How to turn a breech baby.
If you google how to turn a breech baby you will come up with a list of suggestions with perhaps top of the list being external cephalic version (an obstetric technique to manually turn the baby) followed by using the knee to chest position and moxa (a Chinese herb) on the little toe point (BL67).
I would like to consider why babies might be breech and how we can support mothers whose babies are breech. I think it is important that we are not mechanical in our approach and understand that what works for one mother and baby will not work for another. I also feel that we need to look at the relationship between the mother and the baby and to support their connection on their individual journeys to express who they are. This means supporting not just the body in a physical way, but also the mother’s thoughts, feelings and what is going on for her and her baby. This is an aspect of shiatsu and eastern medicine that I find really helpful. Working with the meridian pathways and points of Chinese medicine is about including all of this.
Why would we want to turn a breech baby?
The first thing to remember is that many babies are breech (ie bottom rather than head closer to the pelvis) around 32 weeks. By the end of pregnancy without doing anything in particular, 57% of these babies will turn head down (cephalic) with 25% turning after 36 weeks. Only about 3-4 % of babies remain breech and don’t turn. I find many women start to get worried around 32 weeks if their baby is breech, because these days the pressure is to have an elective Caesarean. A lot of this worry is unnecessary as most babies will turn. Worry and stress on the other hand, are not a particularly helpful emotions during pregnancy. Of course there are also some women who might be worried about vaginal birth and are in some ways relieved that they have a reason to have a Caesarean.
It is only relatively recently, 2010, that there has been more pressure to have a Caesarean delivery for a breech baby. Until then most breech babies were delivered vaginally. However in 2010 a Canadian study , (Hannah, http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(00)02840-3/abstract
concluded that C section was the safest option for a breech baby. After this it became more difficult for women to get support for a vaginal breech birth. This study has been criticised and many places are now beginning to offer vaginal breech delivery as a choice for some women.
We need to remember that often there is not an issue, the baby just happens to be positioned breech and can quite easily be born vaginally, as many are. Sometimes there are complications which mean that a vaginal delivery is not advisable. Mary Cronk, a UK midwife who has specialised in vaginal breech deliveries states, and this makes sense to me, that a breech baby, with no obvious complications, can
“be born easily and spontaneously, if the labour proceeds spontaneously and easily…(however) ..
I do not believe that there is any place for induction or augmentation in a breech labour. If a breech labour does not progress, this woman’s body is telling us something, and we should listen. There is no emergency, there is no rush, this labour just isn’t progressing, and this baby should be delivered by caesarean operation.
I do not feel that there is any place for either trying to push breeches through pelvises with oxytocic drugs or pulling them through with actively managed breech extractions. I feel that this management is what has contributed to giving vaginal breech delivery poor outcomes and such a bad name. In my experience, if the labour does not progress well and spontaneously, the baby needs to be delivered by caesarean operation.”
Why might a baby be breech?
Firstly, we must not forget that there may be nothing “wrong” at all. The baby just wants to be that way and will be born easily vaginally with no complications. I restate this, as I feel it is important not to make the woman feel that there is anything “wrong” either with her or her baby. We are not all the same and some babies choose a different way of being born. It is important to honour these differences. In some cultures, a breech baby was considered to be lucky . It was thought they would have good fortune or grow up to be healers. How we view a breech baby is determined a lot by our cultural beliefs and assumptions. In our culture we tend to see breech babies as being a “problem” and we have to make them turn. Sometimes postnatally baby’s hips are more open but in most cases this can easily be remedied with some simple baby shiatsu/massage.
Secondly we need to remember that in turning head down, the baby is bringing their heart away from the mother’s heart and getting ready for separation from her. I love the Chinese expression that a breech baby is “clutching at their mother’s heart”. It could be that the baby is really happy in the womb and wants to stay close to their mum. It could be the opposite: that the baby is scared to come out. I have worked with women in both of these situations. Sometimes it is the mother who is not ready to let go of her baby and accept the end of the pregnancy. Sometimes I have worked with women who have had a sudden shock (such as their mother being ill or dying) or their partner is away and not certain to be back for the birth. I have worked with women where their relationship with the partner is unclear or even violent and difficult where the mother doesn’t feel safe. In these kind of situations, it makes sense that the baby doesn’t feel safe to be born and be in these difficult situations.
We could say that something is shifting in the ancestral energy: each time a baby comes into the world the family dynamics change, not just of those members who are still alive. Our work is then to help the mother support the baby to make the transition. Sometimes just speaking about what is going on helps shift the situation. Sometimes it is in working physically with the body that the mother can allow certain feelings to release. I work a lot with the Extraordinary Vessels, which have direct links with the ancestral energy and I have found that they help bring powerful emotions to the conscious so that the mother and baby can process them.
Thirdly, in a small number of cases there may be specific issues which are stopping a breech baby from turning such as uterine abnormalities (such as bicornuate (heart shaped) uterus), oligohydramnios (low levels of amniotic fluid which may restrict the movement of the baby), polyhydramnios (too much fluid), low lying placenta, developmental issues with the baby or cord issues. I have worked with many women whose baby tries to turn, they notice the baby moving and may even have contractions, but the baby is unsuccessful. Later we have discovered that the cord is too short, or the baby’s head was stuck between two fibroids or stuck up in the top of a bicornuate uterus and so couldn’t move. In these cases, having a Caesarean is the only way the baby can be born.
How to support a mother
I find that shiatsu, and indeed most forms of bodywork such as massage or osteopathy or acupuncture can be amazing tools to support the mum and baby in these different situations. Whatever kind of birth is going to happen, we can support the mother and baby to prepare for it. I include lots of work of connecting the two more consciously and facilitating the connection between the two. Work like the Heart-Uterus meridian (use my visualisation and adapt it to breech) or just getting mum to place her hands over her baby and talk to them and find out what is going on. I always include deep sacral work as it helps give the baby more space. I always include some work with the Extraordinary Vessels especially the Girdle Vessel (Dai Mai) or Penetrating Vessel (Chong Mai).
I’d love to hear how you work with breech babies.