At Home, With Nature
Breech Birth
In some cultures and at some times, breech birth was seen as special with spiritual significance for the baby. In our current overculture, discovery of a baby in the breech position is met with much distress and fear. This is partially due to some poorly controlled but very influential studies on breech birth and increasing preference for and reliance on surgical birth. In many areas cesarean birth is given as the only option. However, there are some passionate breech birth specialists who are traveling the world teaching breech vaginal birth skills and an increasing number of providers, especially midwives, learning and offering vaginal breech birth as an option.
What does breech position mean?
Breech is when the baby's bottom rather than their head is presenting (nearest your cervix). Estimated 3-4% of babies at term are in a breech position. There are different variations of breech position: frank, complete, incomplete, footling and kneeling. As pregnancy advances towards term 37-42 weeks, babies increasingly choose a head-down position. At 28 weeks of pregnancy around 25% of babies are breech, and at 34 weeks 5% of babies are breech. Babies can change position in minutes, even during labor, though it’s increasingly rare because of the baby's increased size and decreased space to maneuver.
Why would a baby stay breech?
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Emotional- maternal fears, disconnection from her baby or partner, feelings of unsafety
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Mother’s anatomy- tight abdominal or pelvic tone, fibroids, uterine shape with septum
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Baby’s anatomy- placenta location, cord length, structural anomalies
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Mystery- sometimes we don’t know why and that’s okay. Babies are intelligent and there are factors which only they know. In the final weeks of pregnancy they are navigating their way into the best position for birth they can and sometimes this is breech.
What to do if your baby is breech?
Tune in with why you think your baby may be breech; talk to them, journal, connect with your spiritual support. Move your body, as your movement helps your baby to move. Listen deeply, is there something that your baby’s position is trying to tell you?
Encourage Baby to Move/Create Space for Baby to Reposition:
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Homeopathy
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Acupuncture
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Chiropractic
External Cephalic Version (ECV) may be offered around 36 weeks and is done by an OB under ultrasound in a facility with access to cesarean should the baby not tolerate (become distressed during) the procedure. Epidural anesthesia is generally offered and uterine muscle relaxants may be used. ECV has a success rate of 30-60% (ACOG). There are risks related to ECV.
Find a provider who is supportive of your wishes for Vaginal Breech Birth or Cesarean Birth:
Vaginal Breech Birth (VBB) with a trained and experienced midwife (or OB) has similar risk outcomes for babies as does cesarean birth, and much lower risk to mom and future babies because of the risk of surgery and downstream risk during VBAC. This is according to high quality international evidence and many multi-center studies with trained providers (BWB link). The Term Breech Trial was a poorly controlled and now disreputed study which showed better outcomes for cesarean born breech babies and is largely responsible for the shift in lack of medical support in the US for VBB.
Obstetric Culture
There has been a promotion and continuation of fear around Breech Birth. The reasons for this are beyond the scope of this page but if you plan a VBB, work with your fear around breech and encourage anyone else planned to be in attendance to do the same. Breech Without Borders has excellent resources for education including courses for parents and many videos on their website (link) and YouTube channel (link). CranioSacral therapy, massage, and acupuncture are very helpful for the nervous system.
Current OB practice is to offer an ECV at 36 weeks of pregnancy and to schedule a cesarean birth at 38 weeks. They cite lack of training as the reason for this though training for VBB is readily available through Breech Without Borders and other high-quality programs. Hands-on training courses take a day to complete, with many hours of online study materials included.
Is it reasonable for OBs, CNMs or Midwives to not be trained in Vaginal Breech Birth?
I like to compare the occurrence of breech presentation at 3-4%, with the occurrence of shoulder dystocia 0.6% to 1.4%. All obstetric providers are trained to resolve shoulder dystocia and would be considered negligent if they did not have or refused to have training for shoulder dystocia. Though the occurrence of shoulder dystocia is much less than breech presentation.
All providers who attend births, including OBs, nurses, and EMTs, could be faced with an surprise breech at time of pushing and possibly need skills taught during training to safely assist birth of a breech baby when there is no option for cesarean.
It is estimated that of Vaginal Breech Births which reach the “rumping” phase (emergence/crowning), around â…” will be born spontaneously and â…“ may require or benefit from maneuvers to expedite their birth.
Find or switch to an experienced midwife trained in Vaginal Breech Birth. Sometimes this means relocating for birth. Gather any resources which help you to feel informed and prepared. Have minimal other participants at your birth to keep distractions low and oxytocin high. Develop a relationship of mutual respect and connection with your birth team. Share your fears and needs. Wait for birth to begin spontaneously.
Since attending midwifery school in 2004, I have taken every breech training which has been available to me. I currently attend a monthly study group with Kristine Lauria CPM, who is very experienced with breech, twin and even triplet homebirth, and is a midwife with Doctors without Borders. Every year or two I attend Breech Without Borders hands-on training and contribute to their statistics project. I have attended around 16 VBB, and look forward to attending more. I am passionate about offering breech birth as an option for families and am available for free consultation to explore this option.