Written by Tina Kokott
In the weeks leading up to my 28-week appointment with my midwife, I felt something was different with my baby. I found it hard to breathe and could only eat small portions as I felt so uncomfortable. The morning of my appointment it dawned on me, my baby’s head must be up, squishing my stomach and diaphragm. My midwife confirmed he was breech. She also assured me that there is no reason to worry at all, as there was still so much time for him to turn head down.
My initial thought was “How good is intuition?” and “It’s okay, I trust him. He knows what he is doing.” However, not long after that came the doubts. What if he doesn’t turn? Do I need a C-section? Can’t I birth breech vaginally? Isn’t that dangerous?
All the feels
If you are in your last trimester and have been told your baby is breech, I understand what you are going through. I have felt your concerns for your baby. I know the fear of your choices being taken from you. I believe it is important to acknowledge all it is you are feeling and thinking.
What are your concerns? Are you anxious about not being able to birth your baby the way you want? Is your care provider not able or willing to support the birth you want if your baby is breech? Are you in doubt of finding a care provider that is? Do you think breech automatically means you need a Cesarean section? Do you wonder what’s “wrong” with you, why is your baby upside down?
I believe it is important to determine where your concerns stem from. As I mentioned earlier my intuition told me everything is okay the way it is. But my brain reminded me of the world around me. The worries and fear that rushed through me reflected the fear around breech birth in our current society.
Do I need a C-section?
First things first, you always have the last say. No matter what your care provider recommends, it is up to you to go with that recommendation or not.
What are your options?
While you are still pregnant, you can either try to turn your baby head down or do nothing. If you want to encourage your baby to turn, there are different options with varying success rates and invasiveness. When it comes to birth, you can plan on birthing your breech baby vaginally or opt for a cesarean birth. If a vaginal birth is your preference, you want to make sure your care provider, as well as their back up, are happy to support you with that. Otherwise, you might need to be referred elsewhere.
The same applies if you wish to have a cesarean birth. If you are currently under midwifery care, a referral might be necessary. If you decide to accept a caesarean section, you can either set a date for the surgery or wait until you go into labour naturally. Having an in-labour caesarean will eliminate the risk of prematurity. It will also support your baby’s adaption to the world through the benefits of the labour hormones.
What does the research say?
Breech position is present in 3% to 4% of term pregnancies, meaning after 37 weeks gestation. 25% of babies are breech before 28 weeks, but by 32 weeks it is only 7%. After that, there is still a 50% chance that your baby turns until 40 weeks. So, the earlier you are in your pregnancy, the higher the chance for your baby turning head down until birth. Even if your baby turns before term, there is a good chance it will flip again. And again.
The vast majority of breech babies in Australia are born via cesarean section (96%). In 1991, 23% of breech babies were born vaginally, by 2005 this number dropped to 3.7%.
A breech baby has not always been an issue
Up until the 1990’s Australian obstetricians were expertly trained in the management of vaginal breech birth. Today, this type of birth is rarely taught in obstetrics, hence it has become a dying skill. Added to this, Australia has become a more litigious society and as a result medicine has become more defensive.
The reason for the dramatic change in breech birth was the Term Breech Trial (TBT) (Hannah et al., 2000). The study showed that there was a difference in the number of injuries breech babies experienced when born vaginally. The recommendation was that breech babies be born via caesarean section, and almost overnight women lost the option of vaginal birth. The TBT has since been widely criticised for the way in which women were selected for the study and how their births were managed. There were also weaknesses around the skill levels of midwives and doctors involved as well as a focus upon short-term injury rather than upon the long-term impacts on babies’ brains [SDGC, 2009). Various studies since then (Goffinet et al., 2006) showed that careful selection for vaginal breech birth resulted in no difference in outcome for either group (0%). The re-examination of the TBT demonstrates that caesarean section is no longer the only birth option for women with breech presentation. Read more about the details of the TBT here.
Why is ‘bum first’ a potential risk?
When your baby is born head first, it means that the largest part of his body needs to pass through your cervix first which will be dilated enough for the rest of the body to pass through. A foot, on the other hand, could easily pass a cervix that is not open enough for the bottom or head of the baby. In addition, the head fits neatly against the cervix like an egg in an egg cup. This prevents cord prolapse, where the umbilical cord comes down ahead of the baby and gets pinched between the baby and the mother’s pelvis. A very small percentage of breech babies get in trouble because of that. The mechanics of breech birth also increase the chance of birth injury to the baby.
The variations of breech
There is a variety of breech positions. Depending on the position your baby is in, your care provider is more likely to recommend a cesarean or vaginal delivery.
Your baby is in complete breech when his knees are bent, and his feet and bottom are closest to the birth canal. If one or both feet are presenting, your baby is in footling breech.
Frank breech is when his legs are folded flat up against his head and his bottom is closest to the birth canal. Frank breech is by far the most common type of breech. As the buttocks are about the size of the head, the possibility that the cervix will dilate enough to pass the body but not the head is minimised. With the buttocks pressing against the cervix, the chance of the umbilical cord coming down ahead of the baby (prolapsing) is the same as head-down babies.
Turn your baby around
There is a multitude of options you can try to turn your baby head down before birth. Some are more invasive than others. Here is a small selection.
This might be the last thing you want to hear. But being relaxed, trusting your baby and letting go can be a successful and non-invasive way to get your baby in the best position. There are great meditations that help you visualize your baby in a head down position. Hypnobirthing Australia offers a ‘Breech Turn’ meditation that you can download as well as a ‘Fear Release’ self-hypnosis.
Moxibustion is a form of traditional Chinese medicine in which a burning herb – Artemisia vulgaria – is held close to the outer edge of the little toe. Evidence suggests that moxibustion, when combined with either acupuncture or postural techniques, is safe and increases your chances of turning a breech baby. It is still unknown which kind of moxibustion method works best for turning breech babies. However, using moxibustion twice per day for two weeks (during weeks 33-35 of pregnancy) appears to work for 1 out of every 8 women. You can read more about how moxibustion could work here.
Spinning babies aims to optimize the physical relationship between your and your baby’s bodies. You can find a multitude of activities that might help to turn your baby head down on their website. Ideally, your doula or midwife has attended a Spinning Babies workshop and can guide you through the activities.
ECV (External Cephalic Version)
An ECV is a procedure a trained obstetrician will do at around 37 weeks to turn the baby head down by manipulating him from the outside. A drug (tocolytics) will usually be administered to relax the uterus and prevent it from contracting during the procedure. The baby will be monitored to keep track of the heart rate. The procedure may be uncomfortable, but it should rarely take more than 5 minutes. If the procedure fails, or the baby turns back, some practitioners will try again. To get a better idea of what a successful ECV might look like, have a look at this video.
Researchers found that attempting an external cephalic version at term decreased the relative risk of breech birth by 58% and the relative risk of cesarean by 43%. There were no differences in any other outcomes, including Apgar scores, neonatal admission, or infant deaths. The studies did not look at maternal satisfaction (Hofmeyr et al. 2015). The most common risk is a temporary change in the infant’s heart rate (4.7%); serious complications, such as placental abruption or stillbirth, are rare (0.24%) (Grootscholten et al. 2008). You can find more information on the evidence of ECV here.
Other options to turn your baby include pregnancy massage, acupressure, acupuncture, chiropractic using the Webster technique, rebozo, yoga, osteopathy etc. There is no guarantee that your baby turns for any of these options, so choose what you are comfortable with.
When my baby was breech I tried all different positions to encourage him to turn. But nothing happened until I stopped at around 36 weeks. I believe that I needed to accept whatever may be and just relax. I woke up the next morning and knew he turned head down.
Have a game plan
No matter your birth preference, you should always have a plan. Make sure that your care provider as well as their back up(!) are happy with your plan and won’t turn their back on you later on and try to pressure you into something you don’t want. If you are planning a vaginal breech birth, your birth plan should entail your preferences in case of a cesarean regardless.
Breech is a variation of normal. If you don’t have enough reasons to be in awe of the female body already, have a look at this amazing frank breech birth.
It’s often thought that breech babies keep their heads near their mum’s heart to listen to the beautiful lullaby of their beating heart.
My name is Tina Kokott and I am a Doula who has trained at the Doula Training Academy. If you would like to talk more about your birthing options, please contact me:
Business Name: The Seeds of Birth
Business Email: [email protected]
Instagram Link: https://www.instagram.com/theseedsofbirth/