with the cord and placenta and there is a small risk in turning the baby manually. So this maneuver should be done with monitoring, by experienced professionals, in a setting ready for a cesarean if needed.
There is about a 40-50% chance this will be successful. Sometimes the baby moves easily and sometimes the procedure is painful. It varies. I believe who does this matters, styles vary. I also believe ligament tightness would make this more uncomfortable.

I suggest getting chiropractic, myofascial and acupuncture, homeopathy or moxibustion (or all) before and after the version. Financially this may not be possible, I realize. Rebozo sifting daily before hand and just before the proceude would be relaxing and helpful, I believe. 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). Sidelying Release can help the pelvic floor be softer and more balanced to help make room for all the uterine connections to accommodate the baby. Its worth a try to prepare. Follow up with more of the same, as some babies who flip will be more likely to have a hand near their face during birth, be posterior, or need a cesarean anyway, though the version was successful.

38-40 weeks

Sometimes a woman and her caregiver 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.  An external cephalic version may yet succeed.

Having baby flip doing the body balancing activities is still possible. Keep doing the activities listed I’ve heard women report that they did 5-7 Forward Leaning Inversions in one day and do head stands in the pool and Open Knee Chest (see how its really done) and had their baby flip in the last couple weeks of pregnancy.

 

 40-41 Weeks Gestation

Though many breeches are born about 37-39 weeks gestation some will happily go to 41 or even 42 weeks. For a head down baby, 41 weeks and 1 day is a common time for labor to begin on its own. It certainly can be for a breech, too.

If the mother has a tendency to be somewhat overweight, lower energy or has known low thyroid a longer pregnancy may be more likely, based on my observations. But well-nourished and peppy women can also go to a full pregnancy length.

This gives a couple more weeks for baby to mature. Going into labor and then having the cesarean is recommend by Dr. Michel Odent, breech expert from France, when a cesarean is the planned welcome. Going into labor spontaneously is safer for the breech vaginal birth, as well.

Women who are trying to flip their baby often find it necessary to slow down the efforts and come to terms with a breech birth. Even when facing a cesarean, its more nurturing to you and your baby to have time to plan a better cesarean, with skin-to-skin, delayed cord clamping, and breastfeeding on the OR table than to put all your hope into a last minute flip.

Last minute flips do happen, but not as often as cesarean for breech. Give yourself some time to adapt.

 

Postdates with a breech (after your due date)

With a breech, going all the way to 42 weeks may or may not be more of an issue. Some providers will have to end any plans for a vaginal birth by now. Midwifery statutes often limit midwifery care out of the hospital to 37-42 weeks (or 36-43, depending on where you live).

After 42 weeks the baby’s skull bones are setting up more firmly and a vaginal birth is less favorable. I’ve been to a few breech births after 42 weeks gestation and everything went so well. But, I do sometimes wonder why a mom with a breech wasn’t going into labor if she had been getting regular bodywork for weeks now. Could it be her normal time is 42 weeks?

Or, might labor be delayed because of a slow metabolism? 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.

Mom and baby need intelligent and experienced monitoring to rule out issues of post dates that may complicate labor.

 

Inducing a breech

Inducing a breech is not recommended in out of the hospital settings. Even in the hospital, the risk rises. In some areas where breech is common, Pitocin/Syntocin inductions are done with outcomes that are good enough to keep the options open.

We respect the breech and don’t stress the baby, especially in settings where we don’t have the rescue set up to solve a problem such meddling may make.

Induction by herbs is also considered out of scope for breech.

Try body balancing and see if labor begins on its own. That would be a non-invasive, non-manipulating approach.

During Labor

It is a rare possibility that baby flips to head down during labor.
I assisted a midwife who’s laboring mother’s water had released, labor was mild and not picking up so after 24 hours we transferred and found that baby had flipped after the decision to transfer. The doctor thought we’d misdiagnosed, but the mother’s abdomen was so thin we could feel baby’s knuckles and elbow and found the baby in the opposite direction after entering the hospital, too!

If the plan is to have a cesarean once labor begins, call the hospital and alert them of labor immediately. Then head in right away. Breech births can go quite quickly and you want to be where people are ready to help you.

If you plan to have a vaginal birth, don’t delay either getting to your birth location or getting your birth team to you. While it can be totally normal to have a 24 hour breech birth or longer, many breech labors are quite short. Because the softer bottom is first, it may take you by surprise that you are progressing with such little pain. That’s not always true. But don’t base your decision on pain to tell you when to get to the hospital or when to get the midwife or doctor to you!

 

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.