Challenging Situations: Breech Presentation
As much as birth can be a totally normal, physiological process there are times when challenging situations may occur. This week’s topic is breech babies!
What is a breech presentation?
What does it mean for labor and delivery?
What are my options?
Keep reading and we will dive in!
About 3-4% of full term births are babies in breech presentation (https://www.acog.org/womens-health/faqs/if-your-baby-is-breech). This is opposed to the ideal position of occiput anterior (OA) in which the baby is head down and body is facing their mom’s back or other head down positions.
In many cases, babies will make that turn head down on their own, however, as delivery approaches it becomes a little trickier to get that full newborn-sized body moved all the way around. This means they may be stuck in one of three different breech presentations, frank breech, footling breech or complete breech.
1. Frank breech – The baby’s butt is down at the cervix
2. Footling breech – The baby has one or both feet down at the cervix
3. Complete breech – The baby’s knees are bent and both the butt and feet are down at the cervix
What does a breech presentation mean for my labor and delivery?
While breech babies can absolutely be born safely and healthy, there are some additional factors which will need to be considered in terms of delivery of the baby. Delay of the head being delivered, the cord possibly getting pinched and inhalation of fluids are all possibilities. Additionally, although there has been some resurgence of vaginal breech deliveries and change in guidelines since a study in the early 2000s indicated they were less safe, there are very few providers who are still trained and regularly perform vaginal breech deliveries. This means a higher chance of a scheduled cesarean delivery for most mamas UNLESS mom and/or the provider are able to coax or maneuver that baby into a head down position.
What are my options?
1. You can do nothing. As mentioned before, many babies are born safely breech. If you and your provider feel confident in a vaginal breech delivery, you could definitely move forward with that or if you’d prefer to leave the baby be and schedule a cesarean that is an option.
2. Breech Tilt - This is a non-invasive inversion option which a mom could practice multiple times a day to try to give the baby space to flip on their own. (https://www.spinningbabies.com/pregnancy-birth/techniques/other-techniques/breech-tilt/)
3. Using music, sound or your voice to try to coax the baby to move their head closer to hear better. Also non-invasive, so may be worth a try along with other methods.
4. Moxibustion - Performed by an acupuncturist, it is a Chinese Medicine technique in which herbs are burned just outside the little toe. (https://evidencebasedbirth.com/evidence-for-using-moxibustion-to-turn-breech-babies/)
5. Breech External Version - The most invasive option of trying to rotate a breech baby is usually done in a doctor’s office or hospital. First, an ultrasound and nonstress test is usually done to confirm the condition/position of the baby, placenta, womb, etc. The mother may be given something to help relax the uterus and/or prevent pain but it is not always done. From there while the mother lies on her back, the provider with the guidance of the ultrasound will press on the mom’s belly to lift the baby out of the pelvis and gradually turn the baby into a head down position. This can be uncomfortable for the mother and the baby is monitored throughout to make sure they are tolerating the procedure. The procedure itself only takes 5 to 20 minutes.
Making the most of a Planned Cesarean
Despite all efforts, you and your provider may decide that a cesarean is the best option. Even if it is planned, it can still be a bit unexpected and disappointing if you were originally planning a vaginal delivery.
Some things which may help you feel most empowered in your cesarean are:
1. Let yourself feel whatever emotions you may have surrounding the surgery. If you feel like talking about them, maybe talk about it with a partner, friend, doula or your provider so you can help process it fully.
2. Talk to your provider about a Gentle Cesarean and what options you may have such as a clear drape, skin to skin after delivery, arms free, breastfeeding in the operating room, delayed cord clamping, music during delivery, etc.
3. Make a plan if the baby needs extra attention who will go with the baby and who will stay with mom.
4. Lastly, prep early for postpartum and enlist extra help. Physical recovery will take longer than a vaginal delivery and extra help will allow you more time to get in that rest needed.
Helpful Resources
Spinning Babies (spinningbabies.com) is a FABULOUS resource regarding natural means of preparing your body and baby for childbirth and optimal positioning. Additionally, they have a number of resources specifically geared towards breech babies. Also, I linked a few Evidence Based Birth articles in regards to different methods used to turn breech babies and the evidence out there behind it. I highly encourage reviewing their articles when deciding which method or methods you may be interested in trying, if any.
Bottom Line
Breech presentation in babies late in pregnancy can be challenging and may cause some last minute changes to your birth plan. Keep in mind, although it can be challenging, it still in many instances is viewed as simply a variation of normal. If vaginal delivery is still important to you to try and attempts to turn baby fail, maybe you do some research and see if there are any providers in your area which may attend vaginal breech deliveries. Flood yourself with birth videos and stories of positive vaginal breech deliveries and rock that birth mama! As an alternative, a cesarean is a totally valid option as well and you can totally rock that too! The most important thing is being aware and well informed of ALL your options and I hope this post helps in that.
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