Babies in utero can be quite the wee little acrobats & are well known for flipping around constantly during pregnancy as they have a lot of room to move in the womb.
A baby is not officially considered breech until around the 35-36 week mark - this is when the space in the uterus starts to get a little cramped as your baby continues to grow and your amniotic fluid levels start to decrease, making it a little more challenging for baby to turn head down.
Many breech babies will turn themselves in the last month of pregnancy and can even turn at the last minute in labour. Only 3-4% of babies will be breech at the end of pregnancy in Australia.
Different types of breech presentations
Frank Breech:
This is a position where your baby’s bottom is pointed straight down with its legs folded straight up in front of their body with their feet near their head.
Footling Breech / incomplete breech:
This presentation is where either one or both of your baby’s feet point downward towards your cervix and will deliver first, before the body.
Complete Breech:
This is where your baby’s bottom is pointing downward and their legs are drawn up to their chest, cross legged (folded under themselves).
Transverse Lie:
This is a version of a breech presentation where your baby is positioned horizontally across your belly instead of vertically. A transverse position would make their shoulder enter the vaginal canal & be birthed first.
How Australian hospitals approach breech babies & birth
Around your 35-36 week midwife appointment, if your baby is found to be breech, hospitals may offer an ECV (External Cephalic Version) around 37 weeks.
An ECV is a manual technique performed by an experienced doctor attempting to turn your baby from a breech position - to a head down position, using the help of ultrasound to help guide the doctor during the procedure.
The procedure itself can be quite uncomfortable for some mothers & has about a 40-50% success rate.
Some risks, however, include baby going into distress, premature rupture of membranes (waters breaking), placental abruption and pre-term labour. This is another reason why hospitals will only offer an ECV from 37 weeks as this is when your baby is considered full term & potentially needing an emergency delivery due to the procedure being carried out.
While there are some experienced professionals that are well versed in breech births, many hospitals in Australia are not comfortable with allowing mothers to birth a breech baby vaginally, you will be offered a caesarean section as an alternative.
This is due to the risks associated including physical injury to baby & umbilical issues such as cord flattening or twisting which can create a lack of oxygen to your baby.
Ways to turn a breech baby without hospital intervention
Chiropractic Care - The Webster Technique
The primary goal of Webster certified practitioners is to address misalignments to make more room in the pelvis.
The goal is to free up space in the pelvis & uterus for your baby to turn, and to ultimately aid with labour and delivery.
This gentle technique is specifically focused on the pelvis and sacrum, as well as the muscles and ligaments in and around these areas and can be used all the way through pregnancy, regardless of your baby’s position.
Moxibustion
Research done has shown that using moxibustion helps increase the chance that a breech baby will turn to the head down position.
Moxibustion works by stimulating an acupuncture point. It is safe for pregnant women and their babies. Moxibustion works best when started at 33-34 weeks.
Unlike acupuncture, moxibustion uses heat stimulation at various temperature levels. This heat stimulation can yield inflammatory responses and induce vascular changes
The application of moxabustion increases blood flow creating an environment of movement and activity in the growing baby promoting optimal positioning in utero
Acupuncture
Acupuncture itself can help encourage your baby to turn, reduce stress, and to relax any tight muscles that might be preventing an ideal presentation.
The process includes focusing on the most dynamic points of the body to activate the uterus.
Acupuncture plus moxibustion is more effective in turning babies in a breech presentation. Such a method appears to be a valid option for women willing to experience a natural birth.
Spinning babies
Spinning babies is a physiological approach to preparing birth.
With self-care and specific body activities, spinning babies helps restore body balance and make room for the baby. Babies then put themselves into the best positions possible for birth – within the anatomical space available
There are a number of programs available suited for the different ways that your baby might be positioned (breach, transverse, oblique lie etc), with a tonne of helpful free resources and videos on the website for you to try.
Peas & hot water bottle
Babies instinctively like to keep snug and warm and prefer to be comfortable in the womb. By placing a bag of frozen peas near the head with a hot water bottle at the bottom of your uterus, you can try to encourage your baby to move away from the cold and towards the lovely warm area, turning head down in the process.
This can be more effective when used in conjunction with a breech tilt.
Breech Tilts
Breech tilts should only be done if you know your baby is in the breech position. The goal of a breech tilt is to raise your pelvis above your head so that your baby can tuck it’s chin in (known as flexion) which is the first step to encouraging your baby to turn over.
The easiest way to do this is to lay a closed ironing board on the couch, using a pillow for comfort, lying with your head towards the floor allowing your feet to be up, resting wherever they are comfortable.
Some mothers do a variation of this exercise using a pile of pillows under their buttocks on the floor, instead of the ironing board, and can be a better option to try first if you have no one to help assist.
This position can make you feel a little dizzy and should be done for a few minutes at a time, with the help of someone to assist you on / off the ironing board or pillows. At any stage you are too uncomfortable - stop.
Leaning forward / maternal positioning
Knowing that the the back of your baby’s head is the heaviest - by spending a lot of time leaning forward, on all fours, and avoiding leading back or reclines positions in general - maternal positioning can help baby rotate and turn into a more optimal position - this is also a great technique to encourage back-to-back babies rotate away from a posterior position.
Good positions to try include hands and knees, kneeling leaning forward, sitting over a backwards chair, sitting forward on your sit bones (rather than leaning back and tilting your sacrum forward), keeping your knees below your hips when sitting & lunging / stretching to help open up more space and lengthen tight ligaments that may be restricting your uterus.
Baby Turning Exercises and Stretches
I personally found this sequence of 8 mobilisation, stretches and inversion techniques especially helpful for turning my little guy head down.
Jess from “Pregnancy and Postpartum TV” has a great video & linked PDF for download in her YouTube video “How to turn breech baby INSTANTLY | 8 Exercises To Turn Breech Baby Naturally”
Using this sequence along with spinning babies techniques, you can help mobilise your pelvis to prepare to make space, loosen any tight ligaments and to encourage your baby to turn head down with 8 gentle exercises and stretches.
Walking
Using long strides, briskly (but gently) walking every day can help lengthen and release the psoas muscles - a large pair of muscles between the ribs and pelvis that wrap around and the front of the pelvis and attach to your upper thigh bone.
A pair of tight psoas muscles will keep the baby high and can impair your baby’s descent and engagement.
A longer, more supple psoas is one of several factors that helps the baby engage towards the end of your pregnancy.
Conclusion
While having a breech baby in the third trimester is usually not a problem as most will turn on their own, there are ways you can encourage an optimal position for your baby at varying stages of your pregnancy.