Breech Babies
Ideally, in the final weeks of pregnancy, baby will move into the vertex
position (his head facing downwards) to prepare for birth.
Approximately 3% of babies settle into a breech position, with head up
high, and feet or bottom down low in the pelvis.
The standard treatment for breech babies is cesarean section. Most
physicians do not have experience doing vaginal delivery of breech babies.
Thus, many moms want to know: is there anything they can do to encourage
baby to turn head down?
Before 34 weeks, don’t worry too much about baby’s position.
But, at 34 – 35 weeks, if baby is still head-up, that’s when we want to
get to work, as it is easiest to get a baby to turn head-down between 34 and 36
weeks of pregnancy. Check with your caregiver before trying any of these
methods.
Non-Invasive
Ways to Encourage Baby to Turn
Positions You Can Try:
Breech tilt with pillows: Lay on your back with your knees bent, and
your feet flat on the floor. Raise your pelvis up, and slide in enough pillows
to raise your bottom up 10 – 15 inches higher than your head.
Ironing board: Lay an ironing board or other board so it’s at a 40-45
degree angle. Lay on your back, with feet up and head down. Bend your knees.
Open knee – chest position: The best picture I’ve found is http://www.spinningbabies.com/Pages/Page%204.html
Do any of these positions three times a day for 10-20 minutes at a time.
It’s best to do it when baby is awake and active.
Music or
voice: Playing music down near the bottom of your belly (put headphones or a
walkman down near the pubic bone), or having your partner talk to the bottom of
the belly are supposed to encourage your child to rotate his head down to
there. Combine this with the positions mentioned above. (Note, the research done on this actually
used an unpleasant loud buzzing noise at the top of the uterus, and the baby
turned away from the unpleasant noise.)
Swimming: Spend time
in water (in the swimming pool, in the bathtub). Theoretically, this increases
your amniotic fluid, which may make it easier for baby to turn. In the pool, do
visualizations…
Visualize the baby
turning. Talk to your baby,
encouraging it to turn… These things can’t hurt, and some people swear by them!
Alternative
Medicine (These are more invasive options than the home remedies listed above:
consult with medical professionals before trying these.
All these work best from 34 – 36 weeks.
Homeopathic Measures. “If your baby is found to be breech
close to your due date, try homeopathic Pulsatilla 200c once a day. Repeat one
more day if the baby hasn't turned yet. If your baby found to be breech early,
Pulsatilla 30c take three to five pellets under the tongue twice daily for two
weeks. Or try using homeopathic Pulsatilla 6X one tablet under the tongue four
times a day. Take Pulsatilla tablets, then do breech tilt.” [Note, consult with a caregiver trained in
homeopathics before following this regimen.]
Chiropractors: Some chiropractors are trained in something call
the Webster technique: It is described at /www.icpa4kids.com/webster_technique.htm.
Information on efficacy is here. To
find a chiropractor trained in this technique, go to here: www.icpa4kids.com/find_pediatric_chiropractor.htm
Acupuncture/Moxibustion. Acupuncture may be effective at turning the
baby, especially if supplemented with a light electrical current. Moxibustion
involves putting a burning herb near acupuncture points. This may also help
baby to turn. This website
describes how moxibustion is done, but they recommend doing it yourself. It is
far better to go to a trained practitioner. I do not know of a place to search
for one, but you can call your local acupuncture providers, and ask if they
have experience with this.
Most Invasive. The obstetric technique known as version is used at
37 weeks, under careful monitoring, as it may cause labor to begin. http://familydoctor.org/handouts/310.html
See below for care providers in the
The following is a list of care providers in the
Chiropractors:
· Dr.
Scott Mindel,
· Heather
Denniston in Issaquah. Her practice is
Lifetime Chiropractic. She charges $35 a
session and usually requires about 6 sessions.
· The
website ICPA has a list of all the chiros who do this technique. www.icpa4kids.com/find_pediatric_chiropractor_washington.htm
Acupuncture.
Here are some acupuncturists who may work with breech babies.
· Susan
Moore is an acupuncturist in Ballard who specializes in prenatal issues.
· Dr.
Pushpa Larsen Giaconne (sp.?) at Arbor Vitae in
·
·
· Gracewinds
Perinatal Services (206) 781-9871
· Roni
Sellman OMD, LAc 206-852-8266
· Seattle
Naturopathy Acupuncture & Birth Center Morgan Martin, LM, ND; Felice
Barnow, ND, LM, RN; Rick Posmantur, ND, LAc 2705 E Madison Seattle, WA,
98112 206-328-7929 Fax: 206-328-6066 info@snabc.com www.seattlebirthcenter.com
· Joyce
Greenberg: 206.760.4828.
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Research
Data:
The items below were collected by Kelly Beeken
Research Info follows:
External Cephalic Version for VBAC
Am J Obstet Gynecol. 1991 Aug;165(2):370-2.
External cephalic version after previous cesarean section.
Flamm BL, Fried MW,
Department of Obstetrics and Gynecology,
Approximately 100,000 cesarean sections are performed each year
in the
Eur J Obstet Gynecol Reprod Biol. 1998 Oct;81(1):65-8.
External cephalic version after previous cesarean section: a
series of 38 cases. de Meeus JB, Ellia F, Magnin G.
Department of Obstetrics, Gynaecology and Reproductive Biology,
University
OBJECTIVE: To determine if external cephalic version (ECV) is a
reasonable alternative to repeat cesarean section in case of breech
presentation. STUDY DESIGN: Retrospective study of 38 women with one previous
cesarean section and a breech presentation after 36 weeks of gestational age
who have had at least one experience of ECV. Statistics used the Fisher's test
with significance when P<0.05. RESULTS: Version attempts were successful in
25 of the 38 women (65.8%). Seventy-six percent of the successful version women
went on to have vaginal birth after cesarean section. A total of 19 successful
vaginal deliveries occurred (50%). Success rate of ECV was lowered when breech
was the indication of the previous cesarean section. The vaginal delivery rate
was increased after successful ECV in patients previously vaginally delivered,
but this difference did not reached significance (P=0.057). No maternal or
neonatal complications occurred. CONCLUSION: ECV is acceptable and effective!
in women with a prior
low transverse uterine scar, when safety criteria are observed.
Int J Gynaecol Obstet. 1994 Apr;45(1):17-20.
External cephalic version after previous cesarean section--a
clinical dilemma.
Schachter M, Kogan S, Blickstein I.
Department of Obstetrics and Gynecology,
OBJECTIVES: To describe our limited experience with external
cephalic version from breech to vertex presentation at term, with the use of
ritodrine tocolysis, in women who had undergone a previous cesarean delivery.
METHODS: Eleven parturients after previous cesarean delivery underwent external
version after 36 gestational weeks, utilizing tocolysis with ritodrine, after
excluding cases of low-lying placenta, severe oligohydramnion or ruptured
membranes. Patients were then followed until delivery and scar examination was
carried out after vaginal delivery, or at re-cesarean section, according to
mode of delivery. RESULTS: All 11 attempted versions were successful. Six
patients subsequently delivered vaginally and five by re-cesarean section. None
of the uterine scars showed any signs of dehiscence. Three of the five infants
delivered by re-cesarean section weighed over 4000 g, whereas all of the
vaginally-delivered infants weighed under 3500 g. CONCLUSIONS: External
cephalic!
version to vertex
presentation after previous cesarean section was successful in all 11 carefully
selected patients. No untoward effects were noted, and no signs of scar
dehiscence were found. The safety and efficacy of this procedure after previous
cesarean delivery should be examined further.
I'm not just picking out the good ones... this is the only
research there is.
Webster Technique
Sacral subluxation causes the tightening and torsion of specific
pelvic muscles and ligaments producing uterine constraint. It is these tense muscles and ligaments and
their constraining effect on the uterus which prevent the baby from comfortably
assuming the vertex position. The Webster Technique is defined as a specific
chiropractic analysis and adjustment that reduces interference to the nerve
system, facilitates balance in the pelvic and abdominal muscles and ligaments,
which in turn reduces constraint to the woman_s uterus allowing the baby to get
into the best possible position for birth.
Dr. Larry Webster, Founder of the International Chiropractic
Pediatric Association discovered this technique as a safe means to restore
proper pelvic balance and function for pregnant mothers. In expectant mothers
presenting breech, there has been high reported success rate of the baby
turning to the normal vertex position.
Any position of the baby other than vertex may indicate the
presence of sacral subluxation and
therefore result in intrauterine constraint. It is strongly recommended by
instructors of this technique, that this specific analysis and adjustment of
the sacrum be used throughout pregnancy, to detect imbalance and prevent
intrauterine constraint.
To find DC: http://www.icpa4kids.com/find_pediatric_chiropractor_washington.htm
Moxibustion Treatments
It seems as if when more technology finds its way into
obstetrical care, so does alternative healing. Traditional Chinese medicine,
for example, uses moxibustion to promote version of fetuses in breech
presentation. The success of this process was reported in The Journal of the
American Medical Association (JAMA. 1998; 280:1580-1584).
Moxibustion is the process whereby moxa - a dried herb, usually
the species mugwort (Artemisia vulgaris) - is burned either directly on the
skin or indirectly above the skin, over specific acupuncture points or areas on
the body. When lit, moxa burns slowly and provides a penetrating heat that can
enter the channels to influence the Qi and blood flow, therefore releasing
therapeutic properties. Moxibustion has been used in combination with
acupuncture for centuries.
A very common form of indirect moxibustion uses moxa sticks that
are lit and held about an inch above the point or area to be treated. Another
method is the use of the moxa box, which allows heat from the moxa to be
distributed to a larger area. Applying moxa cones to the skin is a form of
direct moxibustion. Treatment can be applied for a variety of conditions for a
few minutes to a longer period of time.
Francesco Cardini, M.D., a private practice physician in
All 260 study participants from the outpatient department of
Women's Hospital of Jiangxi Province, Nanchang, and Jiujiang Women's and
Children's Hospital in the People's Republic of China, were primigravidas in
the 33rd week of gestation with normal pregnancy and an ultrasound diagnosis of
breech presentation.
The 130 subjects randomized to the intervention group received
stimulation of acupoint BL 67 by moxa rolls for 7 days, with treatment for an
additional 7 days if the fetus persisted in the breech presentation. The 130
subjects randomized to the control group received routine care but no
interventions for breech presentation. Subjects with persistent breech
presentation after 2 weeks of treatment could undergo external cephalic version
anytime between 35 weeks' gestation and delivery.
During the 35th week of gestation, 98 (75.4%) of 130 fetuses in
the intervention group were cephalic vs 62 (47.7%) of 130 fetuses in the
control group. Despite the fact that 24 subjects in the control group and 1
subject in the intervention group underwent external cephalic version, 98
(75.4%) of the 130 fetuses in the intervention group were cephalic at birth vs
81 (62.3%) of the 130 fetuses in the control group.
The researchers
concluded that among primigravidas with breech presentation during the 33rd
week of gestation, moxibustion for 1 to 2 weeks increased fetal activity during
the treatment period and cephalic presentation after the treatment period and
at delivery.
Another helpful article: http://www.birthinternational.com/articles/andrea13.html