As doulas we run into clients who have a breech baby and feel driven into a corner. Doulas can help the mom feel supported and educate her about her local resources. Here are a few things you might not know.
1. Fear and lack of training drives current outcomes for breech births, not correct education. Educating care providers will improve breech birth outcomes. Vaginal breech births began their decline in 1980’s. The University of Toronto conducted a study of 1997- 2000 and reported serious newborn morbidity in 3.8 percent of babies who were delivered vaginally versus 1.4 percent of the infants who were delivered by C-section. This study stopped breech trial of labor around the world, but the study turned out to be faulty in many ways. Higher mortality rates don’t seem to be true in places with good protocols and experienced staff… but there continues to be great fear around vaginal breech births.” In fact, a 2006 study that focused on women in Belgium and France who presented with breech babies found rates of mortality or morbidity “did not differ significantly between the planned vaginal and cesarean delivery groups.” Since then over 100 studies have been performed to support vaginal breech birth. This 2015 study looks at breech births around the world.
2. What are the Breech positions? In the past they were just a variation of the norm
Frank (50-70%) Birth Without Fear
Footling (10-30%)
Complete (5-10%)
3. Are they doomed to a c-section? In 2016 3.9% of all babies were breech 93% were born by Cesarean (EBB). In 1999, 24 percent of women with babies in a breech position planned in advance to have a C-section, which rose to 60 percent in 2007. Perinatal mortality is increased 2- to 4-fold with breech presentation, regardless of the mode of delivery. Deaths are most often associated with malformations, prematurity, and intrauterine fetal demise. (Birth Without Fear)
Breech stats at 35 weeks to spontaneous labor found that breech positioning is more common prior to term—25% are breech before 28 weeks, but by 32 weeks only 7% of babies are breech (EBB) Today by 34 weeks care providers expect baby to be head down. If they are not by 34 weeks, the care providers get concerned.
4. Is an external version an option? Success rates in 2016: Research supports best if done at 35-36 weeks.. 55.8% of the versions were successful, 68.0% of people went on to have spontaneous vaginal births (EBB), 44.2% failed versions and 88.2% people went on to have Cesarean births. In a 2017 Australian study 66% of pregnant people had ever heard of a version, and most of them (87%) had learned about version from books or family/friends—not from care providers.
5. Breech vaginal birth success rates: in a 2007 study 40 percent of mothers in that situation still choose a vaginal birth. The risk of perinatal mortality is approximately 0.5/1000 with caesarean section after 39+0 weeks of gestation; and approximately 2.0/1000 with planned vaginal breech birth. This compares to approximately 1.0/1000 with planned cephalic birth (online library). ACOG states that "women should be informed that maternal complications are least with successful vaginal birth; planned caesarean section carries a higher risk, but the risk is highest with emergency caesarean section which is needed in approximately 40% of women planning a vaginal breech birth. [ACOG New 2017]" The presence of a skilled birth attendant is essential for safe vaginal breech birth. Women near or in active second stage of labour should not be routinely offered caesarean section. Either a semi-recumbent or an all‐fours position may be adopted for delivery and should depend on maternal preference and the experience of the attendant. If the latter position is used, women should be advised that recourse to the semi-recumbent position may become necessary. [New 2017]
6. Who is likely to carry a breech baby? Moms who are diabetic are 3 times more likely to have a breech baby than the general population. Smoking is associated with a 30% higher risk of a breech birth if it occurs during the pregnancy. More than 60% of all women presenting in the unit for breech birth are first time mothers. 93% of babies who are born in the breech position have no congenital abnormality of any kind.
7. Trained care providers and support people improve birth experience. "In light of recent studies that further clarify the long-term risks of vaginal breech delivery, the American College of Obstetricians and Gynecologists recommends that the decision regarding mode of delivery should depend on the experience of the health care provider Cesarean delivery will be the preferred mode for most physicians because of the diminishing expertise in vaginal breech delivery." (ACOG)
We can do 3 things to help:
1. Educate to stop fear cycle
2. Give options to empower parents
3. Release muscles to allow baby to flip
II. Opening pelvic space gives baby a greater chance to move into a head down position.
1. 3 Sisters of balance from Spinning Babies
A. Forward Inversion
B. Sifting with a Rebozo
C. Side-lying Release
2. Peanut Ball for a Breech Inversion (see video below)
3. Massage using the rebozo
4. Myofascial Massage Release
5. Leg Circles
6. Open Knee to Chest
7. Chiro (Webster’s Technique) 82% success rate
8. Acupressure (Moxibustion) using moxibustion twice per day for two weeks (during weeks 33-35 of pregnancy) will work for 1 out of every 8 women (EBB). I have found the traditional moxi sticks more effective. The smokeless ones don't get as hot and the herb does not seem as potent.
9. Shake the Apples (see video below)
10. Standing sacral release
III. The Brain is a powerful friend or foe. You can help moms release and open up the emotional, psychological, and informational part of the brain.
1. Emotional: Most times the Breech position is due to an emotional issue. If you release the emotions (fears and worries) baby will flip shortly thereafter. I find this to be the most important part. Give her hope! Listen to her fears. Most of the time all she needs is a safe place to unburden all her fears.
A. Give the mom permission to feel.
B. “Brain, Heart, and Lady parts” (Mary Campbell- Midwife) They are all tied together!
C. Journaling in the tub alone. Just have her write stream of consciousness: all her thoughts be it crazy, good, or bad. All are valid and the swirling thoughts and emotions need to come out.
2. Psychological:
A- Free yourself by cutting out the social garbage and don’t listen to it. Their choice is not your choice.
B- Hypnobabies: Bubble of Peace
3. Informational:
A- Listen to her fears
B- Educate her and explore her options to find what she wants and the strength she has to do it (c-section, ECV, wait it out, moxibustion, change doctors, deliver vaginally anyway, find a home birth midwife, etc)
C- Teach her to feel her baby and map what position baby is in. This helps her feel she is part of the process.
4. Try this breech routine. It takes on average 3 days to flip. Start at 34 or 35 weeks. Before 34 weeks, the baby has not settled yet and will flip back and forth. The closer you are to 40 weeks, the lower the possibility of flipping.
A- Forward Leaning Inversion: 1 X’s daily
B- Rebozo Sifting: 10 or more minutes daily
C- Side Lying Release: 5 minutes on each side
D- Breech Inversion: 3 X’s a day 20 minutes apart. If you want you can also put frozen veggies on mom’s belly behind baby’s head. Place warm compress near pelvic bones and baby’s butt on the side where hands and feet are. Have mom wear earbuds so that she can stay relaxed. (don’t do it if mom has high blood pressure or any other medical concern from her care provider)
E- Positive Thinking: Tell Baby “Turn Baby Turn” and rub belly clockwise
F- Manteada (5 mins) with rebozo while laying on her back on the floor
G - Take a long private bath and journal your stream of consciousness while in the tub alone with relaxing music, lighting, etc. Let your body float and relax. This step is probably the most important of all.
*Do all this for 3 days. If baby flips, stop breech inversion. Walk 1-3 miles every day after that
F- After 3 to 7 days if the baby does not flip, introduce more options.
1. Moxibustion: 2 X’s a day
2. Shake the apples can be done with a rebozo or hands on the buttocks of the mom
3. Standing Sacral Release Every 2 days
4. Hypnobabies for Breech Babies
5. Leg Circles: lay on back and circle hips or stand and circle both hips.
6. Circular Mini massage under bottom of ribs and abdomen
7. Myofascial Release Massage
8. Open Knee to Chest for 10 minutes 3 times a day
9. Wait: Give baby time to flip. 96-97% of breech babies are head down when mom goes into labor on her own.
If you are a care provider and want to learn to deliver breech babies look into Dr. Stu, Betty-Anne Daviss, & Spinning Babies,