When Your Baby is Breech
Many babies are breech presentation (bottom first!) at some point during pregnancy, however it is estimated that only around 3-4% of babies will be a breech presentation by the end of the pregnancy.
Following the Hannah trial women have been advised to opt for caesarian section as the safest option for them and their babies. However, follow up trials by the same team found no significant differences in maternal and baby outcomes at 2 years of age.
There is good reason to believe that women who go into labour spontaneously at term, with a ‘normal’ size baby can expect a good outcome, especially if the woman has had a normal labour and birth with a previous baby. Despite this, caesarian section remains obstetricians’ advice for many, and the most recent NICE caesarean section guidance in 2011 still advises elective caesarean sections for women whose babies are breech at term.
There are a few tips and tricks of the trade to encourage your baby to turn head first if they are still breech at close to term. (Note: these are mainly unevaluated methods with anecdotal ‘success’ at turning breech babies to a head down position. If you any of these methods cause you discomfort, or if you think your baby may have turned head down, then do stop.)
- Walking – this is probably the easiest and most effective way to encourage a breech baby to turn. Walking uses gravity to pull the heaviest part of the baby downwards to your pelvis.
- Cold compress – hold a cold flannel or cold drinks bottle from the fridge on the top of your bump and your baby will try and move his head away from the cold.
- Light – shine a torch down low on your abdomen to encourage baby to go and investigate.
- Music and Sound – place a headphone low down on your abdomen, just above your pubic bone, and play music or a tape of your voice to encourage you baby to seek out the source of the sound! Your partner can also talk to baby from this position too, to see if they can encourage baby to come down for a closer listen.
- Massage and positioning -lie on your back with several pillows under your hips, so they are raised higher than your head. This encourages the breech to drop out of your pelvis (make the tilt slightly less if you feel uncomfortable). Then gently massage your tummy in a circular motion, encouraging baby to do a forward roll into your pelvis (if you ask your Midwife which side your baby’s back is on, it will help you to know which direction to massage in). It is also helpful to do this at a time when your baby is usually active – they are more likely to respond and move if they are awake.
- Visualisation / Hypnosis – visualising your baby turning into a good head down position, or using a personalised hypnosis script can be helpful ways of remaining calm and positive about your baby’s positioning, and can also relax your abdominal muscles more, so making it easier for baby to manouevere round.
- Acupuncture – the burning of moxa at a specific point has been said to help breech babies to turn. Although a recent review of the available research has concluded that there is limited evidence to support the use of moxibustion to turn breech babies at term.
- Reflexology – working on a similar point on your foot to where acupuncturists burn moxa, a trained maternity reflexologist can breech babies to move.
- Homeopathy – Homeopaths often prescribe a specific remedy for encouraging babies to go head down.
If natural remedies do not work, then your obstetrician may recommend External Cephalic Version (ECV). This is not always a very comfortable procedure to have done and needs to be performed in hospital on the labour ward, as it can occasionally result in the need for caesarian section to be performed immediately. It is also not appropriate for all pregnant women – for example it may not be recommended for you if you have had a previous caesarean section, or if your amniotic fluid levels are thought to be low). However, when successful, it means you can go ahead with your plans for a normal vaginal birth.
If your baby remains breech, then there is still the option of a vaginal birth, especially if you go into labour spontaneously and labour well. Discuss your options for birth with your obstetricians and follow the advice you feel most comfortable with.
Types of Breech:
- Frank breech – the baby’s bottom comes first, and his or her legs are flexed at the hip and extended at the knees (with feet near the ears). 65-70% of breech babies are in the frank breech position.
- Complete breech – the baby’s hips and knees are flexed so that the baby is sitting crosslegged, with feet beside the bottom.
- Footling breech – one or both feet come first, with the bottom at a higher position. This is rare at term, but relatively common with preterm babies.
- Kneeling breech – the baby is in a kneeling position, with one or both legs extended at the hips and flexed at the knees. This is extremely rare, and as such is excluded from many classifications.
By Lorraine Berry. GentleParenting’s Pregnancy and Birth expert.