What to Do If Your Baby Is Breech

A breech baby is a commonly used term to refer to a baby who is not in a head down or vertex presentation. Usually, this means the baby is bottom down towards the cervix. About 3-4% of babies at 37 weeks gestation are breech.

It's more common to have a breech baby if:

• You've had several babies before
• You have excessive amounts of amniotic fluid (polyhydramnios)
• Your uterus has growths or anomalies
• Your baby has anomalies
• Your placenta is low lying or you have placenta previa

Most babies are head down by 32 weeks into pregnancy and of those who are not, the vast majority will be head down by the time labor starts.

There are some ways to increase the chances of your baby turning to a head down position that you can try at home, including:

• Tilt positions. This is probably the most well-known method of trying to turn a breech baby. You can do it the easy way and use an ironing board lying on the couch. Place your feet up and your head down. The theory behind this is that your baby's head, the heaviest part of his or her body, will disengage from the pelvis and the baby will turn head down. It's generally recommended to do this for 20 minutes a day until the baby turns. Some women report dizziness from being in this position. Always discuss this or any other exercise with your midwife or doctor.
• Light/music. The use of light or music directly at your pubic bone may encourage the baby to come towards the light or sound. Many women report success with this and it has no side effects. For a nice touch, you can have your partner talk towards your pubic bone, again to encourage baby to move towards the sound. Do this as often as you like until baby turns head down.
• Water. Some claims state that diving into a pool or simply being in a pool will encourage the baby to turn. Again, there are no real side effects noted from being in a pool, but double check with your doctor or midwife about the diving.

Alternatively, you can seek outside help in turning the baby into a head down position. These methods include:

• Homeopathy. Homeopathics, particularly a dried plant called pulsatilla, have been used for centuries in assistance in turning a breech baby. However, speaking to a knowledgeable practitioner is a must when trying to use this to help turn the baby.
• External cephalic version (ECV). External version is generally done around 37 weeks. To be a candidate you must have adequate amounts of amniotic fluid to cushion the baby. The most common way this is performed is in a hospital with fetal monitoring, ultrasound, and often IV medications to relax the uterus. If it's performed prior to 37 weeks, you run the risk of premature labor, plus many babies may have turned on their own. The biggest risk to the ECV is a separation of the placenta. This rarely occurs mostly due to the guidance of the ultrasound. There are also potential complications with cord involvement. Recent studies show that epidural anesthesia may actually increase the success rates of external version, which are stated to be between 65-70 by an experienced practitioner.

Say you've tried some or all of these and your baby is still breech. What does this mean?

There's actually a lot of misinformation about the mode of birth for breech babies. Many people will tell you that the only method of delivery that's safe is an elective cesarean. This is absolutely not true. Many of the problems that were once thought to be caused by the vaginal breech birth were not actually caused by the birth but by something prior to the birth. Most of the breech babies born in the United States are currently not being born vaginally (though this statistic varies drastically from practice to practice).

Many criteria have to be met prior to considering a vaginal birth for a breech baby, though even the experts disagree on what they should all be. Generally speaking your chances of delivering a healthy breech baby vaginally increase with the following:

• Baby is frank breech (feet straight up)
• You've had a baby or babies vaginally prior to this birth
• Baby is not thought to be excessively large
• You have no pelvic or uterine anomalies

Some breech babies are generally better off being born by cesarean. Only your practitioner can help you determine if your baby is one of them. If you do have a cesarean, this doesn't mean that all of your subsequent babies would be breech or necessarily be born via cesarean section.

Sources:

Cluver C, Hofmeyr GJ, Gyte GM, Sinclair M. Interventions for helping to turn term breech babies to head first presentation when using external cephalic version. Cochrane Database of Systematic Reviews. January 18, 2012;1:CD000184.

Coyle ME, Smith CA, Peat B. Cephalic version by moxibustion for breech presentation. Cochrane Database of Systematic Reviews.  May 16, 2012;5:CD003928.

Vas J, Aranda-Regules JM, Modesto M, et al. Using moxibustion in primary healthcare to correct non-vertex presentation: a multicentre randomised controlled trial. Acupuncture Medicine. March 2013;31(1):31-38.