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Breech Birth

Breech Birth

When Your Baby is in a Breech Position
by Vanessa Stephens, The Childbirth Collective

Although vaginal breech birth is possible and generally safer than Cesarean section, it is preferable for safety reasons that the baby be born headfirst. Here are some things to try to encourage your baby to assume a vertex (head-down) position.

Burning Mugwort-Moxa Sticks

...outside of the little toe. Keep close enough to the skin to feel hot but not close enough to burn yourself.

Homeopathy

Use Pulsatilla 30c or 200c, one dose twice daily until your baby turns.

Breech Tilt Exercises

Lay on a board, one end on the floor and the other on a couch, or propped up by loots of pillows, head down and with your pelvis up at a 45 degree angle, for 10 to 15 minutes twice a day (or more often if you can) until the baby turns head down.

Visualization

See in your mind's eye your baby's heavy head slowly and gently surrendering to gravity and sinking down towards your cervix. Imagine that your baby has already changed position and is head down, ready to be born.

Talk to Your Baby

Tell her or him all about your situation and request that she/he change position. You could say how much more comfortable it might be to have his head cradled by your pelvis and going with gravity, how much safer you would feel with her head down, or anything else that comes to mind.

Have your partner or a friend speak to the baby through a toilet paper tube placed down by the cervix. Be relaxed, friendly and gently encouraging. A warm voice and loving words might make the baby want to hear more and get closer to the sound.

Talk to Yourself!

Sometimes a mother holds her baby close to her heart due to fears of birth or parenthood, feelings about safety of the world the baby will be born into, or other emotional reasons. Explore why you might feel a need for your baby to be breech.

Chiropractic Adjustment

Some chiropractors are familiar with the Webster maneuver, which can encourage a breech baby to turn. Find one who knows this technique.

External Version

If the above methods don't work, you may wish to try having your birth practitioner turn the baby manually to a cephalic presentation. This is accomplished by feeling or using ultrasound to determine the way it would be easiest for the baby to turn, then applying gentle pressure hand-over-hand. The relaxation of the mother is the key to the safety and efficacy of this method, so practice deep breathing and any relaxation techniques you know before, during, and after the procedure. Most practitioners will administer terbutaline-a drug that relaxes uterine muscle-to the mother, and this has its own set of risks. Version is more successful if performed before 37 weeks, but babies frequently return to the breech position. If done after this time, there is greater chance that the baby will not turn, but if he or she does, then is more likely to stay head-down. Unlike the above methods, there are some slight statistical risks associated with this procedure: placental abruption, where the placenta detaches from the uterine wall, cord accidents, maternal/fetal transfusion of blood, which is a problem if the woman is Rh negative. If you are Rh negative you may receive a shot of RhoGam after the procedure.

All of the above methods may be used together. When the baby turns, do lots of walking to help her/his head settle in your pelvis. Posture is important, so sit upright in straight-backed chairs or on a birth ball whenever possible until the birth.

If None of the Breech-Turning Methods Works

Vaginal breech birth is not only possible, it is desirable and statistically safer in many ways than cesarean birth. It can be difficult to find a doctor or certified nurse-midwife who will attend a vaginal breech, but they are out there! Some homebirth midwives, known as traditional, empirical or direct-entry midwives, are experienced with vaginal breech births and will attend them. Oftentimes medical personnel or family members scare women with stories or threats of harm. They don't mean to do this; their own fear or lack of experience gets in the way. Surround yourself with people who believe in the natural process of birth. Hire a doula if you can, and don't be afraid to change caregivers or hospitals at any time during pregnancy. Resist lying on your back for the birth. For safety reasons a standing position is best. Try a supported squat with your partner standing behind you, or kneeling with one knee up and one on the floor.

Some women become too frightened or feel too unsupported to attempt vaginal breech birth and opt for a cesarean, which most caregivers are willing to provide. Should this be the case for you, it is strongly advised that you go into labor on your own before surgery. Induced labor is often unsuccessful with an unripe cervix and an early baby. Natural labor is good for babies! It prepares the baby to be born and helps him or her withstand the stress of birth, and prevents prematurity. Some babies even turn head-down during labor.

Whatever you choose to do and whatever the results of your choices, remember that you did the best you could at the time. Your baby and your body have wisdom of their own, and thought it isn't always possible to know the reasons why some things happen, there are always reasons. Only you know what is best for you and your baby. If a particular choice just feels right or wrong, it may be-let your intuition be a guide. The best choices are made from love, not fear. So make yours from an open heart, and best wishes!

Planned vaginal delivery versus elective caesarean section:
a study of 705 singleton term breech presentations.

Irion O, Hirsbrunner Almagbaly P, Morabia A.
Department of Obstetrics and Gynaecology, University Hospital of Geneva, Switzerland.

OBJECTIVE: To compare neonatal mortality and neonatal and maternal morbidity in planned vaginal delivery versus elective caesarean section for breech presentation at term. To identify factors associated with the risk of caesarean section during labour.
DESIGN: Cohort study.
SETTING: University Hospital of Geneva.
POPULATION: Seven hundred and five consecutive singleton term breech presentations: 385 planned vaginal deliveries and 320 elective caesarean sections.
METHODS: Relative risk and risk difference with their 95% confidence intervals (95% CI) were calculated for neonatal and maternal morbidity. Prognostic factors for the risk of intrapartum caesarean section were analysed by multiple logistic regression.
MAIN OUTCOME MEASURES: 1. Neonatal mortality 2. Neonatal morbidity (eg. fracture, haematoma with hyperbilirubinemia, paresis, paralysis, visceral trauma, respiratory distress, umbilical cord arterial pH < 7.0 with 5 minute Apgar score < 7), corrected neonatal morbidity was defined as morbidity after exclusion of major malformations. 3. Maternal morbidity (eg. endometritis, urinary infection, pulmonary infection, surgical complications, hysterectomy, anaemia, pulmonary embolism, cardio-respiratory arrest).
RESULTS: There were significantly fewer maternal complications in the planned vaginal delivery group than in the elective caesarean section group (risk difference 10.5%, 95% CI 3.9 to 17.0). Five neonates with major malformations died. There was no difference in corrected neonatal morbidity between the planned vaginal delivery and the elective caesarean section groups (risk difference 1.9%, 95% CI -1.0 to 4.9). Nulliparity, maternal age > 30 years and a higher body mass index were independently associated with the risk (30%) of intrapartum caesarean section, but it was not possible to construct a predictive model useful for clinical practice.
CONCLUSIONS: There is no firm evidence to recommend systematic elective caesarean section for breech presentation at term. Large unbiased studies are needed to determine whether a potential benefit for the newborns outweighs the increased risk for the mothers associated with elective caesarean section.

 

Doctors need more training in delivering breech babies.(News)
British Medical Journal, June 24, 2000, by Mark Silvert

The single and most avoidable factor in causing stillbirths and deaths among breech babies is suboptimal care given in labour, according to the seventh annual Confidential Enquiry into Still-births and Deaths in Infancy (CESDI).

In cases where the cardiotocograph was available for review, there was clinical evidence of hypoxia in all but one case before delivery, and delays in staff response to fetal compromise occurred in nearly three quarters of cases. These delays ranged from 30 minutes to 10 hours.

The report, which applies to babies in England, Wales, and Northern Ireland, said that a registrar was the practitioner most likely to be involved in the labour and delivery of breech babies. Less than a fifth of these labours had involvement from more senior staff, and consultants were informed in only half of these cases before delivery. Inexperience at the time of delivery exacerbated the risk for an already hypoxic baby in some cases.

Pathology reviews confirmed the clinical findings that hypoxia was the commonest cause of death. Trauma was the sole cause in one case.

Less than a quarter of the postmortem examinations included a systematic and comprehensive examination of factors relevant to the death of a breech baby born vaginally.

In the light of these findings, the new report recommends that trusts should ensure that all staff are skilled in fetal surveillance and that the most experienced available practitioner is involved and present at a vaginal breech delivery.

Structured simulated training is advocated for all staff who may encounter a vaginal breech delivery. Trusts have also been told that they need to ensure good documentation of anaesthetic events, including the time of the decision to deliver, when the patient reached the operating theatre, when the anaesthetist was informed, and when the baby was delivered.

One of the recurrent themes noted by the inquiry was the problem with the use and interpretation of cardiotocographs.

A full copy of the 7th annual report can be obtained from the CESDI Secretariat, Chiltern Court 188 Baker Street, London NW1 5SD (tel 020 7486 1191), price 6 [pounds sterling].


COPYRIGHT 2000 British Medical Association in association with The Gale Group and LookSmart.
COPYRIGHT 2000 Gale Group

Breech Scoring Index
by Valerie El Halta, "Normalizing the Breech Delivery," Midwifery Today Issue 38

When determining the feasibility of attempting a breech delivery, this scoring index is of great help. However, it remains paramount that the midwife use her own judgment as well. Never attempt a delivery for which you have neither the skill nor the experience. Even when you have determined that there are no predisposing factors against the delivery, if your heart shouts "No!", don't do it!

Breech Index Scoring System
Score:
0
1
2
Parity:
Primip
Multip
Gestational Age:
>=39 wks
37-38 wks
36-37wks
Estimated Weight:
8 lb.
7-8 lb.
5-7 lb.
Dilation:
2 cm
3 cm
>=4cm
Station:
-3
-2
<=-1
Previous Breech:
0
1
>=2

This assessment is designed to be made at the onset of labor. A client would be scored as follows:

A multipara (score 2) with a baby who weighs between 7 and 8 pounds (score 1), at station -3 (score 0), dilation 4 cm (score 2), no previous breech babies (score 0), would have a total score of 5.
A score of less than 3 would indicate the need for a cesarean section.
A score of 4 to 5 indicates a careful review must be made and suggests one should proceed with caution.
A score of 5 or more would indicate a reasonable chance for a successful vaginal delivery.
Of course, some moderating factors exist. If a multipara has had two 9-pound babies vaginally and this baby is of similar size, she should do fine as long as the baby does not go postdates.
I usually subtract one point for footling breeches because they are somewhat more difficult to manage.
In general, I have found this system to be very reliable for predicting outcome.

More Information about Breech Birth:

Heads Up!  All About Breech Birth
http://www.breechbabies.com/

MoonDragon's Breech Information
Breech Presentation Positions & Overview
http://www.moondragon.org/obgyn/pregnancy/breech.html

Normalizing the Breech Delivery (Video Tape)
by Valerie El Halta

Breech Birth: Woman-Wise
Breech Birth: Woman-Wise

by Maggie Banks

 


Breech Birth

Breech Birth

by Benna Waites, Anthony Craib (Illustrator)

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