First of all, don’t stress out. Just because your care provider thinks the baby is breech doesn’t mean you’ll automatically have to have a C-section, especially if you’re not yet 36 weeks along. Somewhere around the 34-week mark my midwife thought my son might be breech, and all of a sudden every midwife in the whole practice seemed to crowd into the exam room to chime in about acupuncture, yoga, confusing acronyms I’d never heard of, and something called moxibustion. I felt totally overwhelmed by all the options and techniques they were suggesting. (Eventually, an ultrasound revealed that what the midwives thought was the baby’s head was actually his bum—phew. Crisis averted.)
It’s also important to know that the easiest technique for turning a breech baby is extremely low-effort: just give it time. Most babies do turn on their own before their due date. In fact, your chances of having a breech baby decrease with each passing week. While about 30 per cent of babies are breech at 30-32 weeks, only 3 per cent are still breech at term (37 weeks), says OB-GYN Ellen Giesbrecht, a doctor at BC Women’s Hospital in Vancouver.
You may have also heard that yoga positions, swimming, belly dancing, spending time upside down, or doing exercises like pelvic tilts can help. “Many of these are just about using the principle of gravity to get the baby’s bum up and out of the pelvis,” explains Giesbrecht.
Interestingly, the majority of babies will turn at night, when you’re sleeping, due to your reclined position. “Many moms don’t even notice when the baby turns,” says Ruth Comfort, a registered midwife at the South Community Birth Program and Assistant Head of Midwifery at BC Women’s Hospital and St. Paul’s Hospital in Vancouver.
There are several types of breech presentation: frank breech (the baby’s bum—and not his head—is over your cervix, and his feet are way up near his face folded in a jackknife position instead of tucked in), footling breech (one or both feet are below the baby’s bum and sitting above your cervix) and complete breech (instead of being head-down, the baby’s bum is over your cervix, and his knees are tucked up against his chest, in a ball). Bum-first or feet-first is not the optimal position for a vaginal delivery. Many hospitals and OBs will not allow women to attempt vaginal breech births (though some do specialize in this—ask your provider), and midwives in Canada don’t typically deliver breech babies, either. Attempting a home birth with a breech baby is not recommended.
Midwife Ruth Comfort advises women to start by having a conversation with their provider about what kind of breech you’re dealing with. “That affects the efficacy of alternative techniques. It’s tricky because every woman is so different, and the reason her baby is breech may be different, too.”
First-time moms, or women who are extremely fit, may have more trouble getting a baby to move out of a breech position due to tighter pelvic and abdominal muscles, says Comfort. Women having a second or third child may have more luck with babies who turn spontaneously. (However, says Giesbrecht, “the more babies you have, the higher your chances of having a breech baby—that’s just statistics.”)
A uterine fibroid or the specific shape of your pelvis may mean the baby does not have room to turn, and that there’s little chance that any of the following methods will work. It could be that the cord is tangled around the baby’s leg or shoulder. (Unfortunately, this is not easily ascertained in an ultrasound, so sometimes there’s no way to know.) It could be that the baby went through a growth spurt and got trapped in a bum-down position.
“If the cord isn’t an issue and the baby isn’t deeply engaged or wedged in the pelvis, the goal is to give the baby the space to turn on their own,” explains Comfort.
Here’s a breakdown of the most common techniques for turning a breech baby.
This intimidating-sounding acronym stands for external cephalic version, and it’s an intervention performed at a hospital, clinic or birth-care centre under ultrasound guidance. The doctor would use her hands to manipulate the baby’s position by carefully pushing on your belly and abdomen. ECV is usually best performed between 35-38 weeks, after nothing else has worked. The baby’s vital signs are monitored before and after the procedure. According to the medical literature, says Giesbrecht, ECV has about a 40 to 70 per cent success rate. But in her professional experience as an OB, she sees about a 50 per cent success rate. The procedure only takes a few minutes, but it can be very uncomfortable for women. “It’s painful,” says Giesbrecht, “but it’s less painful than recovering from a C-section if the baby does not turn.” Spinal epidurals for pain relief are an option, but your epidural would last much longer than the 2- to 5-minute ECV procedure. (Epidurals during ECV do not improve success rates, adds Giesbrecht.)
2. Forward-leaning inversion
These are postures that Comfort recommends to all pregnant women for optimal fetal positioning as your due date approaches—whether you’re carrying a breech baby or not. For 10 to 15 minutes before bed, or while watching TV, rest in child’s pose or rock back and forth on your hands and knees, if you’re comfortable. This helps with relaxing the pelvic muscles and the gravitational pull inside your uterus. Comfort says that while this technique is not “evidence-based,” it’s also not harmful. You might also try some gentle pelvic rotations—gyrating your hips as if you’re trying to belly-dance—to encourage the baby to move around.
3. Acupuncture and moxibustion
Moxibustion is a form of Chinese medicine and acupuncture, but instead of acupuncture needles, a practitioner applies gentle heat in the form of a mugwort stick, which looks a bit like a cigar. Only one end is lit, and the other (unlit!) end is gently applied to a pressure point on a pregnant woman’s baby toe (known as BL67). Giesbrecht, the OB, says that meta-analyses of acupuncture and moxibustion show there’s no adverse effects, but that these techniques aren’t necessarily proven to help, either. “There are no clear benefits or risks. It’s no better than waiting, but it does no harm,” she says.
Midwife Ruth Comfort, however, points to research from Europe. “There are some really good European studies proving efficacy of acupuncture on fetal position, as early as 32 weeks of gestation.”
4. Chiropractics: the Webster technique
Chiropractics and, more specifically, the Webster technique (you can watch videos online), are about addressing asymmetry in the pelvis and hipbones. If you’re used to visiting a chiropractor regularly, ask him or her to check for tighter or shorter ligaments. “This method is about realigning the pelvis and optimizing space for fetal descent, but trust your instincts,” says Comfort. “Don’t do anything you’re not comfortable with.”
5. Pelvic tilt (aka the ironing-board technique)
The breech tilt, or pelvic tilt, essentially means lying on the floor and raising your hips, with your feet planted on the ground and your knees bent. Or, some women position an ironing board so that one end is on the edge of a couch, and the other end is on the floor, creating a sloping bridge. Lie on the ironing board with your head resting on a pillow and your feet elevated, for a 20-minute period. (How you get your pregnant self onto, and off, this ironing board is definitely not going to be graceful. Ask for help.) “Other than the risk of a headache—and one of my patients busting an ironing board while she was lying on it—there are no adverse effects of this method,” Giesbrecht laughs.
Swimming, says Comfort, may not have proven results for turning breech babies, but can be quite relaxing for women. It’s therapeutic for tired joints and achy muscles late in pregnancy anyway, and it won’t hurt the baby.
Have you heard old wives’ tales about playing music to your belly? The theory is that directing tunes toward the base of your bump might coax a baby whose head is near your ribs to turn toward a head-down (also known as vertex) position, closer to the cervix and birth canal. There is no medical evidence to support this method, however. “I’m not even going to comment on that,” says Giesbrecht.
What happens if you have to give birth to a breech baby
Depending on how many weeks pregnant you are, and what kinds of alternative therapies you’re comfortable with, you may consider all—or none—of the above suggestions before it’s time to adapt your birth plan.
“Between 34 and 36 weeks we encourage as many natural techniques as you want to try—that, plus simply giving it time,” says Comfort. “It’s only at the 36- or 37-week mark that you’d book an ECV, begin to plan a C-section, or pursue a vaginal breech birth, if it’s an option for you.”
This can, of course, be frustrating: after a pregnancy that felt like smooth sailing, a flurry of decisions may need to be made last-minute, depending on fetal size, breech position, and—once the big day arrives—the length of your labour. Some pregnant women have difficulty adjusting to the reality that they can no longer go forward with the kind of birth they’d always envisioned.
“There’s a lot of grief around giving up the idea that you’re low-risk, that you’re no longer having a ‘normal’ pregnancy, and that you can’t have the delivery you expected,” says Comfort. “But I tell my patients not to worry too much and not to feel guilty if the baby won’t turn. Trust the baby—he or she may be breech for a good reason.”