Can we turn breech babies?
And should we try ?
Inspired by my knowledge of TCM and my work with mothers and their babies, I want to explore why babies might be in the breech position and how this may impact birth. I consider whether it is desirable to try to change their position and ways we might encourage them to move, including whether the acupuncture point on the outside base of the little toe, BL67 works.
A ‘breech baby’ is the term given to a baby whose bottom, rather than head is down in the pelvis towards the end of pregnancy.
If you want to see some of the techniques I describe I have a video on YouTube
A baby snuggling up to their mother’s heart
I always thought that the ancient Chinese described a breech baby as “clutching at their mother’s heart.” I love this description; however, I can’t find a reference for it, and it is not described within the ideograms. If you know the source, please let me know. Maybe I even made it up myself years ago! If I did then, these days, I prefer the phrase “ a baby snuggling up to their mother’ s heart.”
Why is a baby clutching at or snuggling up to their mother’s heart?
There are many possible reasons:
They are comfortable in the womb and are not ready to leave.
Their mother is enjoying being pregnant and doesn’t want the pregnancy to end.
The baby is scared of birth, or the environment into which they will be born.
The mother is scared about the birth, or bringing their baby into an unsafe world: perhaps she has financial worries; is on her own, or her partner is violent?
The baby may be physically stuck: their cord is too short; their head is stuck between fibroids; the placenta is in their way, or their mother’s womb is heart shaped (bicornuate) and they are stuck in one part of the womb.
The mother is not moving much, her pelvis is out of alignment, her tissues are restricted and it is hard for the baby to change position.
There is more than one baby in the womb and either or both end up breech.
There is no specific reason other than this is the way the baby is and they want to be born this way.
Each mother and baby are unique and so is their relationship
If we ask these questions then we understand that there is not one way of encouraging a breech baby to turn because each mother and baby are different. We also understand that it is important to consider the nature of the relationship between a mother and her baby and support them both.
We also need to remember that there may be nothing “wrong” at all. The baby just wants to be that way and will be born easily vaginally with no complications.
What is a breech baby and what are the implications for birth?
The word "breech" originates from the Old English brēc, plural of brōc, meaning "leg covering" or "pants." Gradually "breech" was used to describe the buttocks and used for trousers: "breeches,"
There are different types of breech presentation with different implications for birth.
Frank: This is the most common accounting for 50–70% of cases. The baby has its hips flexed and the legs extended so that their feet are by their head and their bottom is down in the pelvis. It is considered the most favourable breech position for vaginal birth. The baby's bottom can effectively dilate the cervix, and the risk of umbilical cord prolapse is low (approximately 0.5%).
Complete: This is less common. The baby sits with its head flexed and its legs crossed. There's a higher risk of umbilical cord prolapse (4–6%) compared to frank breech, but vaginal birth can be considered.
Incomplete or footling: Relatively rare, this is more common in preterm births. One or both hips are extended so that one or both feet are down in the pelvis. This carries the highest risk for vaginal birth because the risk of umbilical cord prolapse is higher (15–18%) and head is more likely to get stuck.
Cord prolapse is when the cord descends before the baby into the birth canal. It is higher in a footling breech because there is space through which the umbilical cord can slip ahead of the bottom, especially after the waters (membranes) break. If the cord comes first it might become compressed during contractions, compromising blood and oxygen flow to the baby. If this is the case, the mother needs to get into an inverted position, such as kneeling with bottom up and head down, to reduce the pressure, while awaiting midwifery support.
Most babies turn head down before birth.
It is important to remember is that about 7% of babies are breech around 32 weeks compared to 25% at 28 weeks. By the end of pregnancy without any intervention, 57% of these babies turn to be head down (cephalic) with 25% turning after 36 weeks. Only about 3-4 % of babies remain breech at 40 weeks. Many women worry around 32 weeks if their baby is breech, because, depending on your health care provider there can be pressure to have an elective Caesarean. Much of this worry is unnecessary as many babies will turn. Worry and stress on the other hand, are not particularly helpful emotions during pregnancy. There may be some women who might be worried about vaginal birth and are in some ways relieved that they have a reason to have a Caesarean.
Pressure to have a Caesarean section
It is only relatively recently, 2000, that there has been pressure to have a Caesarean delivery for a breech baby. Until then most breech babies were delivered vaginally. A 2000 a Canadian study, The Term Breech study (Hannah et al) http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(00)02840-3/abstract
concluded that C section was the safest option for a breech baby. After this it became more difficult for women to get support for a vaginal breech birth. This study has been criticised and many places are now beginning to offer vaginal breech delivery as a choice for some women.
Planned vaginal breech delivery can be safe for both mother and baby when:
They meet certain criteria (e.g., term, frank breech, normal fetal weight, adequate pelvis)
Experienced providers are available
Informed consent is obtained and protocols are followed
Selection and provider skill matter:
With strict selection criteria and skilled providers, outcomes for vaginal breech births can approach those of caesarean.
The PREMODA study across France and Belgium (over 8,000 cases) found no significant difference in neonatal outcome between planned vaginal and caesarean deliveries when managed in controlled settings en.wikipedia.org+2ginekologiaipoloznictwo.com+2acog.org+2.
However much of the knowledge on supporting vaginal breech delivery has been lost. Many policies have not been updated and some care providers continue to restrict its availability.
How to support a vaginal breech delivery
Many breech babies can be born easily vaginally. However, there may be complications which mean that a vaginal delivery is not advisable. Mary Cronk, a UK midwife who has specialised in vaginal breech deliveries states, in the Aims Journal in an article “Hands off breech” and this makes sense to me, that a breech baby, with no obvious complications, can
“be born easily and spontaneously if the labour proceeds spontaneously and easily…(however) ..
I do not believe that there is any place for induction or augmentation in a breech labour. If a breech labour does not progress, this woman’s body is telling us something, and we should listen. There is no emergency, there is no rush, this labour just isn’t progressing, and this baby should be delivered by caesarean operation.
I do not feel that there is any place for either trying to push breeches through pelvises with oxytocic drugs or pulling them through with actively managed breech extractions. I feel that this management is what has contributed to giving vaginal breech delivery poor outcomes and such a bad name. In my experience, if the labour does not progress well and spontaneously, the baby needs to be delivered by caesarean operation.”
Some of the complications of a breech baby may stop the baby turning as well as being born vaginally. Uterine abnormalities (such as bicornuate: heart shaped uterus) or oligohydramnios (low levels of amniotic fluid) polyhydramnios (too much fluid), low lying placenta or developmental issues with the baby or cord may restrict the baby’s movement so they cannot move easily. I have worked with many women whose baby tries to turn, they notice the baby moving and may even have contractions, but the baby is unsuccessful. Later we have discovered that the cord is too short, or the baby’s head was stuck between two fibroids or stuck in a bicornuate uterus and so couldn’t move. In these cases, having a Caesarean is the only way the baby can be born.
A breech baby in some cultures brings luck
In some cultures, a breech baby was considered to be lucky . It was thought they would have good fortune or grow up to be healers. How we view a breech baby is determined a lot by our cultural beliefs and assumptions. In our culture we tend to see breech babies as being a “problem” and we have to make them turn. Sometimes postnatally baby’s hips are more open but in most cases this can easily be remedied with some simple baby shiatsu/massage.
Getting ready for the separation of birth
In turning head down, the baby is bringing their heart away from the mother’s heart and getting ready for separation from her. This process may need support. Both the woman and her baby need to accept that this precious time in the womb is ending. This can be simply acknowledging this and encouraging the woman to focus more on her birth: what does she need?
However, it is not only the mother who needs support. With birth, something shifts for the whole family. Each time a baby prepares to come into the world the family dynamics change, including those members who are no longer alive. This is what TCM calls “ancestral Essence” or “Jing.” Sometimes I have worked with women who have had a sudden shock (such as their mother being ill or dying) or their partner is away and not certain to be back for the birth.
The power of working with the body to prepare for birth holistically, not only focusing on “turning “ a baby
It is important to put any work focusing on potentially encouraging a breech baby to turn, into the context of supporting mother, baby and the family to prepare for birth. I might add in some specific things for a breech baby, but not overly focus on them. I always tell my clients that they can only “encourage” their baby to turn. We can’t make it and there may be a good reason they are breech.
The first thing I focus on is the connection between the Heart-and womb to help the mother tune into her baby. You can use this visualisation and include awareness of the position of the baby, or just get mum to place her hands over her baby, talk to them and find out what is going on. It is surprising what mums can pick up.
Often they realise that the baby has been aware of some anxiety that they have, or simply feels ignored or that there is no space to welcome them in. Once the baby feels heard that may already enable them to be ready for birth and to turn.
I do include the famous BL67 point at the base of the little toe nail, but I don’t only focus on this point. I include it while working with the mother in a forward leaning position - perhaps over a ball. This position is helpful for any mother and baby at the end of pregnancy. It helps to relieve pressure on the pelvis and create possibilities for the baby to adjust their position and prepare for birth. It is important for any mother, especially with a breech baby, to move. Today many women are in office bound jobs and do not change position enough. Their pelvic muscles hold patterns of over and underuse. Lack of movement also impacts a baby as they have less opportunity to move as well and to build up muscle tone necessary for the movements of birth. Specifically for a breech baby, I would encourage the mother to rest in inverted positions which take the weight of their baby’s bottom away from the pelvis, giving them space to turn.
In the forward leaning and inverted positions I always include deep sacral work as it helps give the baby more space as well as relax tension in the lower back for the mother. Deep sacral work is one of the most helpful techniques for labour.
I always include some work with the Extraordinary Vessels especially the Girdle Vessel (Dai Mai) or Penetrating Vessel (Chong Mai).
I find that working physically with the body, with shiatsu, or other forms of bodywork such as massage, osteopathy or acupuncture enables mother and baby to release and process feelings at an unconscious as well as conscious memory. Birth is an ancestral memory. We are influenced by the memory of how women in our families gave birth. By working with the Extraordinary Vessels, we can help bring powerful emotions to the conscious so that the mother and baby can process them.
If you like my approach I have written a book called “Beautiful Birth” and have an online course. https://www.wellmother.uk/books/
Most of my posts on here talk about the Extraordinary Vessels and how they can transform your life.
So is trying to turn a breech baby a good idea?
It is worth a try, because a lot of the work is what we would want to do anyway to prepare .
I’d love to hear any stories that you have to share about your own breech baby and how you birthed them, or for those of you who work to support women with breech babies.
I originally wrote a blog post on breech babies in 2016 but I wanted to expand it. However I thought you might be interested in reading some of the comments on the original blog about turning breech babies:
Lilli Pock, Vienna, November 1, 2016 at 7:04 pm
Thank you Suzanne,
thank you for the blog article about turning breech babies, it is very interesting and so well put in words!
I worked with 4 pregnant women whose babies were breech (all of them over 36 weeks) one of them with twins. I used parts of hypnobirthing, yoga, a lot of talking, collecting possibilities of other natural techniques that I could not provide but knew of, tips for changing daily habits (like avoiding sitting on a chair or car too long), bonding with the baby, and of course shiatsu, but as I wasn’t so familiar with the importance of the Extraordinary Vessels I see now, I would have had a different approach with the shiatsu session. 2 babies turned within the next 12 hours after, making the already fixed date of the c-section (days later, because tendency here is to set the date 2 weeks ahead of due date) not necessary. These women came only once to give it (me) a try.
Also my neighbour bore her 6th child in breech 2 weeks over due date. Very rare case here in Austria! Only one hospital in Vienna will help you with breech birth, all others it’s 100% c-section case. I am glad to know her, a lovely woman, and I use that story to tell in some occasions to set things back to centre or straight, as with all the other stories going around there is less and less “good” birth stories that tell about breech birth. Doctors also frightened this woman, setting date for a c-section 4 weeks before actual birth. She just cancelled, had doubts as well at some nights but was so glad later after a quick and good birth experience that she’d trusted her body and her baby.
Also very important, some babies just can’t turn, thinking this must happen puts a lot of pressure on as well. You explained it much better than that, but yes, so important!
I really like your wisdom, way of thinking and explaining.
Thank you very much for sharing!
suzanneyates November 8, 2016 at 12:56 pm
Thank you for sharing your experience Lilli about turning breech babies. And great to hear how it is in different countries. Great to hear about your neighbour’s breech baby at 42 weeks…
shiatsuglasgow November 1, 2016 at 11:10 am
Hi Suzanne thanks for this, such an important subject on turning breech babies! So many women are fretting through the last weeks of their pregnancy over having to turn a breech baby. They seek out all sorts of treatments that can be done to turn their breech baby. I used to do Moxa on BL67 myself, and it seemed to be working in most cases. It was wonderful. But more and more I realise that it is the Well Mother approach that you taught me that was at the root of the successes, rather than the Moxibustion.
I hardly ever use moxa now as I find the time is better spent on your methods of talking and encouraging mother, which are so effective. Also working with her energy and helping her connect with her own and her baby’s/babies’ energies, accepting and having faith in her body to birth this baby, not in a right or a wrong way, but in the best way for her and this baby. This confidence, coming from herself as the centre of the matter, is so wonderful for promoting a positive birth experience, with all the love and not with fear. And now slowly, slowly here in Glasgow the possibilities for women to deliver breech in hospital are beginning to increase, if they can be determined to persevere/ be patient, and put their own needs above those of the medical professionals.
I have a couple expecting twins soon and this whole subject is more important than ever in their case!
I hope you don’t mind me posting this link here to an article by Michel Odent. http://www.wombecology.com/?pg=fetusejection
suzanneyates November 1, 2016 at 2:59 pm
Dear Lucy, thanks for your feedback on my blog on turning breech babies. And it is great to hear that more options are opening up for women in Glasgow.
Regarding the illustration, usually the baby is in the uterus, not the stomach, regardless of its presentation.