My Baby is Breech! Does That Mean a Guaranteed C-Section?

I went to Buy Buy Baby yesterday to return a $180 Motorola baby monitor.

Why, you ask? Because Sunday, during his first nap, Liam got on his knees, in his crib, and knocked his i-Baby monitor off the shelf. Just like that, it stopped working. Broken. I spent a good half hour lowering his crib and the rest of the afternoon at Buy Buy Baby looking for a new monitor.

Update: Surprise! The i-Baby decided to come back to life on Monday morning. Hence why I was at Buy Buy Baby yesterday, returning the brand new monitor. Serious #MomProbs.

I waited in the customer service line behind a woman who seemed to be about 8 and a half months pregnant, her belly round as a cantaloupe. She was visibly uncomfortable, massaging her lower back with her palms.

“Well,” I overheard her sigh into her cell phone. “Turns out the baby is breech. We’re seeing our doctor next week to schedule a C-Section.”

Screen Shot 2016-04-07 at 11.28.47 AM.pngI didn’t say anything because once she hung up the phone she got called over by the cashier, but I wished that I could’ve told her about Spinning Babies, a site I spent a lot of time on as Liam’s due date got close.

Although Liam wasn’t a breech baby, he did settle in a Right Occiput Transverse (ROT) position around 35 weeks. Babies in ROT position are usually referred to as “posterior” because they usually end up rotating to the posterior as labor proceeds.

Yes, posterior labor means it hurts like hell and lasts a lot longer than the average labor. Good times. 

Getting back to breech babies, though…

Every time a pregnant woman hears the word “breech” (me included), the first thing that comes to mind is : 

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But really, breech is just a variation of “normal”. It does not necessarily guarantee a cesarean birth. It’s important to know that not all head-down babies have easy births and not all breeches are difficult. Turns out that most breeches have smooth births when birth is spontaneous (more on that later!)

Breech can mean a lot of things:

Breech.jpg

(Frank Breech tends to be the most favorable for vaginal birth.)

Aside for these three positions, healthcare providers may even chart a baby in an oblique (when the head is in the mother’s hip, diagonally) or transverse (horizontal lie) with the label “breech”.

According to Spinning Babies, most babies are breech during the month before 30 weeks. Breech doesn’t become an issue until 32-34 weeks, and many midwives suggest interacting with a baby at 30-34 weeks to encourage a head-down position.

  • Before 24-26 weeks most babies lie diagonal or sideways in the Transverse Lie position.
  • Between 24-29 weeks most babies turn vertical and some will be breech.
  • By 30-32 weeks most babies flip head down and bottom up.
  • By 34 weeks pregnant, the provider expects baby to be head down.
  • Between 36-37 weeks, a provider may suggest a external cephalic version.
  • About 3-4% of full term babies are breech; term is from 37-42 weeks gestation. 

If your baby turns out to be breech past the 30 week mark, I suggest watching this film by Dr. Elliot Berlin, about various mothers’ emotional responses to finding out they are carrying breech babies. I watched the trailer and am sure that if I was expecting a breech baby, I would want to be a part of this conversation somehow.

The site BirthWithoutFear.com also mentions a book called  Emergency Childbirth (by Gregory J. White) which may be helpful to mamas expecting breech babies.

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Breech births occur in approximately 1 out of 25 full-term births, usually due to one of the following reasons:

  • The baby may be born earlier than full term and hasn’t had time to turn head down.
  • Most babies are breech due to uterine ligaments and muscles being either too tight and asymmetrical (twisted or torqued) or too loose.
  • Imbalance (asymmetry) in the mother’s pelvis or soft tissues (due to crossing legs often, sports injuries, carrying a toddler on hip, etc…)
  • Two studies show that more mothers of breech babies have low thyroid function compared to all women who don’t have a breech baby at time of birth. This may show a metabolic connection to fetal position.
  • A low lying placenta blocks the room for the head.
  • The cord is wrapped around the baby.
  • The first time mom has a tight abdomen, super strong core, less water.
  • The mom whose birthed about 5 or more times, has a loose womb and baby isn’t prompted to turn head down by muscle tone.
  • About 1 in ten breech babies has a mild or major physical difference reducing their ability to turn head down. For instance, some Down’s Syndrome babies will be breech.
  • The SI joints or the symphysis pubis may be out of alignment.

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External version is a non-surgical technique to move the baby in the uterus. In this procedure, a medication is given to relax the uterus. An ultrasound is usually done to determine the position of the baby, the location of the placenta, and the amount of amniotic fluid in the uterus. Although usually successful, this procedure is recommended early — it tends to become more difficult as the due date approaches.

Chiropractors can loosen ligaments by doing the Webster Technique. Aligning the pelvis and relaxing tight uterine ligaments is why chiropractic adjustments often help breech babies flip to a head-down position.

These are some other things to try before calling it quits:

Turning_a_Breech

Specific activities to try (according to Spinning Babies) :

Forward-Leaning Inversion five-seven times a day for 30 seconds each

-Follow the above with a Breech Tilt or Open Knee-Chest (not knee chest, see the description)

Sidelying Release on both sides for several minutes each side.

Moxibustion (especially between 34-36 weeks) 2x a day

-Stand on your head in a swimming pool (deep enough to cover your belly)

-Chiropractic Webster Maneuver with pubic symphysis aligning

-Maya massage and Rebozo Sifting

-Forward Leaning Inversion is to stretch and lengthen the utero-sacral ligaments and it is in coming back up to sit on the heels that the technique gives more room in the lower uterine segment. 30 seconds repeated about 5 times a day for 3 days may give great results. See reasons why you wouldn’t do this on the Forward Leaning Inversion page. Photo by Keidi Lin Photography

Psoas Resolution

-Leg circles (releasing adhesions by moving the ball inside the leg socket, this is a gentle technique)

-Deep, circular mini massages between the rib and abdomen all along the edge of the front of the rib cage to loosen the superficial margin between the fascia around the rib cage, the respiratory diaphragm and the peritoneum (this really works well with the one above and the one below on this list)

-Release tension with deep, mini circular massage along the margin from the hip to top of the pubic bone on both sides

-Dip The Hip, figure 8s

Craniosacral therapy and myofascial release (more than the 3 releases I mention here)

-Hypnosis and/or journaling and talking to your baby about the reasons for breech presentation and a resolution for it, if one is appropriate to your situation.

-Seek professional help to evaluate your thyroid function and seek a natural or medical solution as appropriate.

-Loose ligaments may be supported by wearing a pregnancy belt. Add a belt if you have had several babies and now are carrying your baby in a breech position. Do the techniques the same. But wear a belt afterwards. Explore your body’s response to the belt. It should be supportive but not tight.

Screen Shot 2016-04-07 at 3.13.27 PMI became familiar with the rebozo during our childbirth classes because it was recommended to us in order to relieve lower back pain. It is a great activity to practice with your significant other as your due date gets closer.

According to Spinning Babies, a lot of breech babies who flip to a head-down position may end up posterior as well. Exercises like the forward-leaning inversion and the breech tilt can help the baby flip head down.

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

-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.

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Even though the majority of breech babies are born perfectly healthy, there is a slightly elevated risk for certain problems. Birth defects are slightly more common in breech babies (the defect might be the reason that the baby failed to move into the right position prior to delivery.)

Complications such as umbilical cord prolapse, injuries to the baby’s skull, brain or limbs, baby’s head getting stuck in the birth canal, prolonged and difficult labor, increased risk of perineal tears or an episiotomy may occur during a vaginal delivery attempt. That is why it is recommended to be in a hospital setting in case medical intervention is necessary.

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The famous phrase “Hands Off The Breech” is a message to all providers and expecting parents. Hands-and-knees birth allows the baby to complete the spontaneous cardinal movements (rotations necessary to move from breech to vertex.)

Sadly, nearly all American doctors are unqualified to deliver breech babies, and many midwives are untrained as well. Your childbirth educator or doula may be able to provide the name of a doctor or midwife who can, but expect to travel a good amount — there aren’t many.

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Most breech babies, in the USA, are born by cesarean surgery (they are considered to be too dangerous for vaginal birth.) However, in many university hospitals around the world (notably Norway, France, and Canada), the safety of vaginal breech births has been proven over and over again.

In 2009, Media Centre of Canada published an article reporting that Canada had reversed its policy on breech birth, featuring The Society of Obstetricians and Gynaecologists of Canada.

In the article, Dr. Robert Gagnon, a principal author of the new guidelines and Chair of the Society’s Maternal Fetal Medicine Committee, said, “Breech pregnancies are almost always delivered using a caesarean section, to the point where the practice has become somewhat automatic. What we’ve found is that, in some cases, vaginal breech birth is a safe option, and obstetricians should be able to offer women the choice to attempt a traditional delivery.”

To attempt a vaginal birth:

  • The baby must be full-term and in the frank breech presentation.
  • The baby must not show signs of distress while its heart rate is closely monitored.
  • The process of labor is smooth and steady with the cervix widening as the baby descends.
  • The health care provider estimates that the baby is not too big or the mother’s pelvis too narrow for the baby to pass safely through the birth canal.
  • Anesthesia is available and a cesarean delivery possible on short notice.

A cesarean birth may be necessary if:

  • Baby is less than 28-30 weeks gestation.
  • Baby is over 42 weeks gestation.
  • Baby seems large, 4,000 grams or 8 pounds, 13 ounces, (except in a rapid frank breech labor with good progress, so again, not absolute, but should alert you to other factors.) This is a conservative screening limit.
  • Mother has diabetes.
  • Baby has InteraUterine Growth Retardation (IUGR).
  • Care provider will touch the baby during the birth interrupting the breech baby’s spontaneous cardinal movements and possibly causing the arms or head to extend with resulting need to rescue the baby with breech maneuvers.
  • Labor is slow after 5 cm or stops all together after labor had been going well.
  • You do not have a person (OB, Midwife, Birth Attendant, cab driver) who knows how to release stuck arms.
  • Labor doesn’t progress with good, strong contractions and freedom of movement
  • Baby doesn’t descend during late labor
  • There are any other issues that indicate surgical birth, such as a placenta covering over the cervix.
  • The mother or birth attendant is not confident with the natural birth of a breech baby

Other factors:

  • Slow progress
  • Metabolic sloshiness – low thyroid function, fertility issues, conception through artificial insemination, hypertensive
  • Pelvic torsion or somewhat small diameters
  • And again, lack of skill and experience in birth attendant, including OB or Midwife, whether or not they are confident.

A cesarean birth can be more baby-centered by:

  • Allowing labor to begin on its own, and then having the surgery within an hour or two
  • Delaying clamping of the cord until the cord stops pulsing, and
  • Putting baby into mother’s arms in the operating room and
  • Cuddling and breastfeeding in the recovery room.

(Spinningbabies.com)

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Midwife Mary Cronk, one of the most experienced midwives with home breech birth in the world, has written a very excellent article on the breech as an unusual but not abnormal position, and the hands-and-knees position to protect the baby’s own spiraling motion through the pelvis for safe breech birth. Read this exquisitely valuable article by Mary Cronk.

 

Jane Evans, a UK midwife who works closely with Mary Cronk, continues their education efforts with midwives and physicians interested in the Cardinal Movements of breech birth. Jane wrote Breech Birth; What are my options?

 

Ina May Gaskin, America’s foremost midwife, posts an exciting article on the lost art of breech birth. Her spirit and wisdom comes across the page to you.

 

Maggie Bank posts her articles on breech birth at BirthSpirit.com. She also has a Breech Birth book out with excellent photos.

 

A group of parents and professionals in Canada are promoting the normalcy of breech birth and helping connect parents with professionals that support natural breech birth and the research to support breech vaginal birth at Coalition for Breech Birth.

 

Here is a beautiful picture of a laboring woman on her hands and knees with her baby mirroring her position as she is halfway born! Musings of a Redhead blogspot.

 

Here is a video of another mother in hands and knees. The complete birth and 30 seconds of the postpartum is intact, so you can see the birth in real time. Her baby’s Apgars were 10-10. Breech Home Birth at SpinningBabies.blogspot.com. This birth is entirely hands off, except for the long delay in wiping the baby’s head clean so Mama could kiss her and the midwife not being verbal enough to ask the other midwife to move the wet pads out of the way so the baby could be put through the mother’s legs to her arms.

 

Lisa Barrett, Australian Midwife has a lovely blog with home breech photos to her commentary on the normalcy of breech. She also has a video of a Frank Breech (legs extended). You notice the position of the baby whose chest is to the mother’s tailbone (head and sacrum anterior at this point). This is the safe breech position assuring the arms are not stuck at the pelvic inlet.

 

Here is the lovely story of a footling breech, born at home. There is a lull in labor during which the mother walks the neighborhood. She comes home and has her boy. There are entrapped arms, which we don’t see, and a trapped head for which we see the midwife deftly correcting the flexion and then baby is out. Good thing the midwife really knew her moves! Pictures are gorgeous, very candid, like you are there and peeking in on this precious event.

 

There is a lovely breech waterbirth on YouTube (you decide about the music selected). The time seems agonizingly long until you learn the Cardinal Movements and the signs that the birth is proceeding well (Thank you, Jane Evans, for teaching us this!). See the baby fix her own extended head and come out. The baby’s SA position and the pulsing cord assure that there is time for her to do this and that there is no cord compression. Tone is good; but you see the placenta come with the head. That was a long time for the head, and the uterus let the placenta go during that time. Fortunately, the baby came before running out of oxygen with this early placental release. A beautiful video, powerful, transformative, challenging and entirely hands off. I am so grateful for this video! Thank you, breech family for posting it!

 

When there is a surprise breech its best to keep your hands off the baby completely. A surprise breech is often progressing well — and that’s why the midwife or doctor either didn’t check position in labor (though they can mistake down for up occasionally, it happens) or they arrive at the birth as the baby is coming. Here is a mother’s story of her surprise breech and the midwife’s mentor knew to keep hands off!

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