The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA
A Holiday Treat from gentlebirth.org
Sing Along with the Nutcracker Suite - Yes, there are lyrics!
Breech Baby Study - This study is for women after they've given birth to a breech baby, whether or not by cesarean. So, once you've gotten a chance to catch up on your sleep a bit after the baby's born, please consider coming back to participate in this study. Thank you!
Clinical Exam Often Misses Breech Presentation in Late Pregnancy - Findings from a new study indicate that clinical examination will only detect about 70% of non-cephalic presentations in late pregnancy. [Medscape is free.]
of clinical examination for detection of non-cephalic
presentation in late pregnancy: cross sectional analytic study.
Nassar N, Roberts CL, Cameron CA, Olive EC.
BMJ. 2006 Aug 4; [Epub ahead of print]
Just a little bit of experimentation can quickly build skill in detecting the difference between the sounds of the fetal heart and the other sounds so that an attentive practitioner can locate the fetal heart fairly quickly. The difference in heart location for a breech is very different from that of a vertex baby.
I consider it responsible practice to use this skill at every prenatal appointment after 32 weeks to confirm a vertex presentation, especially if palpation isn't convincing. It is also helpful to be attentive to the issue of fetal rotational orientation (anterior/transverse/posterior) so that a woman carrying a baby in a posterior position can also be attentive to this issue.
This test can be done with just a few extra seconds of time for a skilled practitioner. For those who do not have access to a Doppler, listening to the fetal heart directly with the ear is also very sensitive to the location of the fetal heart.
See other Rapid
of Breech Presentation - Canadian guidelines [June, 2009]
No more automatic C-section for breech births, says Ob/Gyn Society
Halifax - June 17, 2009 - Physicians should no longer
automatically opt for caesarean sections in the event of breech
birth, according to new guidelines for Canadian health
professionals released today by the Society of Obstetricians and
Gynaecologists of Canada.
Presentation White Paper is an excellent place to start.
Baby, Turn, how to turn a breech baby - What are the options
when your baby is breech? from fitpregnancy.com
Making Choices: Options for a woman with a breech baby
A Canadian MD, Andrew Kotaska, commented on the booklet: "It provides no opening whatsoever for a vaginal birth if the woman declines ECV or if the fetus remains breech, stating simply that the safest approach is cesarean section. This simplified "breech=section" stance is no longer condoned by the clinical practice guidelines and committee opinions of the RCOG and ACOG, published in December and July, 2006 respectively.
The RCOG states specifically: "If a unit is unable to offer the
choice of a planned vaginal breech birth, women who wish to choose
this option should be referred to a unit where this option is
This study controverts the study from a few years ago that suggested that cesarean was the safer route for breech babies.
So this study shows that vaginal breech birth is as safe as cesarean for term breech babies.
to the term breech trial: the rise and fall of a randomized
Am J Obstet Gynecol. 2006 Jan;194(1):20-5.
RESULTS: Most cases of neonatal death and morbidity in the
term breech trial cannot be attributed to the mode of delivery.
Moreover, analysis of outcome after 2 years has shown no
difference between vaginal and abdominal deliveries of breech
Cesarean fails to improve long-term breech outcome [10/25/04] - American Journal of Obstetrics and Gynecology 2004; 191: 864-71
Investigating whether elective cesarean for unborn babies in breech presentation reduces the risk of death or neurodevelopmental delay at 2 years of age.
In women with breech presentation at term, elective cesarean may
not reduce the risk of death or neurodevelopmental delay in the
resulting infants at 2 years of age, study findings indicate.
with vaginal breech delivery: data from 1980 to 1991 -
OB/GYN News, Oct 15, 2003 by Sherry Boschert
Selected term singletons in breech position can be safely
delivered vaginally at appropriate facilities, according to Dr.
Linda M. Hopkins.
Heads Up! - All about
Birthing Breech - a new web page with lots of resources.
Information for families expecting a breech baby
Informed Consent and Waiver of
Medical Referral For Vaginal Breech Birth
of Fetal Position During Pregnancy and Risk of Nonvertex
Catherine Takacs Witkop, MD, MPH1, Jun Zhang, PhD, MD2, Wenyu Sun, MD, MPH2 and James Troendle, PhD2
RESULTS: Data for 7,045 women who underwent routine prenatal
ultrasound examinations were analyzed. We found no association
between nonvertex presentation at 15–22 and at 31–35 weeks of
gestation. A nonvertex fetus at 35 weeks had a 45% chance of
spontaneous version by delivery. Multivariable logistic regression
analysis found that multiparous women had half of the risk of
nonvertex presentation as nulliparous women. Smoking during
pregnancy (odds ratio [OR] 1.47, 95% confidence interval [CI]
1.10–1.96), low volume of amniotic fluid at 31–35 weeks (OR 3.74,
95% CI 1.85–7.53), and fundal position of the placenta at late
ultrasound examination (OR 1.85, 95% CI 1.23–2.78) were all
associated with significant increases in the risk of nonvertex
position at delivery.
CONCLUSION: Spontaneous version of a nonvertex fetus at 35 weeks of gestation is still likely.
Babies normally turn themselves head down between 28-32
weeks. They have a stepping reflex which causes them to
"walk" around the inside of the uterus when the bottom of a foot
is against a hard surface, such as a contracted uterus.
Those lovely toning contractions (formerly called Braxton-Hicks
contractions) provide a perfect surface to trigger baby's stepping
reflex. Babies also need a normal amount of amniotic fluid,
and a relaxed mommy. One astute client suggested that it
would make sense to put a hand against baby's foot to trigger the
stepping reflex while the mom is in the various positions to try
to turn baby. Sounds like a good idea to me!
Commentary on the above study:
NEW YORK, Aug 11, 1998 (Reuters) -- Routinely opting for cesarean delivery for babies lying in the breech position at term does not necessarily result in lower morbidity and mortality rates for infants or mothers -- and may even raise the rate of maternal complications, a study suggests.
A breech delivery occurs when an infant's feet or buttocks emerge before the head.
"There is no firm evidence to recommend systematic elective caesarean section for breech presentation at term," say Olivier Irion and colleagues of the University Hospital of Geneva, Switzerland.
The study, published in the July issue of the British Journal of Obstetrics and Gynaecology, examined 705 consecutive breech deliveries at term in a single maternity unit at the Geneva University Hospital, over a 12-year period.
Results show that compared with women who had elective cesarean delivery, women in the planned vaginal delivery group had shorter hospital stay (5 days versus 7.5 days), and a significantly lower risk of complications such as urinary tract infection and endometriosis. These women were also less likely to sustain a life-threatening complication such as a hysterectomy, pulmonary embolism, and cardiorespiratory arrest.
In general, women who underwent planned vaginal delivery were younger, taller, and thinner than women who delivered by cesarean section, the researchers found.
There was no significant difference in the risk of neonatal complications between infants born after a trial of vaginal delivery and those born by elective cesarean section. There was also no difference in neonatal complications between infants born by cesarean section performed during labor and those born by elective cesarean section.
The authors acknowledge that their study could detect only large differences in neonatal and maternal morbidity, and that a much larger study is needed to detect smaller but important differences.
"We have to admit that the best mode of delivery for breech
presentation will remain uncertain until large randomised trials
with carefully selected outcomes such as long-term infant and
mother morbidity are completed," they conclude.
Bicornuate Uterus [Ed: Note that even
with a bicornuate uterus, there is always a point in early
pregnancy where the baby can be head down. The trick is to
do daily exercises earlier in pregnancy depending on the length of
One of the women I worked with was a water aerobics student. She took a special class for pregnant women throughout her pregnancy. There were 12 other women in the class. My client was the only one who had a vaginal birth. All the others were sectioned for breech or transverse lie. A chat with the instructor revealed a trend in all of her previous classes as well.
I had turned that baby several times and after the last time
asked her to stay out of the pool on a hunch. After all that I
have had a couple of others still breech at 37-39 weeks. (these
women came to me very late BECAUSE they were gonna get sectioned
for breech). Told them to stay out of the pool and do slant boards
and we would attempt version at their next visit. Lo and behold
they were vertex at the visit. Had great births. Same story with
another water aerobics lady after moving to Oklahoma. She came to
me transverse at 37+ weeks. Her records showed that her baby had
been breech or transverse throughout the pregnancy but her midwife
had never mentioned this as a problem (last visit with her was at
36 weeks) Again, staying out of the pool coincided with conversion
Breech Presentation -
This page presents a brief explanation of breech presentation, and
outlines a method rooted in Traditional Chinese Acupuncture (the
Zhiyin method) which encourages the baby in the womb to a normal
A useful book on singleton breech "birth" rather than breech
"extraction" is Breech Birth Woman-Wise by Maggie Banks,
Publisher Birthspirit Books, New Zealand, 1998 ISBN 0 473 04991 0
One Midwife's Collection of Breech
These are some suggestions mostly from the book Wise Woman Herbal for the Childbearing Year by Susun S. Weed...
Have her walk a lot. Have her soak in water and then walk. She
could try the breech tilt. If you think she has excess water, try
homeopathic natrum muriaticum.Or have her eat lots of watermelon
with the seeds to reduce fluid. Homeopathic pulsatilla is often a
good choice for malpresentations. Some midwives suggest parents
talk the baby into turning. Or have mom search herself to discover
any reason why the baby may be transverse.
There are a lot of different ways of trying to turn a baby - external manipulation, gravity manipulation, acupressure, homeopathy, herbs, visualization. But the first thing to do is to try to figure out why the baby is currently breech. Your baby and your body working together can be awfully smart, and it may be that there's something about the pregnancy that requires a breech or cesarean delivery. (By the way, breech vaginal deliveries with skilled attendants can be quite safe - if you seriously want to try a vaginal breech delivery, it might be worth contacting the people at The Farm in Tennessee. These are the Ina May Gaskin folks who wrote "Spiritual Midwifery". They'll sometimes accept fly-in breech patients.)
So, it would be helpful if you could sit down with somebody and review the ultrasound to look for clues about the placement of the placenta or any cord issues that might favor a breech position. You also probably should do some meditation to communicate with the baby and seek some inner guidance about what's going on.
Hypnosis can help, both with trying to figure out what's going on with the breech and also to help turn it. Aside from the visualization involved, the deep relaxation of hypnosis can help your abdomen to relax enough to allow the baby to turn if it wants to. Anyway, it is important to pursue both medical and metaphysical paths for determining if it's safe to try to turn the baby back. In no case should you try to force anything as you could inadvertently pull on a tight cord or cause placental problems. Generally, a woman will know when and where not to apply external force on herself.
If you want to do things specifically to help the baby turn, it would be really useful to learn how to determine whether or not the baby is breech by feeling your belly to locate the head. Ask your care provider or someone else with experience to help you learn to do this if you don't already know how. You could probably teach yourself by simply pressing gently on your belly to feel the baby's outline and following the various body parts until you get a good picture of how it's lying, but it might be easier if someone else could show you. The reason it's important to be able to do this is so that you know when the baby has turned and don't unwittingly "unturn" the baby through your efforts.
If you've decided that you want to try to turn the baby, there are two-page discussions of this in Susun S. Weed's "Wise Woman Herbal - Childbearing Years".
She says the most successful technique is going to a swimming pool and doing headstands. I would add that it's important to find a pool that's warm enough that you are really relaxed. Ideally, you could find a therapeutic pool that is kept at a temperature higher than a regular pool where people heat themselves up swimming laps. Get into the pool and spend at least 15 minutes just paddling around and having fun. This will help you to relax those abdominal muscles to give the baby more room to turn, and the deep water immersion will increase your amniotic fluid, also helpful to the baby's turning.
The standard postural inversion, i.e. slantboard tilt has good results. Again, try to take a bath first to increase amniotic fluid and make sure you're relaxed.
(By the way, somebody somewhere explained why this works. It never made sense to me that you would try to turn a baby by getting into a position where the head is lower. After all, wouldn't the heavier head keep the baby in that position? But it does two very useful things. 1) It helps to disengage the baby from the pelvis and 2) Apparently when the baby's head comes up against the inside of the fundus, it's inclined to tuck its head and do a somersault into the vertex position! Yeh for baby!)
Visualization - you can imagine a helium balloon attached to the baby's foot, imagine the baby turning somersaults.
Homeopathic remedy is Pulsatilla 30x. One dose every two hours for up to six doses (during the course of one day). Don't take it for more than one day.
Acupressure or acupuncture (preferably with a professional), or you can apply finger pressure on Bladder 67, which is on the outside of the little toe on both feet, right next to the nail. If you can't connect with an acupuncturist or acupressurist, consider a shiatsu therapist or someone else who knows the pressure points.
Just plain swimming can help the baby turn because of the stretching and crouching involved. Maybe doing some bobbing (crouching on bottom of pool in deep water and then pushing off and reaching your hands up high as you break through the water) would be a useful exercise.
Also, do what you can to increase that amniotic fluid. Drink
plenty of water, and being in deep water will squeeze the fluids
in your tissues into your bloodstream and increase the volume of
When I discover a breech presentation, I suggest relaxation,
visualization of the baby not only un-engaging, but turning to the
vertex, and re-engaging in a favorable position (be specific in
your visualizations) The most successful techniques I know of and
have had success with are handstands in a swimming pool,
acupressure on Bladder 67 (this point is located on the outside of
the little toe, just rub and push your fingernail into it) and the
best most effective one is put a radio down your pants! I know it
sounds silly, but I have SEEN babies turn toward the music, right
in front of my eyes, when nothing else worked. Have you talked to
your doctor about external version? The key to this is RELAXATION
on your part, and make sure the doc uses lots of lubrication like
baby oil or KY on your belly, should also monitor the baby
intermittently during the procedure. I have a lot of faith in
vaginal breech, but it is likely that your doc doesn't have much
experience in this area, and so is not comfortable with it. If you
get really desperate, you can contact The Farm in
Tennessee. They allow low risk mothers to come there and
deliver vaginal breeches in their birth center. Let me know if you
want more info. Good luck! I n my opinion, breech all by itself is
NOT a justifiable reason for a primary cesarean.
At 36 weeks if your baby was still breech we'd talk about
spending time head down on a slant board with ice on the baby's
head, pelvic rocks, etc. If the baby was still breech at 37 weeks,
we'd discuss the use of pulsatilla, finding a swimming pool you
could dive to the bottom of, etc. If the baby was still breech at
38 weeks, I guess then we'd discuss EV -- but I don't know, so far
I've never had a baby not turn from all of the above.
Here's what a slantboard
looks like, so you'll have an idea of the angle you're aiming for.
You can buy some nice foam slantboards for around $200 from AIR,
Breech tilt: The literature I have from the Bradley folks says
that if done 10 minutes twice a day for 2-3 weeks after the 30th
week the pelvic tilt had an 88.7-96% success rate in 744 patients.
It is recommended that the pelvis be raised 9-12 inches above the
head and be done on an empty stomach. This was reported in OB/GYN
News Vol12, No.1 The OB\GYN list discussed that most of these
babies will turn on their own and that they don't work on it until
37 weeks. I personally think this is too late.
Gravity pushes the baby's head into the fundus, tucks it, and
baby can then do a somersault to a vertex position.
I advise my ladies with breech babies to lie on the slant board
(a lot of pillows on the floor below the sofa will work, or the
ironing board works too) for 5-10 minutes 5 times a day on an
empty stomach. This has an 87% success rate if done by the 37th
I've had great results with moms who have babies who are breech
and they turn them themselves with positioning. I like
head down on folded arms and butt in the air. Mom
wiggles her pelvis and baby often will turn. I had a mom who
with a breech, OB had scheduled her c/sec in one week. She fixed her bed and TV so she could watch it and do head down wiggle wiggle ask I call it. The baby turned and she had a vaginal birth.
The VBAC Companion by Diana Korte has pictures of positions that
may help turn a breech on pg 69 - 70. From the
book, "one is of mom in bathtub with warm water, gently
massage your baby, and encourage him to roll over.
Visualize your baby in the correct position. Talk to him;
him to move into the appropriate position."
Before I get started, let me put in a plug for a yoga during pregnancy book. I personally thing yoga is an excellent way of becoming familiar with your body, and I can't think of a time when that is more important than when giving birth! Anyway, the plug:
Preparing for Birth with Yoga, Janet Balaskas
Element Books, Inc
PO Box 830
Rockport, Mass 01966
OK. Now the yoga postures:
Turning the baby from breech (or transverse) to vertex:
The main posture for doing this is not a pregnancy only posture. It is a classical yoga posture. It is the shoulder stand. However, it is an advanced posture, and will need to be done in a modified position if the woman is not accomplished in the posture already.
To obtain maximum effectiveness, the posture should be done when the baby is the most active. The posture does not turn the baby. The posture gives the baby room to turn and stimulation to allow the baby to turn itself.
Lie on your back on a yoga mat, or good wall-to-wall carpet (no slippery throw rugs!). Place your arms at your side with your palms down. (You will use them to help support your weight) Flex your knees and rock them up over your head while you raise your hips as far off the floor as possible. Keep rocking forward until your chest is against your chin. At this time your helper may stand behind you and brace your hips. Slowly straighten your legs out straight up (actually they should angle slightly toward you head to help maintain your balance. Again, your helper may now hold your ankles to help you maintain the position. Your helper should never exert force to change your position, just help you hold a position once you are in it. You may bend your arms at the elbow and place your hands against your pelvic bones at the waist to help hold up your weight, if you wish. Keep the body upright and the knees as straight as possible. A really bad ascii picture of the position is shown below.
You should try to hold the position for up to five minutes, if possible. You should do the posture at least twice a day for five minutes a time until the baby turns. You WILL feel the baby moving around in there. This is normal. Once the baby turns it is no longer necessary to continue this posture.
Keeping the baby in the vertex position.
The tailor sitting position is really good for keeping the baby turned. For those that want to go a little further, the following modification also helps.
Start sitting in the tailor position. Place the soles of your feet together, touching, in front of you. Try to keep your knees as close to the floor as possible. Bring your feet as close as possible in front of you. Lean forward slowly over your feet, keeping your knees down as far as you can. If this is too easy, grab your toes with both hands and pull them toward your chest as you lean forward. Sit in this position from 10 to 20 minutes, twice a day. Only lean as far forward as is comfortable. Continue this posture every day until the baby is born. (No pictures)
Turning the baby from posterior to anterior (and keeping it there)
This is the pelvic rock, another classical (but very easy) yoga posture.
Get on your hands and knees. Start by sticking your head down, and arching your back as high as possible by rocking your pelvic and shoulders. You should have your back arched like a cat, with your head down between your elbows. Slowly start rocking back in the other direction until your back is swayed down until your stomach almost touches the ground and your head is thrown up and back (you are looking almost at the ceiling). Almost the entire impetus for the motion from one extreme to the other should come from rocking the pelvic joints back and forth. Each repetition should take at least 1 to 2 seconds to complete. Perform 25 to 30 rocks at least 2 to 3 times a day. Continue this posture every day until the baby is born. (No pictures)
This posture is also good for keeping the baby turned vertex, but not a good as the sitting posture.
Shoulder stand picture:
------\ _______________ \ ) | And hold | / / <--------------- | ankles here | / / _______________ / / ( \ | \ _| / ) / / ( / \ | \ | \ / | o | \ | _^--a _/____/__ _______________ ( / '-------,___ | DH/Helper | \__--\_________.------._.-- | stand here | _______________
Doesn't anyone else have the patient do knee chest exercises? It
still surprises me how well this works, to the point that if the
exercises don't work then a version will probably be unsuccessful.
I've only just discovered the idea of "breech exercises". Is
there any published evidence of efficacy ?
This is somewhat anecdotal, but in Ob.Gyn. News, Jan. 1, 1977,
Dr. Juliet DeSa Souza, retired professor of obstetrics and
gynecology at Grant Medical College, Bombay, India, reported to
the World Congress of Gynecology and Obstetrics that postural
treatment corrected breech presentation to a head-first
presentation in 89 percent of 744 patients studied. She also
reported that in her private practice 70 of 73 cases were
My understanding of "knee-chest exercises" is to have the woman
on her elbows and knees, so her hips are higher than her head, and
to stay in that position for 15-20 minutes a few times a day. I
tell my patients to read a magazine article or chapter of a book.
Alternatively, the woman can lie on her back with her hips elevated well above her shoulders for 20 min. 2-3x daily (preferably on an empty stomach at a time of day when the fetus is normally active). She can elevate her hips on pillows or use a slant board (or ironing board) or put her hips on the couch and her shoulders on a pillow on the floor.
I've also heard of doing handstands in a swimming pool. I know a couple of people (one an L&D nurse) whose babies turned while they did this. Purely anecdotal, of course, but it seems to help some people.
I recommend these exercises for those who are breech after 32-34
weeks. We send them for an external version at 36-37 weeks if this
I have my patients get down on their elbows and knees and shuffle
along the floor, telling them to pretend to "pick lint off the
carpet". My anecdotal experience has been very positive, at least
for the chuckles (until they realize that I'm serious), but I
think also in spont. version to vertex.
I am going to leave the list of usual "turn a breech "
suggestions up to the rest of the list. I would like to add
something that we do in our practice ( with lots of success ) that
you may not hear anywhere else. That is that babies often turn to
the breech position in order to come up to comfort the mom.
Because it sounds like you are so anxious ( even though the basis
of your anxiety is the position ) I would consider this to be a
strong possibility. So, try spending some time talking to the
baby. Tell it that you would feel much better if it would put it's
head down. You appreciate the fact that your baby is trying to
comfort you but the best thing would be for it to get in the most
positive position for the birth. Is a breech birth out of the
question for your MW ? This would certainly increase your anxiety
!! I don't understand why she would want you to wait to try to get
the baby to turn.
Hypnosis and Conversion of the Breech to
the Vertex Presentation
Lewis E. Mehl, MD, PhD
From Archives of Family Medicine, Vol. 3, Oct. 1994
Hypnotherapy may help pregnant women turn their breech baby around to the normal head-first, or vertex, position. A researcher at the University of Vermont, Burlington, used hypnosis with one hundred pregnant women whose fetuses were in the breech (feet-first) position between the thirty-seventh and fortieth week of gestation.
The intervention group received hypnosis with suggestions for general relaxation and release of fear and anxiety. While under hypnosis, the women were also asked why their baby was in the breech position.
The study, which appeared in the Archives of Family Medicine, reported that 81 percent of the fetuses in the hypnosis group moved to the vertex position, compared with 48 percent of the control group. Not surprisingly, hypnosis was most effective for the women motivated to use the technique.
Natural Health magazine, November-December 1995
My midwife's recommendation is shining a torch (flashlight)
directly above the pubic bone onto your belly - i.e. putting it
directly on the skin. She says it has never failed her. I
tried it (although not at 36 weeks, but a little earlier) and it
produced an immediate response in there - major upheaval and
Are you familiar with the frozen peas trick? I figure out
which way the baby wants to turn to make it to a vertex
presentation. Then I have the mom (while doing her pelvic tilts)
place a bag of frozen peas on the back side of the baby's
head (babies tend to move away from the cold). Then they place a
flashlight and/or some nice music down close to the vagina (babies
gravitate toward the light and music).
There are some unusual ones I've heard of too. How about momma
putting an icebag on the fundus, while she sits in a bath of warm
water? Baby is said to move away from the cold! (Cute huh?)...
never tried it, but sounds quite interesting!
**Or package of peas, or frozen package of uncooked rice/popcorn
** Also, shining a light in the direction you want to go**
I was 38 weeks and apparently carrying a substantial baby when my Obstetrician confirmed what I feared - that my baby was in a breech position. I got out a pack of frozen Corn Kernels, got on my knees, with my head on the couch, I relaxed and put the improvised ice-pack on the fundus. Baby moved down but stopped and did not turn. I took an hour's break, switched the corn for ancient, solid-frozen mixed veggies and re-checked that bub's position was as I remembered from the turning attempt. Yes, I knew the position of the baby and which way I wanted bub to turn, so I assumed the position with my head on the couch, to give baby maximum room, I thought. I put the ice-pack on the back of bub's head and pressed gently but firmly in the direction I wanted bub to go. Baby moved around fairly slowly until I guess the top of bub's head was on my left hip. Then bub stopped. No struggle, no problem, but if I let go, the head would start to bob up again. I moved to the bedroom and lay on my bed - I held bub's head down with the ice-pack but bub didn't shift. I used my free hand to reach around to where I imagined bub's bottom or legs to be and pulled up - effectively prodding baby's bum. I don't know if this caused bub to kick with indignation or if my poking helped get bub's bum up above the brim of my pelvis or something, but -- swoosh- plonk! Vertex presentation!
All the time I was attempting to turn the baby, I was monitoring
myself for discomfort, light-headedness, or even just a feeling
that something was not right. I felt baby kick with her
usual frequency and vigour throughout and felt nothing
unexpected. I had the phone beside me at all times, just in
Nice things (music, whale sounds) near pubic bone.
I have also heard of a mom with a persistent breech who actually
placed headphones on her abdomen in the fundal area and played
"headbanger" music. The baby went vertex very soon after.
Presumably the baby didn't appreciate the music and turned to get
away from it.
Have also heard that you put stereo headphones playing music or recordings of you and your family's voices on lower abdomen, where you want head to go. I have also heard that you "put a radio between your knees" when you are on the ironing board.
One suggestion that I saw here on m.k.p was from someone's
midwife to play your favorite music on a walkman and put the
headphones on the bottom of your belly.
While you're heading to that swimming pool or Watsu tub, why not
try doing some inverted slants or knee-chest? Think I'm
joking because your head would be out of water? Try using a
snorkel to allow yourself to breathe while you relax completely in
an inverted posture. Have a friend hold your
feet/lets/knees/whatever from the side of the pool to achieve a
nice slant. Get creative!
I always get my mom in a warm pool. At least 72 degrees. She
walks into the pool holding the baby's bottom out of the pelvis.
As the water gets deeper she can let go of the bottom of her belly
as the water will hold the baby up. When she is up to her
shoulders the belly is de-weighted and so is the baby. She should
then dive head first down to the drain kicking her feet to help
her get down. Water rushing by her stomach will help the baby to
turn. I've never had this fail. One of my moms had to dive three
times before the baby turned. The idea is that the mom and the
baby are de-weighted and the heavy part of the baby (the head)
will turn around. It also lets the baby decide which way to turn.
Of course your mom needs to know how to swim.
A few questions: What week? How long does she stay head down (as
long as she can hold her breath?) and where do you find such a
pool? Is that warmer than most health club pools and what about
the chlorine? I would love to try this. Actually, lately I have
not seen that many breeches stay breech. It is starting to worry
me that I will get a run on surprise breeches just to bring the
numbers back in line. I use the tilt exercises, mother massage of
baby, and gentle e. version at about 36-37 weeks. I use low
lights, a warm room, and wait til mom is relaxed to start. We
spend about 30 to 45 minutes, if needed, to do the procedure. We
just put a pillow under the mom's hips and use a rocking motion
with slight pressure. After the baby moves to transverse, the head
frequently takes a dip and then shows up in the pelvis. The first
couple times this happened I was afraid I had "lost" the head and
had trouble getting oriented to quickly get FHTs for reassurance.
Now I sort of expect the "disappearing head trick". If a baby
won't go very easily, I don't push it. Also stop if big FHT
changes. [Ed.: It's important to remember that many state laws
explicitly prohibit midwives from doing external versions because
of the potential risks for an overly forceful version.]
You mention some causes of breech babies, among them the fact that their mothers tended to spend a lot of time in the pool (I take an aqua aerobics class 2x week so you can see why I am concerned!) Yet, a great deal of your website is devoted to turning the baby by swimming, doing pool exercises, and so on....
So... which one is it? Should I or should I not continue
going to the pool?
There are no studies about turning babies with water, and even good studies aren't guaranteed to tell us "the truth". You might want to ask your midwives to explain to you more about why babies typically turn head down; this should help clarify why it might be true both that spending a lot of time in water might prevent the baby from turning, and that getting into the swimming pool with specific intent to help the baby turn might accomplish that.
I know this probably sounds about as clear as mud, but it should
make more sense to your midwives, who can explain how it relates
to your particular situation.
- This is a neat website. In her article on breech babies
she gives directions and photos of how to use moxibustion, which
is something I hadn't seen illustrated before.
Breech Presentation -
This page presents a brief explanation of breech presentation, and
outlines a method rooted in Traditional Chinese Acupuncture (the
Zhiyin method) which encourages the baby in the womb to a normal
nonvertex presentation with moxibustion: a systematic review and
Vas J, Aranda JM, Nishishinya B, Mendez C, Martin MA, Pons J, Liu JP, Wang CY, Perea-Milla E.
Am J Obstet Gynecol. 2009 Sep;201(3):241-59.
This review pooled the results from studies published between
1980 and 2007 that looked at ways to turn fetuses that were not
well-positioned for head-first birth into that position. The
studies compared moxibustion to other ways to encourage the fetus
to turn (hands-to-belly maneuvers, having the mother lie with her
head lower than her feet, acupuncture). Moxibustion involves
burning the herb mugwort (Artemisia vulgaris) over an acupuncture
point found on the outer corner of the smallest toenail. Seven
studies presenting data from 1087 women were included in the
analysis. All the women in the studies in this review were
randomly picked to receive either moxibustion or one of the other
methods, to strengthen confidence that any differences in
experiences of study groups were due to the moxibustion.
Combined results from the studies showed that the fetuses of women receiving moxibustion were 36% more likely to turn to a head-first position than those who got other treatments or no treatment, and this result was statistically significant. To check this result, the study authors looked separately at four trials that used similar starting points for moxibustion, all after the 32nd week of pregnancy. Here too, the likelihood of the fetus turning to a head-first position was more than 30% greater for the women who got moxibustion than for those who got another treatment. The study found no differences in safety between moxibustion and the other methods. Surprisingly, there was also no difference in the rate of cesarean birth between the groups. Six of the seven studies were carried out in China or Italy. Practice patterns in those countries (e.g., greater acceptance of vaginal breech birth) may explain why the review did not show a higher risk of cesarean section in the group that did not get moxibustion; if done too early, babies could also flip back into breech position, which could impact this outcome.
The take-away: Vaginal breech birth is currently rare in the
U.S., where cesarean delivery is routine when the fetus’s position
is not head-first. With known risks associated with cesarean
delivery for mothers and babies, and no known downside to
moxibustion, all women with fetuses that are not head-first by the
third trimester should receive information about the safety and
effectiveness of this treatment. Most licensed acupuncturists can
perform moxibustion. Further research should explore the best
frequency and timing of the practice.
Correction of Breech Presentation A Randomized Controlled Trial
Francesco Cardini, MD; Huang Weixin, MD
JAMA - November 11, 1998
Context.—Traditional Chinese medicine uses moxibustion (burning herbs to stimulate acupuncture points) of acupoint BL 67 (Zhiyin, located beside the outer corner of the fifth toenail), to promote version of fetuses in breech presentation. Its effect may be through increasing fetal activity. However, no randomized controlled trial has evaluated the efficacy of this therapy.
Conclusion.—Among primigravidas with breech presentation during the 33rd week of gestation, moxibustion for 1 to 2 weeks increased fetal activity during the treatment period and cephalic presentation after the treatment period and at delivery. [(75.4%) in the intervention group vs 62.3% in the control group]
I would like to try Moxa as I found some that was given to me,
but don't have a clue about how to use it (how long, where, how
often?) and would like to hear any experiences others might have.
I have had a couple of clients use moxa sticks to get labor to start and in the process help a posterior turn. They had to go to an acupuncturist though who used a black marker to mark the points that the moxa stick would be used on. There were several points (like acupressure points) on her arms, sternum, and legs I think. The girl with the posterior baby had additional points marked. Then at home her husband used the stick like this (according to instructions from the acupuncturist):
You hold the lit moxa stick an inch or so above the pressure
point and when the woman says she feels it "hot", you quickly pull
the stick away - this was about 2 to 3 seconds, then immediately
you put the stick back down over the pressure point again until
she says "hot". You do this three times and then take your thumb
and apply pressure on the mark for about 10 seconds (I think that
was how long - a slow count to 10). Then you move on to the next
mark in the sequence. You do each mark 3 times (in sequence) - at
least that was all these girls had to do because after that they
were getting results (contractions). However one of them had to go
back to using the moxa sticks again after a while because her
contractions quit on her after a while.
We use a cigar instead of a moxastix. It is the same
principle as using the moxastix except the moxastix stays "lit" by
itself The point of moxabustion, as I was told (and I could
have it all wrong), is to heat up the acupuncture points
I talked to my Acupuncturist about Moxa and in his opinion it is also the herb not just the heat. Mattering on who you ask, most traditional Chinese healers do believe it is the herb and heat not just the heat. I've used Moxa for years and from what I've been told the older the herb the better(it's kind of like it ages).
I love using it it seems to make so much sense, using heat to
How does the herb work in this way? Like aromatherapy or
Although it could be aroma therapy, I think that the combusting
oils and ingredients are carried onto and into the tissue.
Breech Presentation -
This page presents a brief explanation of breech presentation, and
outlines a method rooted in Traditional Chinese Acupuncture (the Zhiyin
method) which encourages the baby in the womb to a normal
See also: For
Parents - How to Get the Best Care/How to Find Chiropractors
Webster Technique Certification (Webster Certified)
The International Chiropractic Pediatric Association offers Doctors of Chiropractic the opportunity to receive a Certificate of Proficiency in the Webster Technique. Instituted in the year 2000, this certification proficiency class offers both a hands on examination of the Webster Technique, a specific analysis and adjustment used for pregnant mothers. This chiropractic technique helps to correct sacral misalignment, balance pelvic muscles and ligaments which in turn removes torsion to the woman's uterus, its resulting constraint to the baby, and allows the baby to get into the best possible position for birth.
Here's their referral
directory, which states whether each chiropractor is Webster
technique certified or not.
for Breech Presentation
CHIROPRACTIC HELP BREECH PRE-SENTATIONS?
EDITOR'S NOTE - We have received feedback from representatives of the International Chiropractic Pediatric Association, who were concerned that these web pages may contain some misinformation about the Webster Technique. They wish to emphasize that:
My name is Dr. Jeanne Ohm and I am Secretary to the International Chiropractic Pediatric Association. I am writing to inform you about a non-invasive, very gentle adjusting technique created by the late Dr. Larry Webster, founder of the International Chiropractic Pediatric Association.
The clinical case studies at this point in time are showing an 80-100% success rate with this technique.
Members of the ICPA will be participating in a research study in the early portion of 1998 and are looking to reach midwives in their areas who have women needing this service. What we need is phone contacts for midwifery organizations in the US and Canada so our doctors can make contact with you.
If you are interested in finding out more about the technique, you may e-mail me at firstname.lastname@example.org.
To locate a qualified DC in your area, please check out the ICPA website and referral directory.
For additional information on the Webster Technique (for both the practitioner and lay person), one can visit www.makinmiracles.com There the lay person will find articles, definitions and a direct way to contact me with questions (I am the DC who always answers them) Also the practtioner may also find class schedules, technique tips and also e-mail me for info.
We are looking forward to working with midwives in helping to
eradicate the injuries caused by traumatic birth. Dr. Webster's
Breech Turning Technique is one such way.
It is called the "Webster Technique." I am including the instructions from Anne Frye's "Holistic Midwifery" for you to pass on to your chiropractor.
Larry Webster's Chiropractic Technique for Turning Breech Babies:
This technique was developed by Larry webster, an Atlanta chiropractor. It is included so that you can give it to a woman's Chiropractor (do not attempt to do it yourself if you have no training!). It has worked when everything else has failed to turn a baby. Out of one group of 700 women carrying breech, only 18 of their babies failed to turn with this technique.
Step One: Place the woman in a prone position. Flex each leg toward her buttocks; find the side of most resistance. Adjust sacrum (P-A on that side, contact point sacral notch below P.S.I.S., use light thrust due to softened ligaments of mother).
There are two possible occurrences after adjustment:
Step Two: Place woman in a supine position On the side opposite of sacral adjustment, draw a line 45 degrees lateral and inferior from the umbilicus; draw another line from the ASIS inferior and medial 45 degrees. Where they bisect hold an I-S contact with your thumb (3 to 6 oz. of pressure). Rotate thumb from bisect point 15 degrees in either direction until muscle bundle is felt. HoId thumb contact for 60 to 90 seconds. You will feel the muscle drop away from your pressure. Stop at this point Do not adjust another segment that day.
Adjust every 2 to 3 days for 2 weeks; the baby should turn. If
during the second or third visit there is equal resistance on both
buttocks, do not adjust. On alternate days you can adjust
elsewhere along the spine. (Vallone, 1990)
Midwifery Today published a set of instructions for the
chiropractor to adjust certain vertebra to encourage the breech to
turn. Also the homeopathic remedy is Pulsatilla 30X. I am sure
acupuncture may also be used but I have no experience with it. I
think they use moxa on the outsides of the mom's little toes along
with stimulating the ho-cou points.
A few of the MWs in our state have had fantastic results in turning breeches and OP's with a chiropractic maneuver called the Webster Technique. We finally got together this weekend to learn the tech. from a Chiropractor who took a seminar with Dr. Webster, the D.C. who developed it.
Apparently Dr. Webster (died a few yrs ago) was first inspired after attending his daughter's birth who's baby was breech. Though the birth was successful he still felt there must be something more that could be done to help a baby present vertex. One morning this technique just came to him. He wrote it down, didn't look at it and went to work. Later, he looked it over and decided to give it a try. He eventually used this technique on over a 1000 women with a very good success rate.
The technique is VERY simple. I will try to describe it to anyone who is interested. Delete now if not....
In general it is best to have this technique done every other day for at least 6 visits before the due date. The fastest Webster saw it work was within 45 minutes. Even after the baby turns, mom should be checked up to delivery.
The first thing to determine is which of the mother's hamstrings is tighter than the other. Mom can lay on her side (or stand w/support). Bend the knee of each leg back to buttock to find the tighter hamstring (sometimes it is also the shorter leg). This side will be the one for the first point of contact.
The first acupressure contact point will be just below the sacral notch (in acupressure also known as bladder 43). With mom lying on her side, very light pressure is applied, post. to anter., for 10 to 15 seconds.
Then mom lies supine and the 2nd contact point will be on the OPPOSITE side of the first. Feel along the iliac crest and find a tight spot. Place the back of your thumb (nail side down) on that spot & move your arm upward (inferior to superior) along the crest with very light pressure (really no "pressure", just the weight of your thumb).
That's It! Though we could do it, a chiro. has the advantage of being familiar with these areas and for detecting "tight spots". You could show the technique to the chiropractors you work with or have them call the doctor who showed it to us. Webster was in Atlanta so many docs there know the technq. and there are several in SC who now know it.
We were told that there are no side effects or disadvantages to
this techniq., that what it does is re-establishes communication
between mom and baby. It was demonstrated to us on a pg mom with a
vertex lie. It won't make her baby turn breech. Let me know if you
would like the DC's name here that showed us how to do this, or if
you need a clearer explanation of anything.
I've sent breeches in for this adjustment for several years which good results. Have found that external versions are also easier once the maneuver has been used.
Two weeks ago Lynn Madsen (author of Rebounding From CB Toward
Emotional Recovery--want to plug it whenever I can!) called about
a primip at 37w whose doc had discovered breech and was priming
her for c/s. Lynn wanted to give her options, doc was open to a
version attempt. I gave her a local chiro # to receive a fax copy
of the Webster technique. This was received by a willing
chiropractor in her area (MN) who did 4x (4d) noting immediate
loosening. The primip went in for the version 3d ago, the baby
turned w/o difficulty first try, several ob's involved in the
version were "just amazed" and very pleased and have requested
copies of the adjustment.
to Turn Babies by Patty Brennan - from Midwifery Today.
For midwives who use homeopathy, I highly recommend Patty
Homeopathic Remedies for the Birth Bag, Fourth Edition.
Homeopathic Pulsatilla may help in turning the breech if the
woman is open to trying it. I usually use a 200c potency for it.
pulsatilla 200c 1xday; repeat one more day if baby hasn't turned
or Pulsatilla 30C (homeopathic; dosage 3-5 pellets under the tongue twice daily for 2 weeks) which encourages position change.
or Try using homeopathic Pulsatilla 6X, one tablet under the tongue four times a day. Combine this with the breech tilt exercise at least twice a day for 10 minutes each time. Have the mom take one Pulsatilla tab before beginning the breech tilt.
Homeopathic Pulsatilla 30X is indicated for turning a breech.
Pulsatilla 30c or 200c, one dose q 2 hours up to six doses in one
day can be used to turn a breech. Also for further info, it can be
used in for any malpresentation, including posterior. ( It is most
effective if used in conjunction with a slant board, crawling,
pelvic rocking, etc.) The book I have says not to take it for more
than one day.
I wonder why homeopathic pulsatilla encourages the baby to turn.
Pulsatilla (homeopathically) causes the muscle fibers in the
uterus to even out.
Someone told me about a doctor in Belgium who ran a maternity
hospital who was also a Bach flower practitioner, who uses Bougainvillea flower
essence for turning breeches, it was supposed to work really
well. I just tried it and it worked amazing fast. This client has
hypertension and couldn't use the slant board or elevate her hips.
I would love to know if anyone else ever tried it.
version for breech presentation at term (Cochrane Review)
Abstracts Regarding External Version
Outline and Bibliography for External
Do you do external version?
When do you suggest it?
How do you perform the procedure?
Do you find your moms experience a lot of pain?
What is the success rate?
These questions arose from a conversation I had with an older L&D nurse. She mentioned that she would never recommend version because
I had a 36 week secundagravida in my office Thursday with a
breech. I poked on the baby and it responded by moving. I put a
little pressure and it moved toward the pelvis. I did this again
and it was vertex. Easiest version I have ever done. Probably
would have turned on its own.
In our practice it is the MDs who do external version in the
office under ultrasound guidance. I would like to learn to do
Sure....... the word is SLOW... and gentle! (well, that's two words)... And listen with a Doppler every second.... and for 15 minutes or so afterwards.. Schedule at least an hour long appointment ... Have mom do fetal movement counts afterwards too for the next couple days at least.
I think the safest way is under ultrasound but it isn't always practicable and many versions are done in office or at home -- usually with two midwives - one holding the Doppler for FHTs
With a relaxed mom and very easy movements you just sort of massage the baby the way you want him to go.. first get the presenting part out of the pelvis if it's that low -- though it usually isn't...
Rest between each movement -- you sort of schootch the baby a little bit and then hold the progress while you listen and listen to the FHTs.. any change and you go right back! (this is a necessary precaution..)
Some feel that you just flip the baby into the new position and listen to FHTs and all should be well -- - - but I think that's where the horror stories come from. The only case I know of where there was a bad outcome was a doc office version. They got the baby turned easily and quickly and then listened to the FHTs which were not good and getting worse -- they turned the baby back to breech and the FHTs still kept getting worse and rushed over to try to do a cesarean in time but it was too late -- I don't know if they actually did the section of if the baby was gone by then. I don't know for certain if the method of constant listening and moving by stages would prevent that sort of event or not.. but I think it might... I've heard of a few times where gentle movement caused lousy FHTs so the baby was moved back and FHTs recovered. Those babies are better off where they are...
I think of our midwife-type versions as "the gentle art of persuasion" - - slowly getting a head up baby turned head down.
We usually aim to cause a forward somersault (since this seems the more natural way a baby would move on his own).. but sometimes a kid seems to move more easily the other way.
I always say to go slow, but the occasional baby will wiggle right around on his own as soon as you start working on him! Keep listening and make sure this is the best thing as far as FHTs go -- if he moves that quick and easy then all is probably well...
I've heard (and wish I could see it) some midwives just do a deep tummy massage and that this makes the babies turn on their own...
There's an extremely interesting version method I've never heard of before in WIlson CLyne's (Concise Textbook for Midwives; Pb. Faber --- I have the '75 edition); guess it's Ok to quote-- I'd love to hear y'alls comments.
pg 426 "The author favors the patient do the version: Assuming an LSA breech, the steps are as follows:
"Firstly, Slip the palm of the left hand into the pelvis below the breech, and gently elevate it. Now tell the patient to take very deep breaths. Holding firmly on to the breech, you commonly find that it slides gently upwards as she breathes. In other words, the up-and-down movements of the diaphragm have pushed the baby's head downwards.
"Secondly. Slide the baby's head towards the right side of the uterus. Now you have a transverse lie.
"Thirdly. Raise the breech towards the fundus.
"Fourthly. Glide the head into the pelvis, and check the fetal
I think the best way to learn version is to try it on women who are early in their pregnancies, like around 28-32 weeks. The babies move so easily at this age that you can really get a feel for what it would be like to do it on a larger baby. Since at this age the water level is high and the baby small, I think the risk of danger to the baby in minimal, but I would still listen carefully to the heart rate, during the version (if it takes more than a minute or two) and afterwards. Of course if you meet with serious resistance, stop! I do a version on most of these early breech babies, especially with primips, as I find that they stay down most of the time. Since I started to do versions early, I have had only 1 breech birth in about three years (poor for my practising breech techniques....good on my gray hair population!) I personally think waiting to do versions until 36-39 weeks is hard on the baby, the mom and it doesn't always work.
The technique I use is to find the head and the position of the back. I find that the majority of the babies will easily "dive" into a vertex position. So I take the fingers of both hands onto the top of the head and while flexing the head I pull/push the head downward towards the mother's hip that the baby is facing. I don't use a lot of pressure, but with big babies your fingers will get tired sometimes, it can take as long as 15 minutes of continuous pressure on the head to get some babies to get the hint and move. Some baby's heads will seem to disappear when they get to a transverse position, it means that the head has moved into the pelvis without your knowing it (check there first), or the head is back at the top. If it's back at the top, I listen for the heart and if it's OK, I will try to move the baby in the other direction....most likely the baby wasn't in the position you thought at the beginning, or it's one of those rare babies who like to "back dive" down. If I get a version that doesn't work at one visit, I will wait and try again at the next visit...I suspect that some babies want to make the trip down facing away from you, and it's hard to help it in that case, you just have to hope his position changes by the next visit. On these stubborn babies I remind the mother to keep her hands off the head, because I wonder if some of these babies like their heads rubbed. The breech tilt and herbs or homeopathic remedies seem to work, but with a persistent breech I depend more on my own hands.
I have tried to do a version with the mom in a breech tilt position, but just lying down with a pillow under the head works just as well, and the mom doesn't feel like she's falling or nauseous.
Another reason I like moving the babies early, it that unless the
baby is in a nicely tucked (complete breech) position, the larger
the baby gets the more those straight legs of a frank breech
hinder the version. I think that's why most breech births are
frank or footling.
See if you can have her sit tailor fashion and bend forward as far as possible from the waist several times a day.......drive the vertex deep into the pelvis.
|About the Midwife Archives / Midwife Archives Disclaimer|