The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS,
a homebirth midwife in Mountain View, CA
The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS,
a homebirth midwife in Mountain View, CA
|
The AMA wants to make birth centers illegal, along with homebirths,
even though
Read more about the ACOG 2008 Press Release from The Big Push for Midwives and Childbirth Connections You can also educate yourself week-by-week in your pregnancy with theLamaze Weekly Pregnancy Newsletter for Parents |
Contact Laura
A. Sheehan, D.C., handsofsteele@sbcglobal.net,
415-681-1031.
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.]
Diagnostic
accuracy of clinical examination for detection of non-cephalic presentation
in late pregnancy: cross sectional analytic study. [full
text]
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
Responses
ICAN's
Breech Presentation White Paper is an excellent place to start.
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 available."
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.
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.
UCSF's
experience with vaginal breech delivery: data from 1980 to 1991 - Obstetrics
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.
breechbaby.info - Information
for families expecting a breech baby
Informed Consent and Waiver of Medical
Referral For Vaginal Breech Birth
Natural
History of Fetal Position During Pregnancy and Risk of Nonvertex Delivery
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.
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!
OB/GYN News, Oct 15, 2003 by Sherry Boschert
Catherine Takacs Witkop, MD, MPH1, Jun Zhang, PhD, MD2, Wenyu Sun,
MD, MPH2 and James Troendle, PhD2
CONCLUSION: Spontaneous version of a nonvertex fetus at 35 weeks
of gestation is still likely.
Visualization/Affirmation Poster
One way to encourage your baby to turn into a head-down position is to
use visualizations and affirmations. This Visualization
Poster is truly inspired and inspirational - it can be ordered from
a U.S. distributor, Birth With
Love.
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 the septum.]
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 to vertex.
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 presentation.
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 Turning Techniques
Another Collection of Breech Turning Techniques
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 amniotic fluid.
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, 1-888-243-3279
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 week.
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 called me
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
ISBN 1-85230-431-6
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 | _______________
[from ob-gyn-l]
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 corrected.
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 doesn't work.
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 turning maneuver!
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 case.
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.
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 presentation.
Moxibustion
for Correction of Breech Presentation A Randomized Controlled Trial
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 indicated.
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 bring
healing.
How does the herb work in this way? Like aromatherapy or something?
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 presentation.
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.
Bagnell
Technique for Breech Presentation
CAN 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 ohmdc@home.com.
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.
Using
Homeopathy to Turn Babies by Patty Brennan - from Midwifery
Today. For midwives who use homeopathy, I highly recommend Patty
Brennan's Guide
to 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 yet
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.
External
cephalic version for breech presentation at term (Cochrane Review)
Abstracts Regarding External Version
Outline and Bibliography for External Version
Do you do external version?
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 this.
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 heart."
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.
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.
Turning a Breech with Acupressure
Turning a Breech with Chiropractic / The Webster
Technique
You are looking for an equalization of resistance on flexion of legs on
the buttocks. This equalization should take place before going on to step
two. If the woman is evaluated on her side, the lower leg will automatically
be 1 inch more resistant; allow for this in your evaluation.
Turning a Breech with Homeopathics
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.
Turning a Breech with Flower Essences
External Versions
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?
She volunteered that the docs she watched perform the version "hated to
do them" the mom was loaded with mag. sulfate and in Trendelenburg position
and that the babies usually returned to breech. She didn't know the gestational
age when these docs did the version and stated that this was the only method
of turning a breech they ever used.
How To Keep a Baby Vertex After Turning
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