Breech Presentation in Pregnancy

14 September 2018
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Breech births occur in approximately 1 in 25 full-term births, but this statistic is drastically skewed due to the number of mothers who opt for an elective c-section between gestational weeks 37-40 due to their baby’s position.

As a family chiropractor, I see many mothers throughout their pregnancies. I cannot begin to count to number of women who begin to worry about a baby who is sitting in a breech position. The first thing that I remind them is that there is still time! Until labor actually begins, and even throughout early labor, there is time for a baby to change positions. However, I completely understand the state of panic as the weeks fly by and a baby remains in a less than ideal position.

I will cover all of the ins and outs of the Webster Technique and how chiropractors can aid in helping a pregnancy be as uneventful as possible in another post, but today I want to break down breech positioning and the options you have as the mother.

To begin, there are several positions in which a fetus can become situated in utero; the most common being head down in an either left or right occipital anterior position. This means that the baby’s back is facing the mother’s abdomen (complete OA position) or is turned slightly with the back facing the left or right side of the mother and the head looking the other direction. These are commonly referred to as LOA and ROA positions (Left or Right OA). While these are the most common and easiest to birth positions, there are several other options a baby may choose.

A transverse, or side-lying baby is the only position in which is truly unsafe to birth. It can possibly be fatal for both baby and mother; however, a c-section does not need to be scheduled, as a baby can turn once labor begins. When the body begins labor, different hormones are released and both mother and baby work together. This can encourage the baby to turn head down. If baby’s position does not turn as the labor progresses, a c-section will be needed.

A breech baby, one who is sitting upright, presents a whole new level of challenges. There are three breech positions:

• Frank (or extended) breech—legs are straight and feet are up near the baby’s head.
• Complete (or flexed) breech—knees are bent, but feet are above the baby’s bottom.
• Footling breech—feet are below the baby’s bottom.

 

Most medical birth teams will start discussing the scheduling of a c-section after 36 weeks gestation. Typically, it is recommended to have the surgery between 38-40 weeks gestation, but it seems that most doctors choose never to discuss the most natural option: let labor occur naturally. It wasn’t but a few decades ago that all doctors (and midwives) delivered breech babies. It is known as a ‘hands-off’ delivery, meaning the birth team does not assist the baby as it is born. Pulling, tugging, or rotating a breech baby as it is born can cause severe problems, complications, or even end in death. Due to these risks, most doctors today have never even witnessed a breech birth, therefore will not perform one. It is a sad turn of events, as the risk is so little, and is truly only an increased risk when the birth is interfered with.

Breech presentation can be the effect of a pregnancy with multiple fetuses, placenta previa, amniotic fluid levels in abnormal range, abnormal pelvic conditions, or just a stubborn baby. It can be easy to learn that your baby is in this position, as kicks are felt in the lower abdomen. An ultrasound will also tell you more exact information.

If you are faced with a breech pregnancy and would like to help baby find a better position, there are several things you can do:

Practice Good Posture: Poor posture can encourage poor fetal positioning.

Exercises from www.SpinningBabies.com

Chiropractic Adjustments: The Webster Technique has a high success rate with encouraging babies to find a more ideal birthing position.

Therapeutic Massage: Muscles and tendons control more than one would expect. By using pressure points and massage, the body can be triggered to relax and allow the baby to move easier.

External Version: This manipulation is not recommended until after 34 weeks gestation, but most doctors will not perform the technique until 38 weeks, as they want baby’s lungs developed prior to trying to manually ‘flip’ the baby. This technique does not come without risks, as it can cause the placenta to be torn from the uterine wall, bleeding to occur, and immediate delivery of the baby. While rare, these are possible outcomes and make sure you discuss them with your birthing team.

Of course, there is always the option of having a vaginal breech birth. Finding a doctor who will perform this delivery may not be easy, but it is not impossible. Several midwives will attend breech deliveries, and it is your right to birth your baby as you please. A hospital may have you sign a waiver that you are going against medical recommendations, but it is your birth. You need to feel comfortable with your birth team and confident in your decisions, no matter what you choose.

References:

https://spinningbabies.com/learn-more/baby-positions/other-fetal-positions/left-occiput-anterior-loa/

https://spinningbabies.com/learn-more/baby-positions/breech/when-is-breech-an-issue/

https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/a-breech-baby-at-the-end-of-pregnancy.pdf

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(00)02840-3/fulltext?_eventId=login

http://americanpregnancy.org/labor-and-birth/breech-presentation/