Once more into the breech

You’ve bought your little dear the latest travel system, maxed out your cards on a luxurious bed nest and invested in a beautiful woven wrap to carry him in. How does he thank you? By deciding to turn the ‘wrong way round’ towards the end of your pregnancy. Brilliant!

Never fear, all is far from lost. Take a deep breath and read on to find out more about what you can do to encourage your little one to perform a flip and your options should he really been keen to enter the world bottom first.

This is a bit long and factual, but hopefully useful…

Help, my baby is breech – what can I do?!

At term (37-42 weeks) only 3% of babies are breech. Take heart, if you are waiting for your baby to turn before 37 weeks it is most likely he will! You might want to start thinking about how you can encourage him to shift if you are approaching term though. However close to delivery you are Spinning Babies is always worth a look to see what you can do to optimise your little one’s presentation.

If you are 35 weeks plus, you may want to step things up a bit. A qualified acupuncturist, particularly one who practices the Chinese art of moxibustion, can have dramatic results in persuading a breech baby to turn. Your doula should be able to recommend someone with a good track record and many hospitals and birth centres do have relationships with moxibustion practitioners, so it’s worth asking for a recommendation.

There’s a good summary of some safe ways to try and flip your little one at home here. With everything from frozen peas to shining a torch on the bump it can sound a little like interrogation techniques, so just do what you are comfortable with!

If you have a friendly homeopath it’s worth asking about remedies such as pulsatilla.
What might my midwife or doctor suggest?
Hopefully they will talk you through some of the above options in the first instance (and if they don’t you may want to ask them for some time to try these). At around 36 weeks if junior is still upside down they will suggest you come in for a scan. This allows them to confirm if your baby is breech and check for any reasons why he might be that way round (a placenta in a slightly funny place for example).

If the breech is confirmed you will most likely be offered External Cephalic Version (ECV). This is when a doctor manipulates your bump from the outside to try and manually turn the baby. You’ll want to find out the success rate of your particular doctor as they can vary wildly from 30-80% and it’s worth making sure you have the most experienced practitioner possible. You can ask for someone else if you aren’t happy with the first suggestion. Do also ask about whether they will give you any medication to relax your uterus and make the procedure less painful. There’s evidence that this improves the success rate.

Of course, you don’t have to accept the ECV – some people are worried about risks, others not keen on the pain, some don’t think it’s worth it as the success rate isn’t high at their hospital and others think if their baby is breech he is so for a reason! Take a look at this for more information on ECV.

What are my options if my baby stays breech?
I like the Royal College of Midwives campaign for normal births very balanced view on this:
“A breech presentation is normal, it is just not typical. This is really important to remember: breech is not an abnormality. And a normal labour and a spontaneous birth are not excluded just because the presenting part is breech (although not all breeches can or should be born vaginally).” More of this here.

The options you are presented with will depend on the type of breech presentation, your specific history, the attitude of your doctor and your hospital’s policy. It’s worth therefore being well versed in the facts, options and opinions yourself so you can make an informed choice.

You’ll almost certainly be offered an elective caesarean and you will be strongly encouraged to accept this for more challenging breech presentations or if you have other complications. Most breeches are now born by caesarean and midwives skilled in vaginal breech delivery are becoming more scarce. Requesting a vaginal delivery is therefore sometimes a bit of a fight.

But, a vaginal delivery is still possible and if you are interested in this, it is worth reading this article by the highly experienced midwife Mary Cronk, this by the Royal College of Midwives and as ever the homebirth resource site is a great repository of information on breech delivery, include breech births at home. Also useful is the Royal College of Obstetrician and Gynaecologists position on breech birth options.

Broadly speaking the accepted medical view is that caesarean delivery is statistically a bit safer for the baby, though carries more risks for the mother. This is largely based on a study called the ‘Term Breech Trial‘. There are however many practitioners who believe that when additional complications, inexperienced practitioners and other important factors are excluded from that study, the relative safety of vaginal and caesarean delivery for a breech baby is comparable. Caesarean delivery does have implications for future pregnancies, which is another aspect to consider. Mary Cronk’s article is a great summary of safe and unsafe breech delivery practices and when it is safe to attempt a vaginal breech delivery.

If you decide a vaginal delivery is for you, you’ll want to ensure you can be attended by midwives with a good deal of breech experience. In some cases this may necessitate hiring an independent midwife for which some couples have successfully billed their local NHS trust! AIMS will be able to discuss how to go about demanding an experienced breech midwife from your NHS trust.

Whatever you decide, be sure to do your research so that you are 100% sure of your chosen option and have negotiated the care you need.

I’ll end with this video of a frank breech homebirth, to show that you still have lots of options open to you, even with a breech birth.

Breech homebirth video

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