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Window of Opportunity for Flipping a Breech

What we do to help our breech babies flip is limited by assumptions as much as by knowledge. Assuming that the External Cephalic Version (ECV) or a few techniques late in pregnancy will flip the baby may reduce a baby’s chance at a vaginal birth. Here’s a frank discussion that Gail had with a mother writing in about her situation and plans.

Please know that all women are respected in their choices. There is not one right choice and not one way to go about it. The spectrum of ease idea that some women will find good fetal positioning easy to achieve and others work hard for it applies to breech fetal position as well as posterior. This discussion reflects what might be said as the current thought about flipping breeches comes to Gail’s perspective.

A new way of thinking about why babies might be breech and what might help them flip emerges through the emails.

A first-time mother wrote:

Hi Gail,

I am currently 35 weeks and found out at 31 wks baby was frank breech. I have been doing the exercises religiously (spent an hour last night in breech tilt), going to chiropractor 3x per wk., trying pulsatilla today, and will be open to ecv if she hasn’t flipped by 37/38 weeks. I know of one doctor at the hospital I am currently going to Has performed vaginal breech births so I see him Tuesday and am going to plead and beg him if all else fails.

Can you give me any names of doctors or midwives?

Dear [Name withheld for privacy],

There are a few doctors in the Twin Cities that I know of and a few homebirth midwives [skilled in breech birth].

The doctors may not be very forthcoming over their willingness as they will have to chart their recommendation for a cesarean. If you are willing to negotiate and hold your own, you may be able to find help in a couple hospitals with a couple doctors if they are on call at the time of your labor. [Names of doctors or midwives are not shared here due to the professional political pressure on them for attending breech births. Doctors frequently lose hospital priveledges, midwives may be sued.]

Bless your heart. How far along are you? Let me know if I can help more…

What this mom wrote next:

Thanks so much for the information. I am going to have my doctor attempt an External Cephalic Version (ECV) if nothing works by 37 weeks. Is that the type of body work you [speak of in Flip a Breech]? I spent another hour today in the breech tilt position after taking Pulsatilla [Pulsitilla is a homeopathic remedy. Please see a skilled practitioner to get the right dose for flipping a breech and don’t take it day after day]. I am beginning to believe she may be stuck in the frank breech position. I plan on trying the moxibustion this weekend.Thanks again for your help and advice:-)

Gail replies (with edits for better organization and for the mother’s privacy on the website):

Few doctors in America have the skills for vaginal breech, though similar manevuers are used to extract the breech baby through the surgical opening during a cesarean. [Studies show that skilled physicians can deliver breeches safely . See the PROMODA study, for instance. The conclusion that all breeches should be delivered by surgery by the Hannah Term Breech study of 2000 was disproven quickly after its publication, but as cesarean is quite profitable and breech skills lacking, American physicians and midwives may still quote the study to this day.]

Gail w Sophie doll

Few breech-skilled doctors can openly admit their willingness to catch a spontaneously and naturally birthing breech baby.

So, please don’t ask the receptionist to schedule your appointment to talk to the doctor about a natural birth of your breech baby! You may be told no and refused an appointment. Just get into the office with the doctor before bringing the topic of breech up. This will protect you both from the ignorance and pressures surrounding breech birthing.

Midwives would be home birth midwives, since hospital midwives are not given priveledges to catch breeches, in spite of the tradition of midwives and breech birth. Modern medical practices are not supporting traditional customs for fear of litigation and possibly there is some hierarchical pecking order issues as well. Since doctors are not catching breeches why would they make room for midwives to do so in their facilities.

Baily and Penny 1 month
Choosing a homebirth for a breech baby brings up another set of considerations. Your health and the baby’s health should be quite good and other risk factors low. The midwife should have a full training in what to do if the baby becomes stuck on a diameter of the pelvis to rotate the baby off that diameter. Doctors, of course, need this training, too, if you have a doctor at your birth in or out of the hospital.

Just because a provider has attended breech births doesn’t mean they know this, so ask what their experience with a stuck breech is and have them show you the technique for unstucking a breech. It can be quite simple if they know how to keep it simple. But if they don’t know what’s causing the hold up it can be tragic.

Simple or tragic; precise training makes all the difference for having a happy birth.

Moxibustion has the best results when used daily or twice daily around week 35. See more at our Flip A Breech page.

In an External Cephalic Version, what the provider does is try to push the baby around to a head down position.If the muscles are tight that hold the baby breech, the doctor or midwife must push the baby into those tight muscles. This may explain why ECV is about 50% successful.

Body balancing style bodywork helps address the muscles that may be tight or twisted to let the baby move herself around. A baby being stuck in a breech or posterior position is a reflection of the surrounding muscles, fascia, and ligaments. This can be changed. Some portion of the room may being taken up by the placenta. But imagine that if the “walls” of the womb that the placenta is snuggled against were more flexible then the baby could scoot past by the pull of gravity alone. You see? Balance first.

 

May I speak very frank with you? (Hope you can smile at the pun.) You have a short time to address perhaps a lifetime of body mechanics. You are choosing to do a couple basic techniques and see what happens. A few basic techniques sometimes works. Doing a lot of techniques may not always work either but gives you a chance to address more muscular or pelvic alignment causes.

 

If gravity were the only issue, I think you’d have a head down baby by now. There may be what I call soft tissue issues. Think of a window of opportunity. How wide do you want to open your opportunity for baby to have room to settle head down? A year from now you will want to look back and know that you did what you felt was your fullest. This is strong talk but it is for your full understanding.

Help baby have room to bend her knees. The breech tilt is ok by itself, but if the available space is tight or twisted the baby can’t use the gravity to reposition. More techniques will be necessary.  If baby has very straight legs, tickle where you think the inside of her knees are so that she can bend her legs. Also making the broad ligament soften will make the “walls” around baby more supple and easier to move within.

Balance before Gravity. This means, address the soft tissues before expecting gravity to work for you. If going upside down works in 3-4 tries, then you had the room.  If not, make the room.

You may feel that this is a lot to do and focus on. You get to choose how wide to open the window. Staying calm and relaxed may be easier by choosing a soothing attitude about your efforts.

Enjoy this adventure as something you and your baby are doing together. Talk to your baby. Talk to your inner mystical mama self as if talking to another person. Ask her what her message is in this breech experience. What’s ok for her (you) to do or not to do; to have and to not have (as far as interventions). I suggest making peace with a cesarean so that your stress level can come down and you can be present with the now and not tense against the future. I also suggest making peace with a vaginal breech birth for the same reasons, so there isn’t a shut door to any future. This is a walk you are on in modern times. You wouldn’t have to have worried about this in 1969, but today you are in a phase of surgery for all breech births unless you really are peaceful in affirming your breech birth.

 

See Coalition for Breech birth on Facebook. I support you in what ever you choose to do.

 

Much hope!

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