Turning tactics

It can be a great disappointment to discover late in your pregnancy that your baby is lying in breech position – with his head up, instead of down – especially if you want a natural birth.

These days, most obstetricians in the private sector will only deliver breech babies via Caesarean section. This is because vaginal births when a baby is delivered feet first pose more risk to the mother and the baby. When a breech baby’s waters break (membranes rupture), there is a greater risk of the cord prolapsing. This could lead to cord compression, which may deprive the baby of oxygen and could cause brain damage, disability or even death.

It is also more likely that the head will get stuck when a baby is born feet first. When a baby is born head first, the skull bones are able to move and mould to improve the fit within the birth canal. This is not the case when the head comes out last.

In the first two trimesters, babies move around a lot but from as early as 28 weeks some move into the head-down position, which is thought to be more comfortable for them. Others may wait until later; some babies being known to turn at the very last minute. But, once a baby gets bigger, there is less room for movement in the uterus and, by 34 weeks, if the baby is still breech, there are gentle methods to encourage baby to turn.

Common reasons for babies lying breech include:
Abnormalities with the uterus or baby, low levels of amniotic fluid, problems with the placenta.

In these circumstances, no attempt to turn the baby should be made. Yet Cape Town obstetrician Dr Caro Nel says that up to 10 per cent of babies lie breech for no apparent reason and could be encouraged to turn. There are a number of non-invasive techniques which could support a “spontaneous version”; in other words, encourage the baby to turn itself. It seems that babies who respond to these methods might be breech because of various stress factors. Once the effect of this stress is removed, baby is able to turn.

From 37 weeks, an obstetrician can also manipulate baby to turn with external cephalic version (ECV), where the doctor tries to turn the baby by hand. Some state hospitals have dedicated breech turning clinics for this purpose.

It’s always important to speak at length to your obstetrician or midwife before attempting any method to turn your baby. Babies lie breech for a variety of reasons and it’s important to consider these to avoid causing any harm.

Natural remedies

Homeopathy
Your treatment is prescribed for the individual nature of your symptoms. A remedy that may have a favourable effect on one person may not suit the next. A different remedy may be used for similar conditions. For this reason, it is essential to consult a homeopath to assist your baby to turn.

“My second child turned successfully at 33 weeks with homeopathy. I took three doses of my remedy daily. Within 15 minutes of taking the first dose, baby swung to a transverse position and then returned during the next two hours. This happened with each dose, except baby moved further each time. With the second dose on the second day, baby turned a full 180 degrees and stayed down,” recalls Clare, 33, a freelance writer and therapeutic massage therapist.

Reflexology
This is a kind of massage done mostly on the feet. Certain areas in the feet influence the functioning of an area in the body they reflect. This treatment is helpful from conception, for the duration of pregnancy and may even assist the baby to turn because it helps the body to function more efficiently.

Melony, 38, a computer programmer, recalls that at 38 weeks her amniotic fluid was low and that the space around baby was cylindrical, which seemed to force his legs straight so that his knees lay in his face (frank breech position). “Because the fluid levels were consistently low and the baby was lying breech, I had accepted the prospect of a Caesarean.

I went for a reflexology treatment for its calming and balancing effect, not with the hope that baby would turn. But that night I was woken with a cramping pain and unusual foetal movement. My obstetrician confirmed that my baby had turned head down.

“I have no doubt that his turn was due to the reflexology. However, further complications meant that my baby was born via Caesarean section.”

Alternative treatments

Chiropractics
Chiropractic treatment can be helpful throughout pregnancy for moms experiencing postural discomfort. It can be of particular help during the third trimester, when tight muscles and spinal misalignment might restrict the space available for the baby to turn properly. By correcting tiny misalignments in the bones of the pelvis or the spine, abdominal muscle tension is released, opening the space for baby to turn.

While standard chiropractic treatment could help to achieve this, some chiropractors offer the “Webster Technique”. “This is a specialised method of assessment and adjustment to influence a baby’s position, which I have found to be remarkably effective,” says chiropractor Dr Chad Gordon.

Stay-at-home mome Roshan, 31, was advised by her midwife to try chiropractic treatment to turn her breech baby because of his size. “I was happy to try this as I experienced back pain from being on my feet a lot. I had one treatment a week for four weeks. My back pain disappeared and a subsequent check-up confirmed that my baby was head down.”

Acupuncture/moxibustion
This involves applying needles and heat to some acupuncture points, mostly on the little toe, hands and knees. It has quite a high success rate for turning a baby and is commonly used from 30 weeks onwards, though some practitioners prefer administering it only at 38 weeks.

Hair stylist Seunghee, 33, says, “My first baby was stubbornly breech until 38 weeks. We wanted a natural birth, so by 38 weeks, we had to take action. I had an acupuncture and moxibustion treatment at 39 weeks, which stimulated baby to turn. This was confirmed at a check-up three days later. The treatment was uncomfortable, but not painful. I am certain that various stress factors in my life contributed to baby not turning, and that the acupuncture helped to address the physical aspect of this.”

Regular options

Hypnobirthing
This can help you to relax enough to address negative emotions such as fear, anxiety or anger that can affect both you and your baby. Psychophysiological factors may influence the breech presentation and could explain the high success rate hypno­therapy has had with turning babies to a head-down position. Hypnobirthing is a specialised pregnancy and birth self-hypnosis method.

Financial manager Salwha, 35, successfully turned her second breech baby with hypnobirthing, enabling her to have the natural birth she’d wished for the first time. “My first baby was still breech at 40 weeks, and I was advised to have a Caesarean. I’d insisted that baby be allowed the chance to turn on his own until due date.

“With my second baby, I was reluctant to repeat this, so I tried yoga, homeopathy and chiropractic treatment from 32 weeks. But baby still lay breech at 36 weeks. Sensing my desperation, my midwife recommended a hypnobirthing practitioner. Filled with scepticism during the two-hour session, I was convinced I was not relaxing or ‘going deeper‘ and that it was not having much of an effect.

“Beyond this, I was required to connect with my baby, to ask it why it hadn’t turned, and to visualise the action of the turn. I discovered that I carried anger from my first experience, which somehow became released through this. During the following night, my baby turned head down, which woke me up. Too afraid to hope in vain, I would only believe the scan that confirmed this three days later. I had an uncomplicated vaginal delivery.”

The Indian Bridge
If baby has already engaged in a breech position, then try the Indian Bridge. Lie on the floor with a number of cushions under your bum five times a day for 15 minutes at a time (before or an hour after meals to avoid indigestion). It is important to relax in this position. If you experience severe discomfort, then discontinue. This helps the baby to disengage from the pelvis, giving it the freedom to adjust its position.

An alternative is to adopt a “knee-chest” position with knees, chest, head and forearms on the floor, your bottom high in the air, your knees apart with legs lifted away from your belly.

Midwife Karen, 31, found her first baby had engaged in the breech position at 36 weeks. “I was dedicated to doing the bridge five times a day for two days and found it comfortable. During the night on the second day, I awoke with nausea and intense movement from baby. Baby was found to be head down when I was checked by my midwife the following morning.”

External cephalic version (ECV)
This is when the baby is manipulated by hand from outside
the abdomen to turn him to the head-down position. The
mother is usually medicated to relax the uterus. An ECV is only performed from 37 weeks by an obstetrician at hospital because there is a risk of premature labour. Other risks include cord en­tanglement, foetal distress, placenta abruption and rhesus (blood type) complications.

Obstetrician Dr George Draper explains, “As long as an ECV is performed within the rules, these risks are seldom encountered. State hospitals offer ECV as a standard option for a breech presentation, as long as it is not contra-indicated.”

The success of an ECV depends on the position of the breech (knees flexed or extended), whether the mother has had previous pregnancies, the amount of amniotic fluid and the skill of the practitioner. You and your baby are thoroughly assessed before and after the version, to ensure your safety. Some practitioners recommend wearing cycling pants for three hours after a version to avoid baby turning back.