In this season of change for myself, I wanted to take time to start writing more often, and with that writing, review some of the information I’ve learned as a student midwife.
Recently, the subject of breech birth has been coming across my path. Often when that happens to students–when a particular subject keeps coming up–we start to wonder whether that is preparation for an upcoming birth. I hope this is coincidence and not the truth, but I’m paying close attention just in case. I do have a new preceptor on the horizon, a very experienced homebirth midwife with whom I’ve worked for one birth a few months ago, but there are no births coming very soon for me. So–knock on wood–hopefully the next birth I attend will be smooth and easy.
All that prefacing to say… Let’s talk about breech birth.
First, what is breech? In short, it’s when baby is upright in the womb instead of head-down. A baby may have their bottom coming first with either their legs extended upwards (Frank Breech) or their legs crisscrossed (Complete Breech), or they may have their foot coming down first (Footling Breech). When it comes to breech, Complete is the ideal scenario, producing the fewest additional complications, followed by Frank. Footling does come with more complications, for a variety of reasons. A woman may make a different choice about what to do about her breech baby depending on what kind of breech it is, so it’s important to make a note of the different kinds of breech that may be encountered.
The big question is, Can this be considered a variation of normal? Or does it always mean that something else is going on and baby is in danger?
The answer is… there is no absolute answer. Some babies have come down breech (sometimes without anyone knowing until baby came out) and had no trouble at all. Some have come out breech and had many complications. I don’t think we can say there are any absolutes, but we can say, at least statistically, that breech birth does have a higher potential of creating complications.
Complications of breech could include cord compression (where the cord gets stuck and “clamped” by baby’s wonky positioning, cutting off blood supply to the baby), aspiration in the newborn (if baby startles with their head still inside, they could breathe in fluids, causing breathing problems later on), stuck baby (because the bones of the skull do not fold the same way they do in vertex–head down–presentation, it’s more likely for baby’s head to get stuck), and injury to the mother (mother is more likely to tear). There is also a higher risk of cord prolapse (when the cord comes out before the body, which is a serious complication), since the baby’s bottom doesn’t fill the pelvis and stop the cord from coming out like a head does. When a baby is coming breech, midwives will often prepare for the worst and be ready to resuscitate as soon as baby is out, due to the increased risk of complications.
This is not to say that anyone should panic if their baby is breech. Many babies are born breech without complications, with the help of skilled and confident care providers, and these can be amazing, empowering, beautiful births. My view is simply that each mother should be informed, and should make her choice based on the facts (both of her individual situation and on statistical information), and she should be aware of all her options before she decides. Informed decision-making is my only goal here.
So if your baby is breech, what are your options?
- Spin that baby! The first step that most midwives will suggest is to visit http://www.SpinningBabies.com to start following an exercise regimen meant to turn the baby around from breech to vertex. Many times, the physiology of the mother (tight ligaments, torqued muscles, joints out of place) can influence a baby to turn breech, and releasing those can allow baby to turn. Other times, baby is just being silly, and doing certain exercises can encourage baby to flip around to vertex. Other non-invasive methods to encourage baby to turn head-down include moxibustion, chiropractic care, massage, and verbal instruction. Some are more evidence-based than others, and mothers should explore all possibilities.
- Accept and trust. Some women feel breech is a variation of normal, and without absolute indicators of complications, believe they should birth breech without attempting to turn baby around, or simply trust that baby will turn around when it’s time to birth. While that’s a beautiful thought, the higher incidence of complications (which cannot be predicted) should also not be dismissed or ignored. I do advocate for women to make their own choices in birth, but I also strongly feel these choices should be informed, and a long discussion should be had with the midwife to review the risks versus benefits.
- Perform an External Cephalic Version. This procedure involves a care provider physically turning baby from the outside. They will oil up the mother’s belly to provide lubrication. Then, with firm-but-cautious movements, will use their hands to guide baby into a head-down position. This should only ever be done by a care provider who has received full training in how to do it, and mothers with anterior placentas (where their placentas are located at the front of their belly) should only have this done in a hospital, where an ultrasound can keep track of placenta health and show the care provider where to put (and not put) their hands. It is more invasive, but compared to the risks of delivering breech, may be worth a try.
- Schedule a cesarean. This is always an option. Perhaps not the ideal option for all women, but in many areas, it may be the only option, if doctors trained and experienced in breech are not locally available. Breech is not the kind of birth you want to pressure your doctor into. If they are not comfortable with it, a cesarean is the safest option. You do not want an uninformed care provider accidentally causing more harm by delivering breech without the knowledge of how to do so. It is quite different from vertex birth, and requires an entirely different mindset. The same goes for midwives. If your midwife is not comfortable with breech, or if she is not permitted by her license to deliver breech (birth centers in Oregon are not allowed to deliver breech unless birth is imminent), and if turning techniques have not worked by the time you are in active labor, then it likely is the safest option to have a cesarean.
I don’t want to make this too long, so I’ll stop there. But if you are still curious about breech, you can always watch videos on youtube about it, google it on your own, or have a chat with your midwife about the available options for your area and per her license.
Here are a few resources to get you started: