Evidence indicates that around 4% of babies (about 1 in 20) are in the breech position at term. “Breech” refers to a baby that is head-up, rather than head-down.
Prior to 30 weeks gestation, it is normal for the baby to periodically be in a breech position. In fact, pregnant people sometimes report being able to feel the exact moment that their baby “flipped” or “somersaulted” into head-down, which can be very cool. Others find the baby turns at night while they are sleeping, and they don’t even notice.
However, finding out that you have a breech baby in the third trimester can be a shocking and upsetting experience. Because obstetricians have all but lost the skills necessary to deliver breech babies vaginally, largely on the basis of one potentially flawed study, you may be told that you must have a planned cesarean delivery. In such a situation, it is important to understand your options, in particular because cesarean birth increases your risk of complications in this delivery and any subsequent deliveries. Fortunately, there are numerous ways to encourage your breech baby to move head down. I will address them each in turn, from the harmless, to the alternative, and finally, a last-resort medical intervention.
Babies can hear all sorts of things in the womb, and some studies have shown they can be unbelievably responsive to external cues, even mirroring the facial movements required to make the sounds they hear. There is also belief among midwives that fetal positioning can be influenced by things like where the baby feels the most warmth (for example, some assert that babies born in winter are more likely to be posterior because they experience more warmth on their back when it is aligned with the mother’s). Consistent with all this, some have suggested playing music to your baby, low by your pelvis, to try to get him or her to chase the sound downward.
Swimming, belly dancing, yoga and other gentle movement
Babies need space and soft, supple tissue in order to complete the maneuvers necessary to get head-down. Because we live hectic and often sedentary lives leaving little room for relaxation and physical fitness, it has been theorized that increasing movement — in particular smooth, rolling, leisurely movements — can loosen things up in a way that gives baby additional room and flexibility to move head-down. To this end, activities like swimming, yoga, recreational belly-dancing, and bouncing or rolling on an exercise ball may make your body more amenable to flipping your baby.
Similar to the principles of gentle, tension-releasing movements described in the preceding paragraph, the goal of rebozo work in pregnancy and labor is to jiggle the pregnant woman to a state of relaxation and suppleness. This gives the baby more room to move, along with stimulation, without resorting to drugs or force. A doula trained in Spinning Babies ® can do this for you, and/or demonstrate to your partner. Read more here.
Chiropractors specializing in pregnancy care are often certified in a very gentle adjustment especially for pregnant women called the Webster Technique. The Webster Technique, like so many others discussed here, is aimed at creating more room for the baby. The idea is that in pregnancy, the hormone relaxin (responsible for loosening our joints to make greater room and flexibility), combined with the added weight of the pregnant belly, can cause ligaments and joints to slip out of alignment around the sacrum. When this happens, it can create uneven pull and tension on the uterus that can lessen the room available to baby. The goal of the Webster adjustment is to restore optimal alignment and movement. Many, many women credit Webster-focused chiropractic care with keeping their baby in an optimal position, or correcting a breech position. See my prior post on complimentary practitioners in Greater Boston, including chiropractors, here.
Forward-Leaning Inversion, Open Knees-Chest and Breech Tilt
The forward-leaning inversion, open knees-chest and breech tilt (aka pelvic tilt) are simple exercises that you can learn and do daily in the comfort of your home. They involve getting into a modified upside-down position, which uses gravity to encourage your baby to flip. These exercises are safe in most instances, but it is always important to go slowly, to have someone there to spot you, and to ask your provider if there is any medical reason you cannot try them. Examples of potential contraindications include blood pressure issues, being at risk of stroke or seizure, having uterine pain of undetermined origin, any issues with the location or integrity of the placenta, including bleeding, or overabundant amniotic fluid. For those with extreme abdominal weakness, such as a known diastasis recti, you may want to wear a belly band during these exercises. A Spinning Babies®-trained doula is an excellent person to assist you in doing these exercises prenatally. A sidelying release can also be helpful.
Other soft tissue therapies
Massage, myofascial release work and dynamic body balancing are all incredible options to explore that focus on making the soft tissues supple enough to support fetal movement. I like Nichole Russo at Skin to Soul for bodywork, including myofascial release work, in the Greater Boston area. She has locations in Newton and Woburn. Other prenatal massage and complimentary practitioners are listed on my blog here.
Moxibustion is a form of Chinese medicine practiced by acupuncturists. It involves applying gentle heat in the form of a burning mugwort stick, which looks a bit like a cigar, to a particular pressure point known as “BL67” on the pregnant person’s fifth (baby) toe. One end of the moxa stick is lit, and the other (the end near the toe) is unlit. My husband jokingly refers to this technique as “smoking the toe dope.” However, its potential effectiveness is no laughing matter: studies have suggested moxibustion has a high success rate in turning breech babies when combined with other techniques like posture-related exercises. It is unknown how exactly moxa works to influence fetal position, but the thought is that burning the herb at an acupressure point heightens maternal hormones, which can in turn stimulate the baby to move. See my prior blog posts on Boston-area acupuncturists here to consider where you might go for this service.
External Cephalic Version
The external cephalic version, or ECV, is the most heavy-duty option for addressing a breech baby. Of those listed here, it is the only medical procedure, and is typically treated as a last resort if no others have worked. ECV involves a physician manually manipulating your pregnant belly to attempt to push the fetus head-down from the outside. ECVs are performed in the hospital or other clinical setting, typically between 35 and 38 weeks. Timing must be carefully considered; a successful ECV pursued too early could result in the baby flipping back to breech again. An ECV pursued too late may mean the baby has grown too large to have room to safely turn.
The baby and mother are carefully monitored throughout the procedure and afterward to watch for signs of fetal distress, abnormal bleeding indicating placental detachment, or premature breaking of the water. In other words, the main risk of an ECV is causing an unintentional premature delivery. Certain women may not be candidates for ECV, including those carrying multiples or a baby with known health concerns, those with certain reproductive abnormalities and those with high risk conditions like placenta previa.
The procedure is painful, so the mother is offered an epidural for her comfort. Benefits of this approach include that the epidural may promote the relaxation necessary for success. Additionally, there is a risk that fetal intolerance of the procedure or other emergency could require immediate delivery; in such case, having an epidural on board can save time. On the other hand, epidurals have not been shown to increase ECV success rates, and they do take significantly longer to wear off than the 3-5 minutes the procedure lasts.
Evidence indicates that ECV is successful around 50% of the time. With an experienced obstetrician, that may be higher, although it can be difficult to find obstetricians who regularly offer this service. Although the American Congress of Obstetricians & Gynecologists recommends ECV as a means to reduce unnecessary cesareans, reimbursement rates are not always cost-effective when the alternative a cesarean, which is paid at a very high rate. You can contact me for recommendations on Boston area hospitals and obstetricians known for offering ECV.
If an ECV is unsuccessful, or the baby later returns to breech presentation, most physicians will take that to mean that it should not be tried again. You can watch a video of an obstetrician performing an ECV on an unmedicated mother here.
If baby doesn’t turn (or turns back)
It is important to note that some breech babies will not turn no matter what you do. Others may turn, and then turn back. In such circumstance, it is important to respect that the baby may know something we don’t about a condition inside the womb that prevents it from getting head-down. For example, a persistently breech baby may have a cord that is too short, such that it cannot flip without putting undue stress on its only source of oxygen. This is a good reason why staying breech might be safer for that baby. There could be an undiagnosed fibroid or other uterine growth taking up space. Just like we trust the baby to choose its own birthday by not forcing labor unnecessarily, we also need to trust the baby to show us when assuming the cephalic position is not ideal.
For parents with a persistently breech baby who still desire a vaginal birth, I can point you to a couple providers in the Greater Boston area who are willing to attend vaginal breech births, including for first-time moms when certain criteria are met. Please get in touch for more information.
For parents who are more comfortable with a c-section, or don’t have the option of pursuing a breech vaginal birth, there are still things that can be done to make the birth experience as positive and low-risk as possible for you and your baby. A doula can help you plan for a more gentle, family-centered cesarean, and may be able to accompany you into the OR (depending on the hospital). Alternatively, if you prefer to let labor begin on its own to assure that the baby is actually ready to be born, we can help you advocate for this option, which would involve heading to the hospital for an unscheduled cesarean with whoever is on call the day you go into labor.
With a breech baby, like any decision about birth, it is important to listen to your intuition. If your gut is telling you not to keep trying to turn your baby, tune into that and honor it by only doing as much as feels right. Conversely, if you feel strongly that a planned cesarean is not right for you and your baby, you are entitled to be supported in exploring that too. There is no “right” or “wrong” decision; only what is right for YOU.