A breech presentation means that the foetus lies in a longitudinal line, but with the buttocks and/or feet in place to come out first during birth – and not the head.
Before 25 weeks the incidence of breech presentation is 28 percent. But by delivery this decreases to around three to four percent of pregnancies. The attitude of the breech can vary, depending on the flexion of the limbs.
The causes of breech
The reason for a breech position is not always understood or apparent. Some women have breech presentations in successive pregnancies.
Before the 34th week of pregnancy, there is more fluid and more room in the pelvis than at term. Should a baby be born at this stage, the chances are higher that baby will be breech than if baby was born at full term.
Splinting of the foetus
If a baby is lying with straight (extended) legs with feet in front of face, the baby cannot get into the correct position because the extended legs prevent him from “following his nose” into the head down position. In the case of a multiple pregnancy, the second twin may act as the barrier, thus preventing the first twin from turning.
In the case of excessive fluid, the position of the baby is unstable as this allows for more free movement of the foetus and the foetus is less likely to stay in one stagnant position.
Sometimes the condition of the mother’s lower abdomen or pelvis prevents the foetal head from engaging comfortably in the pelvis and therefore the foetus turns and presents as a breech.
These conditions include a contracted pelvis, placenta praevia, and fibroids. Other reasons include a short cord, pendulous abdomen of a mom who is large or has had many pregnancies or has too little fluid in the womb.
Turning a breech
Visualise the baby moving down with the head very deep in your pelvis, several times a day - especially in conjunction with positions and exercises below.
Swimming as often as possible
This keeps your body and pelvis loose and relaxed. Do this in conjunction with the breech tilt and other exercises below.
Begin at 32 to 35 weeks gestation. Do this three times daily for 10 to 15 minutes each time. Make sure you have an empty stomach, and the baby is active. Prop one end of an ironing board securely on a sofa or chair about 30cm high (or use a slant board).
Lie down on board, feet up and bend knees but keep feet flat on board. Relax, breathe deeply, and avoid tensing. You may also use pillows on a flat surface to raise hips above shoulders. Gravity pushes the baby’s head into the fundus, tucks it, and baby can then do a somersault to a vertex (head down) position.
CD/iPod with headphones
Place inside your pants toward your pubic bone and play classical music for 10 minutes, six to eight times a day.
Try moving it slowly from the top of the uterus toward your pubic bone while you are in a breech tilt position. Use an amber or red light.
Start with your left hand at the bottom of the abdomen and your right hand just above it. Move your hands clockwise around the right side of your tummy.
As your right hand reaches the top of your abdomen, slide the left one over your right and move it down the left side of your tummy. Your left hand leads as you come full circle, continuing clockwise. Massage gently as you would to apply lotion. Massage for ten minutes or more up to several times each day. Ask your partner to assist.
Place on the small toe of each foot at the outside corner of the toenail (sideways so that the toenail and toe pad are stimulated for 30 minutes per day). This is an acupressure point that is a “moving down” point. You can also do this with just finger pressure as you remember to do it.
Motion sickness band
Place with the bead four finger widths above the inner ankle bone – another acupressure point that is used for stimulation of the uterus. Do not use this point if you are experiencing any pre-term labour symptoms.
Glass of orange or other juice
Follow this with a side-lying position with your hips positioned higher than your feet. Babies move more after a sugar high!
with an ice pack on the top of your tummy on an empty stomach, 10 minutes twice a day. Do this while lying on your back on the floor with knees flexed and feet on the floor with three large pillows placed under your buttocks. Try this in conjunction with headphones and visualisation.
Start on all fours, then lay your head and chest flat on the floor with your buttocks in the air, as you round your back and return to all fours.
Kneel with hips flexed slightly more than 90 degrees, but with thighs not pressing against your tummy and your head, shoulders and upper chest flat on a mattress. Try this for 15 minutes every two waking hours for five days.
It is used widely by homeopaths to help turn breech babies. It is a natural remedy, is safe to use in pregnancy, and you can usually find it on a shelf in selected pharmacies or health stores. The potency used for successfully turning breech babies, is Pulsatilla 30x and it is safe because it is a low potency remedy.
Potencies 3C or 6C can also be used. High potencies should only be taken under the guidance of a homeopath or homeopathically trained doctor. There are many advantages to using this natural way to turn your baby.
It’s affordable and not painful. Pulsatilla may turn a baby in the last week, or even days before the birth. It is probably the safest way of trying to turn a breech baby, as it will simply not work if there is a physiological reason your baby can’t turn.
Baby ain't moving
If your baby is lying in the breech position by the 36th week of pregnancy, your doctor or midwife will probably start talking about performing external cephalic version or ECV.
When an ECV is performed, the doctor uses his hands to feel where your baby’s head and bottom are. Then, using pressure from the outside, he or she tries as gently as possible to turn the baby around. You would first have an ultrasound done, to see exactly how the baby is lying.
The scan should also show if there is a reason why the baby shouldn’t be turned manually. Sometimes there is.
Before attempting to turn the baby, you may be given some medication to relax your abdominal muscles. Some babies turn very easily, but some are harder to turn and the mother may feel some discomfort — relaxing and breathing deeply will make it easier for you.
Sometimes babies simply can’t be turned this way, or occasionally they may go back into the breech position on their own, a few days later.
Although many breech babies are born vaginally, there are more risks involved when delivering vaginally and many caregivers prefer to perform a caesarean. Your doctor will advise you.
- A breech baby may not dilate the cervix as quickly as in a vertex or head first position.
- Very often the position of the baby’s legs has an effect of “splinting” against the abdomen (if they are flexed at the hip and extended from the knee) thus making it difficult for the baby to manoeuvre, causing labour to be drawn out.
- One of the dangers to the baby in breech position is that the largest and least compressible part of the body (the head) comes last.
- It is normal for the genitals in both girls and boys to be swollen. This is due to the pressure of the vaginal walls on a soft vulnerable area. This sometimes causes distress in the mother. Swelling will subside quickly.
- The uneven fit of breech to pelvis may cause the bag of waters to rupture early.
- The risk of the cord falling down in front of the baby is higher in a breech position than in a vertex position.