Is a cesarean birth the only option if my baby is breech?

Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood

No, you have numerous options. But before we dive into those, know that it’s common for babies to turn out of breech position up to week thirty-six of gestation. It’s certainly still possible after that, but it’s less likely, as baby is getting bigger, leaving less room for the turn.

If you are nearing week thirty-six of gestation and are feeling nervous about baby turning, the first step in encouraging them to turn is using the gentle turn techniques outlined in the “What to do” section below. From there, I discuss a more intense turning technique, called external cephalic version (ECV), and then help you explore what it would look like to vaginally deliver a breech baby. And finally, we’ll look at the process of coming to terms with a cesarean birth, if that ends up being the best path for you.

What to do

Try the following techniques, after getting the go-ahead from your care provider:

Gentle turning methods: If you’re past thirty-four weeks gestation, you can try natural techniques for turning baby into the vertex (head-down) position. Many of these methods are based on the belief that if your uterus is relaxed and your pelvis is optimally positioned, there’s more space for baby to get into the ideal position. And because their head is the heaviest part of their body, gravity helps them rotate if there’s room. These natural techniques are listed in the sidebar below.

Gentle Breech Turning Methods

Guided meditation: I’ve created a recording to support you in relaxing your uterus while envisioning baby turning into the ideal position; you can download it at the following link: yourserenelife.wordpress.com/breech-baby/. Beyond focusing on the physical act of creating more room in the uterus through relaxation, the essence of this meditation is to energetically connect with your baby and encourage them to turn. This is a helpful track to listen to as you engage in the following baby-turning techniques.

Moxibustion: In this exercise, a witch rubs eye of the newt, unicorn poop, and breast milk on your belly. Just kidding. But the real thing might seem a little out there. Derived from Chinese medicine, moxibustion consists of a licensed acupuncturist burning mugwort close to each of your pinky toes (the Bladder 67 acupuncture point). The idea is that the stimulation of heat by these points encourages the release of estrogen and prostaglandins, which in turn stimulate mild contractions that encourage the baby to turn, without causing preterm labor. Moxibustion is usually most effective when used in conjunction with acupuncture and positions used to turn a breech baby (after you receive the moxibustion).

Acupuncture: In addition to moxibustion, an acupuncturist can apply needles to points that will promote relaxation in your uterus and create an overall sense of calm.

Child’s pose: Encourage your baby’s feet or bum to lift out of your pelvis and flip to the upper portion of your uterus by settling into child’s pose. To do this, kneel on a soft, stable surface with your toes together, and knees hip-width apart. Then, lean forward and settle your forearms on the surface in front of your knees, and rest your head on your hands. From here, focus on getting your butt into the air. If you become light-headed or uncomfortable, ease out of the position.

On-all-fours belly dancing: Give baby gentle encouragement to make the turn by getting on your hands and knees on a soft surface (e.g., your bed or pillows on the floor) and gyrating your hips like you were belly dancing. You can make this less boring by popping on a show or music that makes you want to gyrate. And be forewarned that this hands-and-knees-hip-swirl has been known to make baby-making partners randy.

Pelvic tilt: Get back on that soft surface, lie on your back with your knees bent and feet planted on the floor, then lift your hips into the air. This is the bridge pose used in yoga. But we’re going to make it easier by having a friend or family member stack pillows under your hips until you’re able to rest in this position. Hang out here for ten to twenty minutes, listen to the guided meditation I keep touting, and repeat the process at least once a day.

The Webster technique: Performed by a chiropractor, this technique helps realign the pelvis to provide more room for baby to get into the vertex position. Ask your care provider for a referral for a local chiropractor skilled in this technique.

Music: While this is based on an old wives’ tale, it’s worth a try. Grab a portable speaker or some ear buds, turn on a funky jam, and place the speaker against your pelvis. The idea is that baby will be curious about the music and turn their head toward the speaker to investigate. At the very least, this provides an opportunity to develop baby’s good taste in music.

Spinning Babies Aware practice: Check out the following link to see if there is a Spinning Babies practitioner in your area: spinningbabies.com/spinning-babies-aware-practitioner -directory/. The Spinning Babies organization trains medical care providers and bodyworkers to help pregnant women utilize many of the techniques mentioned above. A practitioner can also guide you through a series of helpful daily activities, found here: spinningbabies.com/start/in-pregnancy /daily-activities/. In addition, you can take a class with a Spinning Babies Parents Educator, who you can find here: spinningbabies.com/spinning-babies-certified-parent -educator-directory/.

ECV: If you’re not able to turn baby with gentler techniques by week thirty-six or thirty-seven of gestation, ask your care provider if you’re a candidate for an ECV. In this not-too-fun-but-sometimes-effective technique, a trained practitioner will press on the outside of your abdomen, trying to turn baby’s head down. It usually takes just a few minutes, but it doesn’t always work.

Factors that increase your chance of a successful ECV include having given birth before and the care provider being able to easily feel baby’s head. Reasons you wouldn’t be able to have an ECV include placenta abruption, severe preeclampsia, or signs of fetal distress. In addition, some care providers won’t perform an ECV if you have low amniotic fluid levels or the cord is wrapped around baby’s neck.

While ECV is usually an uncomfortable procedure, it’s worth a try, as it has fairly good success rates. A study published in Obstetric Anesthesia Digest reported that 33 percent of first-time mothers and 61 percent of mothers who have given birth before will have a successful ECV. And there are ways to potentially increase those success rates. An article published in the Cochrane Database of Systematic Reviews reported that the following treatments may improve the outcome of an ECV, but that further research is recommended.

  • Relaxing the womb with drugs like beta stimulants and calcium channel blockers
  • Stimulating the baby with sound through the mother’s abdomen (see “Music” above)
  • Increasing the fluid surrounding the baby
  • Injecting an epidural or spinal analgesia to promote relaxation
  • Giving the mother opioid drugs to help her relax
  • Using guided meditation, which you might have heard about once or twice in this book

Breech delivery: If the ECV doesn’t work, you can start the search for a doctor who attends breech births. While these doctors do exist, they’re becoming harder to find, as many medical schools no longer teach doctors how to deliver a breech baby. Your best bet is to contact a university hospital and ask if they have care providers who support vaginal delivery of breech babies. You may need to contact numerous hospitals before finding someone. And sadly, the search may reveal that no one in your area attends breech deliveries. If you want to discuss breech deliveries with a doctor famous for his work in this area of obstetrics, and possibly receive a referral, reach out to Stuart Fischbein, MD, OB-GYN, through birthinginstincts.com.

If you find a doctor with the expertise and willingness to attend a breech birth, have a conversation with them about the risks and how they would support you through worst-case scenarios. After reviewing your medical records, they can also tell you whether you’re a good candidate for a breech birth. Circumstances that could make you a good candidate include the following:

  • You’ve given birth vaginally to one or more babies who were around the same size as the baby now in utero.
  • Your baby is in frank breech position, which means their butt is down, instead of feet first. It’s also ideal if their head is angled forward, chin to chest.
  • You don’t go into labor before week thirty-seven of gestation. Coming to terms with a C-section: With all that said, you might find that a C-section is the option you feel most comfortable with, and there is nothing wrong with that. Not feeling determined to have a vaginal breech delivery does not mean you’re “giving up”; it just means you’re following the path that feels intuitively right for you. And that path is different for each woman.

Part of your unique experience might also include disappointment over not having the vaginal birth you’d hoped for. You can feel frustrated by the turn of events, while still trusting that you’re having the birth you’re meant to have.

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