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things you should know if your baby isn’t upside down October 11, 2007

Posted by guinever in : birth, doula, health, pregnancy , comments closed

breechpositionsThere was once a time when women birthed their babies vaginally without a second thought even if the baby was breech. But if you’re planning a hospital birth and your baby isn’t head down, then you’ll go straight to the OR for a cesarean section. If you want to avoid surgery, you need to do everything possible to help your baby get upside down.

what does it mean that my baby is breech?

The term “breech” refers to the position of your baby not being head down. The most common breech presentation is butt first with the baby’s feet up near his shoulders. This is called a frank breech. If the baby’s knees are bent, the feet are down by his bottom, it’s a complete breech. Other possible presentations include footling or double footling where one or both of the feet are down instead of the head.

ways women have found helpful to turn their breech babies

the Webster technique

The Webster technique is chiropractic care done during pregnancy to encourage the baby into a head down position. The chiropractor does not turn the baby like your doctor would do during an external version. Rather, the practitioner adjusts the pelvis. With the pelvis in alignment, the baby naturally goes into the more favorable head down position. Go to this website for more information and to find a doctor in your area who is certified to do the Webster technique.

an anecdote about a breech birth

In the early days of my teaching childbirth education, one of my students labored naturally without any interventions, and then when she had the urge to push, an internal exam showed the baby was breech. Although she had had a few exams during late pregnancy and early labor, the breech position wasn’t caught until the very end. This mom’s advice to everyone is that if the nurses keep telling you that your baby has a bony head, maybe it’s really not the head. They wheeled her to the OR, didn’t even let her attempt to push.

When I heard this story, I was appalled. At that time, I didn’t realize that most breech babies were delivered by cesarean section. I wrote a letter to one of the midwives in the practice, told her I was naive, and asked why this pregnant woman wasn’t allowed to push, especially since she was completely dilated. The midwife e-mailed me back with a lengthy explanation. She told me that she has to go along with what her doctors want her to do and they won’t let a first time mom (called an “unproven pelvis”) try to deliver a breech baby vaginally because research shows that the risk the baby could die was slightly higher with a breech vaginal birth than with a cesarean birth. The risk difference is less than one percent but it is still there. The danger would be if the body is born, and the head gets stuck. With the body born, it is possible for the baby to start breathing which although rare, it is a possibility which can lead to the baby dying. This is a chance the doctors are unwilling to take.

external cephalic version or ECV

This is a procedure where your obstetrician will attempt to move the baby into the head down, vertex position using his hands on your belly. It’s a good idea to drink plenty of water before the procedure. Once a technique done at your doctor’s office, now it seems more and more are being done in the hospital “just in case something happens.” Usually, you are given drugs to help the uterus relax. The baby will not turn if you are tense and scared. So try to relax.

The doctor uses ultrasound to confirm the position of the baby and the location of the cord and placenta. The baby is monitored during the procedure and if the baby starts to go into distress, the procedure is stopped.

things to consider for the ECV

External versions should be done when you’re 37-38 weeks along. Waiting to do the ECV (external cephalic version) until 40 weeks gestation probably won’t work because the longer you wait, the bigger the baby will be. The bigger the baby is, the less room there is for the baby to turn, and the less amniotic fluid there is to aid the baby in turning. (with a smaller baby and lots of amniotic fluid, the baby floats–remember the days in your second trimester where you could feel the baby turning somersaults?) The further along in pregnancy you are, the more likely that the baby’s butt is engaged in the pelvis and therefore stuck, making it impossible to turn the baby!

Some doctors attempt to do the external version at 40 weeks gestation in the OR, knowing full well that it probably won’t work, but giving the mom hope that the procedure could be successful. The risks involved in this procedure are your water breaking, cord prolapsing, or placenta abrupting. That’s why they have you in the OR. If your baby does turn, you either go home and hope the baby stays head down, or labor is induced so you can give birth. If the baby doesn’t turn, you can go home and try again a week later or you’ll just be scheduled for cesarean.

what if my baby won’t turn, can I still have a vaginal birth?

Yes, but you need to find a doctor or midwife who is trained and has experience with breech babies. Unless you’re planning a homebirth, that probably means you’ll have to switch doctors. Young obstetricians do not have any experience with vaginal breech birth because medical school taught them to do surgery and they probably don’t even realize that giving birth to a breech baby is possible. But an older doctor who has been in practice for more than a couple decades probably has caught plenty of breech babies and knows what he is doing. Doctors might not want to attempt a breech vaginal birth on someone without a proven pelvis, so keep that in mind if this is your first birth.

By reading a variety of breech birth stories, you can be better informed about your birthing options. You’ll find cesarean, vaginal, homebirth and unassisted (personally not recommended by me for the majority of women) stories at this site. This “heads up” website contains other useful information on breech babies in addition to the birth stories.

Please note that I offer this information for educational purposes only and that you should always discuss your options with your doctor or midwife.

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