Photos and Description of Vaginal Breech Birth

Footling breech and the pelvic bone.

Breech is a variation of normal

Click here to see photos and descriptions of a vaginal footling breech birth.

Breech Resources: Turning a Breech Baby

I love sharing information with the amazing mamas on my Mamas and Babies facebook page. I recently asked for some resources about breech babies, and I want to share those with you.

For information about the risks and options with breech babies, please see some of my past posts on the subject:

• Breech Presentation: Risks and Options
• Breech Baby (Breech Position or Presentation)
• C-Section Not Best for Breech Birth

Here are some other resources:

• Spinning Babies is the first resource I think of when someone asks about turning a breech baby. It's full of information and tips, and I'm honored that they have a link to my own breech birth story.
• Stand and Deliver has some really great posts about breech: The Dance of the Breech (which has amazing illustrations and descriptions of how to catch a breech baby), and International Breech Conference, Day 1 and Day 2.
• The Times Colonist has a great article about Canadian doctors no longer doing automatic c-sections for breech babies. They are, in fact, trying to teach physicians how to attend vaginal breech birth.
• Traditions in Prenatal Care has a transcript of a radio show on which they discussed breech babies and a technique called "sifting" that can be used to help turn a breech baby into a head-down presentation.
• Here's a website that has 17 ways to turn a breech baby.
• The ICPA has some information about the Webster Technique, which is a method that chiropractors can use to attempt to turn a breech baby.
• And last, if you're on facebook and want support and interaction with other moms of breech babies, you can look up Breech Birth.

Only 3-4% of babies will not turn head-down before birth. Most babies will be vertex and in the optimal position for birth. But for the small percentage who don't, we need to know how to help them, whether by turning before labor begins or in assisting with a vaginal breech birth.

If you have any additional information or resources about breech babies, please share them! I have a special place in my heart for breech babies.

Vaginal Breech Birth: A Lost Art

Here's a photo of me and my sweet breech baby.

Liam

His bottom came out first,

Then one leg came out followed by the other leg,

He kicked his legs in the water,

And the midwife said "Look, he's doing just fine!"

An arm came out next and then the other arm,

And then "he put the hands and the feet on the bum cheeks,

And pushed his head out!"*

The Dance of Breech

*as told to me by my sweet 6 year-old who, along with his 9 year-old brother watched his baby brother's birth.

Thinking Out Loud Re: Breech Babies

This topic has become very important to me since giving birth to a breech baby last year, and I'd like to share some of my thoughts on the subject with anyone who cares to read.

Laws in many states require that mothers whose babies are in a breech or transverse position be under the care of a physician and give birth in the hospital. In cases in which the mother is planning a vaginal birth, this usually means a change in plans and a scheduled c-section. If the mother is planning a home birth with a midwife, this means changing her care to an OB and planning a hospital birth (again, most likely a cesarean section).

Why?

This blog post explains in detail about breech babies: Breech Presentation: Risks and Options.

There are ways to try to turn a breech baby into a favorable position before birth. My blog post above describes some of these, and there is also an excellent online resource called Spinning Babies that gives great information about breech babies and how to attempt to encourage a fetus to turn into a vertex (head-down) position. Sometimes the baby moves on its own or with help and the mother is able to plan a normal vaginal birth. Sometimes however, the baby stays breech, and the mother must seriously consider her birthing options at that point.

A recent study was done which found that the risks of c-section outweigh the risks of vaginal breech delivery: C-Section Not Best For Breech Birth. The study states that vaginal breech delivery is the preferable option of birthing breech babies, and that doctors should be trained to support women in this option.

The sad truth is that doctors are no longer trained in vaginal breech delivery. With cesarean section becoming more widely used, it has become the common method of delivering a breech baby. Unless you have an older doctor who has had experience with vaginal breech births, your doctor is likely unqualified to support you in birthing your breech baby if you want a vaginal birth. With many midwives, however, the skill of vaginal breech birth is still being taught and passed down.

The laws however, do not support the evidence. Automatic transfer of care of breech babies, in my opinion, should NOT be required. I feel the laws should allow for the care provider and the expectant parents to make an informed choice in how to birth their baby.

As explained in my blog post above, there are different types of breech presentation and some are more risky than others. For example, a full-term baby in frank breech position is the best candidate for a vaginal breech birth, and a woman with a baby in this position should be given the option of vaginal birth with a provider who is skilled to support her. This could be a midwife or a doctor, as long as he or she has the proper training, and depending on the woman's preferences and choice of birth place. If the baby is a stargazer (looking upward) there is a great risk to the spinal cord if a vaginal delivery is attempted, and experts agree that a c-section is warranted. These are just two examples of breech presentations.

Transfer of care should be a case-by-case decision based on the precise presentation of the baby. A woman should be informed of her options of attempting to turn the baby, as well as the risks and options associated with her infant's presentation and all proposed methods of birth.

This may not be a realistic expectation with current trends, but I hope that in time changes can be made. If doctors are not trained in their regular curriculum about breech birth, then perhaps additional training should be made available to those who are interested in learning and offering the service to their patients. This training should be evidence-based and consistent, and available to midwives as well. Perhaps a certificate could be given, such as with CPR and NRP (neonatal resuscitation) training. Ideally, it would be a requirement for all birth care providers, as basic as any other training they receive.

Some thoughts about my breech baby

There was something I neglected to mention in my blog post about my home water birth. A few weeks before the baby's due date I went to my OB's office to get the Group Beta Strep screen. My midwife had recommended it and it was only the third time I'd been to the OB's office during my entire pregnancy because I had been seeing my home birth midwife for regular prenatal visits.

As part of the visit, the nurse-practitioner checked the position of the baby. When she felt the large mass down near my cervix she looked confused and really started to feel around more. She told me she wasn't sure it was the baby's head that was down, and that I should have one of the OB's double-check the baby's position the next time I came in. I had no intention of returning to their office, so I brushed it off.

When I got into my car to head home I sat and thought for a moment. I remembered that my midwife had felt the baby at each prenatal visit and said he was head-down. I wondered "what if my baby is breech? Would it change my plans?" I realized that no, a breech position would not change any of my plans. I knew that my midwife had caught a surprise breech at a home birth just a few months before my baby was due, and I trusted my midwife to be able to handle any situation at our planned home birth.

If you've read my birth story then you know that my baby was indeed breech, and we didn't realize it until I had already started to push him out! At the time I was extremely grateful to be at home in the birthing tub with a wonderful support team, and all turned out beautifully well.

Since the birth I've come to realize that if I had planned a hospital birth with my breech baby it would have ended in a cesarean section. I know this without a doubt, and this knowledge has brought me greater gratitude and appreciation for my amazing birth experience. I'm so grateful that I was open to home birth and able to embrace it fully. I had peace with me throughout my pregnancy that home birth was exactly the right thing for this birth, and I also had peace knowing that my baby would be healthy and all would be well. For me this peace came as a result of much study, careful introspection, and prayer. I personally feel that God was loving and gracious in offering me a natural, peaceful means of bringing this precious baby boy into our family, and I am eternally thankful for that.

C-Section Not Best For Breech Birth

The Society of Obstetricians and Gynecologists of Canada will launch program to teach physicians breech vaginal delivery

from Globe Life Health and Fitness

by Carla Wintersgill

"Physicians should no longer automatically opt to perform a cesarean section in the case of a breech birth, according to new guidelines by the Society of Obstetricians and Gynecologists of Canada.

"Released yesterday, the guidelines are a response to new evidence that shows many women are safely able to vaginally deliver babies who enter the birth canal with the buttocks or feet first. Normally, the infant descends head first.

“Our primary purpose is to offer choice to women,” said André Lalonde, executive vice-president of the SOGC.

“More women are feeling disappointed when there is no one who is trained to assist in breech vaginal delivery,” he adds.

"Since 2000, C-sections have been the preferred method of delivery in breech births. Studies suggested that breached births were associated with an increased rate of complication when performed vaginally.

"As a result, many medical schools have stopped training their physicians in breech vaginal delivery.

"The problem now, according to Dr. Lalonde, is that there is a serious shortage of doctors to teach and perform these deliveries.

"With the release of the new guidelines, the SOGC will launch a nationwide training program to ensure that doctors will be adequately prepared to offer vaginal breech births .

"The new approach was prompted by a reassessment of earlier trials. It now appears that there is no difference in complication rates between vaginal and cesarean section deliveries in the case of breech births.

"News of the change is a boon for the Ottawa-based Coalition for Breech Birth.

“We're really, really pleased,” said Robin Guy, co-founder of the coalition.

"Ms. Guy started the group after the birth of her second child in the fall of 2006. Although she had given birth to her first child at home with a midwife, Ms. Guy delivered her daughter in the hospital because of the baby's breech position.

“I was cornered into an unneeded and unwanted C-section because the obstetrician that I had didn't have the experience to catch her,” said Ms. Guy.

"The aim of the coalition is to ensure that women know what their options are when it comes to breech birth. Ms. Guy believes that many women don't realize that vaginal breech births are even possible.

“Educating women is our primary goal because it takes more than just a guideline change,” she said.

"The SOGC stresses that because of complications that may arise, many breech deliveries will still require a cesarean section.

"Breech presentations occur in 3-4 per cent of pregnant women who reach term. That translates to approximately 11,000 to 14,500 breech deliveries a year in Canada.

"The new decision to offer vaginal breech birth aligns with the SOGC promotion of normal childbirth – spontaneous labour, followed by a delivery that is not assisted by forceps, vacuum or cesarean section. In December of 2008, the society release a policy statement that included its recommendation for a development of national practice guidelines on normal childbirth.

“The safest way to deliver has always been the natural way,” said Dr. Lalonde.

“Vaginal birth is the preferred method of having a baby because a C-section in itself has complications.”

"Cesarean sections, in which incisions are made through a mother's abdomen and uterus to deliver the baby, can lead to increased chance of bleeding and infections and can cause further complications for pregnancies later on.

“There's the idea out there in the public sometimes that having a C-section today with modern anesthesia and modern hospitals is as safe as having a normal childbirth, but we don't think so,” said Dr. Lalonde.

“It is the general principle in medicine to not make having a cesarean section trivial.”

"The SOGC believes that if a woman is well-prepared during pregnancy, she has the innate ability to deliver vaginally.

"The national average for babies delivered via cesarean section in Canada is 25 per cent."

Breech Baby (Breech Position or Presentation)

What is Breech?
Breech presentation is when a baby is in a position other than head-down. There are three types of breech presentation. Frank breech is the most common, with the baby's buttocks down and legs straight up toward the face. Complete breech is when the baby is in a sitting position with legs crossed. Footling breech is when the the baby has one or both feet down. The baby's position is checked at each prenatal visit in late pregnancy. By 34 to 36 weeks most baby's have assumed the position they will birth in.

Why is a breech presentation risky?

• The chances of a prolapsed cord increase with a breech baby because the buttocks or feet don't prevent the umbilical cord from being swept below the baby or into the vagina.
  
• When the baby's feet or buttocks are delivered first there is a possibility the head can press on the cord at the cervix and possibly reduce the baby's oxygen supply.
  
• Sometimes the baby's feet or buttocks are small enough that they can be born before the cervix is fully dilated, and the head doesn't have enough room to come out. This could lead to fetal distress and delay the birth of the head.
• Spinal cord injury is also a risk if the baby's head is hyperextended (bent back).

What can be done about a baby in a breech position?
If by 36 weeks your baby is in a breech position, you can try one of the following:

• The breech tilt position: The idea behind this is to tilt your body so that your hips are higher than your head. Ask your caregiver if this is safe for you to do. If you are healthy and the baby is doing well, most caregivers encourage this position. Lie on your baby with your feet flat on the floor. Raise your pelvis and slide firm cushions underneath your buttocks, enough to raise them 10-15 inches above your head. You may need help from your partner or a family member or friend with the pillows. You can also use a flat surface like an ironing board or plank, tilt it by putting one end on a chair and the other end on the floor. Lie down on the board with your head toward the bottom. If it's unsteady at all, have someone help steady it for you. Lie in this position for 10 minutes, 3 times each day at times when your baby is active. It helps encourage the baby to move up away from the birth canal so the baby can move to get into a more favorable head-down position. It's not the most comfortable position, but if you empty your bladder and make sure you don't have a full stomach, it will help ease some discomfort. While you lie in the tilt position, try to relax your abdominal muscles as much as possible and imagine your baby turning a somersault so the head turns toward the cervix. The baby will probably squirm as the head presses into the fundus. There is no medical proof that this method helps turn a baby, but many women swear by it, and it doesn't do any harm. After lying in this position, it's a good idea to assume an upright position to encourage the baby to move back down after being pulled up be gravity.
• Knee-chest position: This position uses the same principles as the breech tilt position, and you may want to try it and see if it's more comfortable for you. For this position, assume a hands and knees position with your knees about shoulder-width apart. Place firm pillows under your pelvis to help hold your hips and pelvis up in that position, and then lower your head and shoulders to the floor. You may want to use a blanket or thin pillow to soften the surface for your head, but be sure to keep your head and shoulders as low to the floor as possible to allow gravity to help pull your baby out of the breech position. Once you're support by enough pillows to keep your pelvis up, you should be able to maintain this position comfortably for 10 minutes or so, also 3 times a day just like the tilt position.
• Use of sound: You can try this by either placing earphones from a music player just above the pubic bone and playing music for the baby when the baby is active. You can also have your partner place his or her head in your lap and talk to the baby. The idea is that babies can hear outside sounds while in the womb, and the baby may reposition itself so that his or her head is down toward the comforting or familiar sound. This method is also completely harmless and comfortable, and many women have reported that it helped turn their baby.

What's the medical approach to turn a breech baby?
If your efforts at home haven't been successful in turning your breech baby, your caregiver may want to try external version. This is done at 37 to 38 weeks. An ultrasound is usually done to determine the exact position of the baby, check how much amniotic fluid is present, and see where the placenta is attached to the uterus. A non-stress test may be done to check the well-being of the baby before or after the version. You may be given a drug to relax your uterus, and some caregivers like to use an epidural to reduce any discomfort. The caregiver uses ultrasound as a guide while he or she presses on your abdomen and tries to manually turn the baby into a head-down position. If the baby shows fetal distress, the procedure is stopped. If the placenta starts to detach from the wall of the uterus, a cesarean section must be done to deliver the baby. Sometimes the version is unsuccessful and the baby does not turn at all. Some babies will turn from the version and then resume a breech position afterward. Studies have shown that external versions are safe and successful about 60% of the time. It can be quite uncomfortable because of the amount of pressure that's used to turn the baby. It can be helpful to have your partner or doula with you to help with breathing techniques and relaxation to give you comfort and allow the caregiver the time needed to turn the baby during the procedure.

Vaginal Birth versus Cesarean Birth for a Breech baby.
It used to be that vaginal breech births were done all the time. Even though there are complications with a vaginal breech birth, it can still be done safely with the right expertise. After the 1970's the overall cesarean section became increasingly common, and doctors began to abandon vaginal breech delivery and use surgery more and more to deliver breech babies. As vaginal breech births declined, fewer doctors learned the techniques to perform a vaginal breech birth. It can be difficult now to find a physician who is willing and has the skills to allow you to birth your breech baby vaginally.

Personal note: I know a woman who interviewed her physician before the birth of her second child. She showed him her birth plan and asked specifically that if the baby were to present in a breech position she be allowed to attempt a vaginal delivery. Her wonderful doctor (who happened to be an older man who had assisted in a multitude of vaginal breech births and has the necessary skills to do so) said that he would love to help her do that. This is rare, and I think it emphasizes the importance of interviewing your caregiver and being clear about your wishes for birth! If your baby is presenting breech and all efforts to turn the baby have been unsuccessful, you may need to prepare yourself for a cesarean birth, as that is the most common method of delivery for breech babies today.

My midwife recently assisted in a vaginal breech birth at a home. She did not have experience with breech delivery, so she called in a senior midwife who knew what to do, and the baby was delivered safely and vaginally. I find it truly amazing what can be done with the right knowledge and approach.

*Information presented can also be found in Pregnancy, Childbirth and the Newborn by Penny Simkin, Janet Whaley and Ann Keppler. This is a fantastic book that I would recommend to all expectant parents.

Upcoming Forum on Breech Birth

My midwife has a monthly forum for all of her pregnant ladies. I'm particularly excited to attend this month's forum this Thursday. One of the moms who has recently given birth had an amazing experience when she birthed her baby breech. Yes, that's right, the baby came out feet or buttocks first! She is going to come and share her birth story with the rest of us, and I'm really excited to hear it.

In past years vaginal breech delivery was not unheard of. I personally have a brother who came out of the birth canal buttocks first. Physicians used to delivery breech babies vaginally all the time, but nowadays the common medical approach to a breech position is to automatically do a cesarean section. In my opinion it's another example of unnecessary surgery, and I'm always thrilled to hear of a baby being born vaginally and safely, especially when there were complications that would have likely elicited medical staff to prep for surgery.

For more information on positioning of the baby, please check my earlier post on posterior babies. Much of the information also applies to breech position. The knee-chest position mentioned in that post is an excellent position for moving the baby out of the birth canal to allow it to move into a more favorable position.