Is Baby Breech?

At your appointment, your midwife will feel your tummy to see which position your baby is in. They may say that the baby is ‘breech’. What does this mean?

Screen Shot 2018-11-08 at 05.56.07.pngWell, optimal foetal position for birth, is baby lying with it’s head down near your pelvis, and it’s spine curved outwards towards your belly. Breech means that the baby’s head is up near your ribcage, and there are several different types of Breech position.

Complete breech — Baby is bottom first with its legs crossed up in front.

Frank breech —Baby is bottom first and its legs are extended upward so that its feet are near its head.

Incomplete breech —Also called a footling breech, baby has one or both feet down towards the pelvis so that its leg(s) are poised to deliver first. This is the most common breech position in premature breech babies.

Throughout most of pregnancy, the baby will move around freely. It is very common for them to spend lots of time in a breech or transverse position (transverse means they are lying horizontally across your body). From around 32-34 weeks, as the baby grows bigger, their movement begins to get restricted. This means that whichever position they have assumed by this time is quite potentially the one in which they will be once labour begins.  However, they can still move, and statistics show that at 32 weeks, around 7% of babies are in a breech position, but only around 3-4% will be in a breech position at full term. This means that 96-97% of babies will assume the head down position by the time they are full term. It is possible for a baby who is in breech position at the start of labour to turn head down during labour.

Oh, and in case you were wondering, in the super unlikely case (only 1 in 400) that a baby is lying in the transverse position when labour begins, a caesarean section will be needed as the safest way to deliver the baby.

So what if my baby is breech at full term?

You will likely be offered an ECV.

An ECV is a manual manipulation of the abdomen in order to turn a breech baby; also known as version. It will only be performed once a woman has reached full term and will be performed in a hospital setting where there are provisions for labour and birth, as it may set off labour. The obstetrician will likely use ultrasound as a guide, and will try to give the baby’s buttocks a little lift and guide the head downwards, attempting to make the baby do a little flip and turn head down (a position known as cephalic). It may be necessary to give the mum an injection to relax the muscles of the uterus and abdomen, and an ECV will not be attempted if there is a chance the umbilical cord is wrapped around the baby in any way. The ECV has about a 50% success rate.

You will likely be offered a Cesarean Section.

For about the last twenty years, c-sections have taken over as the recommended method of birth for babies in breech positions. This is after a studies showed that showed better outcomes for breech babies that were delivered by c-section.

Although, as with any surgery, a c-section carries some risks to the mother, many mums-to-be prefer to take these in order to reduce the risks of a breech delivery for their baby.  

You may like to go for a Vaginal Breech Delivery.

Prior to the increased recommendation of c-sections for breech babies, such babies would have been delivered vaginally. The unfortunate knock on effect of this increased popularity of c-sections is that fewer doctors and midwifes are confident in delivering breech babies as they do not have the experience. Obviously, this has a spiralling effect and many women whose baby is presenting breech at full term will be pushed towards a c-section because of this. If your baby is breech and you would like vaginal delivery, then do make enquiries to see if you can find a midwife or doctor who feels happy and confident to help you deliver your breech baby vaginally. Frank or complete breech positions, where the bottom in presented first are more favourable positions for breech delivery. A footling breech is more tricky, but still possible. The main risk to the foetus in a vaginal breech delivery is that the body can slip out easily first, but then the head can get stuck, because the baby’s head is usually bigger than the body. If this happens, then surgical intervention may be needed to complete the birth.

Recently, as healthcare providers try to cut down on the amount of c-sections being performed, the safety of vaginal breech deliveries has been reassessed, and it has been realised that vaginal breech deliveries are safer than once thought.  Therefore vaginal delivery for breech presentation is now being promoted more. 

How can I prevent my baby becoming breech?

Prevention is better than cure! And there are certain things you can do throughout your pregnancy to reduce the likelihood of your baby ending up in breech presentation at full term. It is best to practise these things from early on, when your baby has lots of space to move around, than suddenly start trying to find ways to encourage your baby to turn once they have settled in a breech position. Saying all this, though, babies do have rather a mind of their own, and although I practised all these good techniques throughout my pregnancy, my large baby was doing somersaults in the womb between 34 and 36 weeks giving me a bit of a scare that he might wind up breech. Fortunately, by 36 weeks he had settled in to a head down position. 

Yoga 

Yoga is a blessing when it comes to keeping your body well aligned and tension free throughout pregnancy, and also encouraging your baby in to optimal foetal position for birth. Find yourself a good antenatal yoga class to attend, or purchase access to my online Pregnancy Yoga class here. You will learn lots of fantastic movements and stretches to help encourage baby’s head down, and their spine outwards towards your belly. Here is just one technique that can be used regularly throughout pregnancy as an excellent way to encourage OFP (optimal foetal position).

Yoga also happens to be a superb way to reduce….

Stress

Stress gets loads of press about how it affects our health, and much has been written about stress and breech babies. Science shows that a woman’s lower uterine area tightens under stress, making it more tricky for her baby to settle head down. Studies have shown that mothers who experience anxiety also experience more breech babies. So, find ways to help yourself stay calm and relaxed during pregnancy. Work against the pressures of the modern world and practice yoga and other stress-relieving exercises. Meditate. Walk. Slow down. Listen to music. These are great places to start, even before getting pregnant, and especially during pregnancy, to avoid baby breech positioning. See www.mama2shape.com/shop where you can purchase a collection of relaxations specifically for pregnancy.

Sitting

During pregnancy, how we sit is very important. Whenever possible, stop sitting altogether, have a walk, have a stretch, practise some sneaky yoga moves or postures. This is super important for optimal baby positioning. Sitting slumped back in a sofa negatively effects your baby’s position within the womb, as it encourages the heavier part off the baby, its spine, towards the back of your body under the effects of gravity. This can lead to a ‘back to back’ position, notoriously painful in labour as it changes the way contractions are experienced.

So, during pregnancy, sit in an upright poisitiom, and slightly leaning forward. The most comfortable way to do this is on an exercise or birthing ball. When choosing a ball, make sure that when you sit on it with your feet flat on the floor, your hips are slightly forward of your knees. All this will help encourage baby into optimal foetal position by encouraging gravity to pull baby’s head down, and it’s spine towards the front of your belly. Also, make sure that you regularly stand, walk and stretch. Move around as much as you can!

What if my baby is breech as I near my due date? Is there any thing I can do?

Yes, you can try moxibustion, which is a traditional therapy in Chinese Medicine. A ‘moxa’ stick which comprises of dried and compacted mugwort is burned next to an acupressure point on the outside of the little toes. This is repeated twice a day for fifteen to twenty minutes until the baby spontaneously turns! The moxibustion stimulates an energy channel: the bladder  meridian which includes the uterus. Women who try this treatment will notice their baby wiggling and increasing their movements as the moxibustion is burnt. The success rate is 75-90% but it is important to perform this therapy before the breech baby settles in to the pelvis and the amount of amniotic fluid begins to decrease or the success rate will be less. Therefore, if your baby is breech at around 34 weeks, moxibustion is a great plan! I used moxibustion successfully at 36 weeks, along with the other advice that I give in this article.

Yoga

Yes! Yoga again! Well, I am a yoga teacher, so it is to be expected! There is a pose called ‘Downward Dog’, which I don’t usually teach during my regular pregnancy yoga classes, as it can be a challenging pose which is strong on the arms, and in pregnancy usually reserved for those who have a previous yoga practise and are already a dab hand at Dog! If you are a beginner then it is still fine for you to practise, and anyone who is pregnant and practising Down Dog should be cautious and stop if feeling dizzy when entering the pose, or if you have high blood pressure. If you feel in any other way unwell or uncomfortable in the pose then don’t do it. In our regular pregnancy yoga classes, we do a version of Downward Dog called ‘Down Dog against the Wall’. This version is not an inversion like the full Down Dog pose is, and therefore gentler on the body and unlikely to make you feel dizzy. It is also easier on the arms and safe if you have high blood pressure. However, when we are considering a pose to help us shift a breech baby, we need the power of the inversion!

When you enter Down Dog, and invert your body, the idea is that the baby’s bottom moves away from the pelvis, and then once you right yourself the correct way up, the baby spins around and takes up optimal position with it’s head down. Babies’ spinning  can be encouraged by doing some more yoga from an all fours base position.

You may have to practise Downward Facing Dog a number of times to shift your breech baby, but take it easy and listen to your body. Rest if you are tired.

You may be interested in reading the following articles which I have used as reference for this piece.

https://www.rcm.org.uk/news-views-and-analysis/analysis/turning-the-breech-using-moxibustion

https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1576/toag.10.3.139.27415