Is your baby in a breech position?

January 24, 2012  |  Not Birth Story, The Midwife's toolbox

frankbreechHere are some suggestions that may help turn your baby to head down!

Most babies are head down or “vertex” at 30 weeks gestation, but not always. At Boulder Nurse Midwives we begin checking the position of your baby at 30 weeks gestation and every visit thereafter. We use a technique called Leopold’s maneuver which means that the midwife will feel your baby’s position with her hands. Baby’s can be breech for a variety of reasons. The baby may not be ready to turn head down yet! This may be very normal and usually babies will turn head down by 35 weeks all on their own. Breech babies can also be in this malposition because of the woman’s uterine shape or there may be a septum or fibroid in the uterus that prevents the baby from rotating. Usually, if the reason is septum or fibroid related, we know this already by ultrasound diagnosis, but not always. Sometimes breech position is related to a short umbilical cord or how the baby is entangled in the cord. If we suspect that your baby is breech at 32-33 weeks we will suggest that you try the following to help your baby rotate:

  1. Frozen fruit or vegetables applied to the baby’s head. This does not hurt your baby but they sometimes move away from the cold.
  2. Acupuncture (Moxy)
  3. Chiropractic (Webster Technique)
  4. Deep water swimming doing flips or hand stands in the swimming pool. (The theory is that the bottom can come out of the pelvis and this helps the heavier head be able to rotate     downward).
  5. Pelvic tilts (Laying on your back and lifting your hips above your shoulders)
  7. Please ask your Nurse-Midwife for referrals to acupuncturists and chiropracters who have experience working with pregnant women.

If your baby has not turned by 36 weeks gestation you will be offered to schedule a ECV (external cephalic version)

This procedure is done at Boulder Community Hospital at approximately 37-38 weeks gestation. The ECV involves an attempt to externally turn the baby under the direction of an OB/GYN MD & Nurse Midwife. We have women be NPO (nothing to eat or drink except sips of water) 8 hours prior to the procedure. Upon admission to the hospital we will confirm position via ultrasound and make sure there is adequate amniotic fluid. The nurse will monitor your baby’s heart beat with a non-stress test and start an IV with a blood draw for a current CBC, platelets and T&S. If there is an emergency, the anesthesiologist needs to see the platelet number in order to safely administer spinal anesthesia for an emergency Cesarian section birth. We give women a medication called Terbutaline to help relax the uterus for the procedure. This medication makes your heart feel racy like you would feel if you had drunk a couple of cups of coffee. It can also cause some women to have a little headache. We watch the baby’s heart rate carefully with ultrasound throughout the procedure and if the baby’s heart slows we stop the procedure immediately and let the baby recover and stop all attempts to turn the baby. We put oil on the belly and the CNM usually lifts the baby’s bottom out of the pelvis while the OB/GYN attempts to move the head downward. We usually try a front flip or back flip or both depending on the baby’s position. Some women want this procedure done under epidural anesthesia to help with discomfort but the procedure is very short in duration so it is usually very manageable with breathing techniques. The pressure and pain from the ECV is no worse or long in duration than a labor contraction.

The risks include placental disruption possibly leading to abruption and fetal intolerance from cord entanglement leading to a potential emergency C-section. If there are signs of fetal intolerance we stop the procedure immediately.

You will be monitored for about 2 hours following the procedure to ensure that your baby looks well oxygenated on the monitor. The statistic that we typically quote for success with this procedure is 50%.

If the procedure is unsuccessful we recommend scheduling a C-section between 39-40 weeks. We do not recommend vaginal breech birth even with providers who feel skilled in this area due to increase risk to your baby.

If your water breaks and your baby is breech this can become an emergency because the cord is more at risk of prolapsing. The head usually acts like a cork on the cervix in vertex presentation and prevents this from happening but with breech babies the bottom does not tend to settle down in the pelvis as easily. This is why we recommend C-section between 39-40 weeks and to call immediately should labor begin or if your water breaks.

Talk with your Nurse-Midwife if you have additional questions or concerns. If you feel a big rotation with your baby please call the clinic and we can check to see if the baby has turned. If your baby is now head down you should obviously stop all exercises to turn the baby from breech to vertex and begin focusing on Optimal Fetal Positioning exercises to now attempt to get the baby in a good Occiput Anterior position!

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