In the last weeks of pregnancy, the foetus usually is seen to move in the head-down position, which is called vertex or cephalic presentation, considered the optimal position for vaginal delivery.
In some cases, however, the foetus’ buttocks, feet or both come out first and this position is called breech presentation, which occurs in three to four per cent of full-term births. Vaginal birth of breech babies has increased risk of complications at birth which is when caesarean section is mostly chosen as the mode of delivery.
The complications in delivery can be mitigated by turning a breech baby to head-first in late pregnancy. One can increase the chances of it by consulting a physiotherapist and obstetrician for postural exercises and manoeuvres.
Reasons for foetus being in breech presentation
The foetus is ideally expected to turn their head down by 32 weeks of gestation. Prior to term about 25 per cent are in the breech position before 28 weeks of pregnancy, but by 32 weeks only 7 per cent babies are breech. There is no known cause for breech presentation but there are some factors that might contribute to the same.
1. Multiple pregnancy
2. More than one fetus in the uterus
3. Abnormal amniotic fluid level
4. Abnormal uterus shape like bicornuate/ heart shape uterus
5. Uterus with abnormal growths like fibroids
6. Abnormal presentation of placenta like placenta previa
7. Very occasionally foetuses with certain birth defects will not turn into the head-down position before birth.
How to help foetus turn for normal delivery
If a foetus comes out to be breech at 32 weeks, the health care provider or women health physiotherapist can suggest the use of a certain exercises and maneuvers that help in turning breech babies. There are several ways that might help a foetus turn in the optimal position for normal vaginal delivery.
1. Postural exercises and specific positions
2. External cephalic version
Postural exercises and positions
There are specific exercises that might help in turning the breech baby if done under appropriate guidance after 32 weeks of gestation. These exercises are collated and crafted under a programme called spinning babies.
This is a programme developed by Gail Tully, a renowned midwife from Minneapolis, Minnesota that might help in flipping breech baby by ensuring the right muscular balance, relaxing involved ligaments, fascia and postural positions. The programme believes that the release of the baby can be as natural as the release of hormones only required is body balance which help in making room for the baby. Babies then can put themselves into the best position or optimal position for birth.
Here are some of the exercises:
1. As advised by renowned physical therapist Penny Simkin posture plays a vital role in the baby’s alignment in the uterus. A perfect posture will provide your baby an enough space to turn over. The right way to maintain good posture is to stand straight with your chin perpendicular to the ground; your shoulder relaxed not protruding front or back. Always keep your lower abdomen muscles activated and butts pulled in.
2. Knee to chest position is the most common position for turning breech babies after 32 weeks. There are many international studies that have supported this exercise as it helps the lower portion of your uterus to expand, thus more space for the baby to turn the right way. But this position is advisable only after 32 weeks if baby is still breech.
3. Cat and camel pose also known as hands and knee position. This posture will help in increasing the flexibility hence flipping over of the baby can be achieved.
4. Forward leaning inversion is the most renowned position of spinning babies’ programme that helps in creating room in the lower uterus. Baby will use that space, with the natural pull of gravity, to snuggle into a more ideal position for birth. The Forward-leaning Inversion technique was discovered by Dr. Carol Phillips a chiropractor. This posture is like open knee chest exercise but requires more effort. This position should be done under supervision along with knee chest position results in better outcome.
5. Breech tilt is yet another position that requires an assessment and supervision by the physiotherapist. This exercise helps by creating some pressure on baby’s head to tuck his chin, thus increasing the possibility of him flipping over.
External cephalic version (ECV)
This is a manoeuvre practiced by a trained healthcare provider to turn the breech baby. In this, the health care provider will put his hands on the outside of the mother’s belly and turns the baby into a head-down position. The process is done under ultrasound with medication. ECV is recommended only after 36 or 37th week of gestation.
Moxibustion is a kind of specialised acupuncture in which the therapist uses a tightly rolled stick of mugwort herb, much like a stick of incense. The coal at the end of the moxibustion stick is held over an acupuncture point for heating. Repeating this two to three times a day has proved to be helpful to some mothers in flipping breech babies. The highest rates of success came in the 34-35th weeks of pregnancy. This should be done by a certified acupuncturist who is trained in moxibustion.
Things to remember:
1. It’s mandatory to seek advice from the obstetrician before trying any technique or exercise as there may be health risks.
2. In case of any discomfort during the exercises, one should inform their health care provider immediately.
3. It is advisable to have plenty of fluids during the time.
4. Sometimes, all you need is to wait patiently for turning your baby into the head down position naturally. Breech vaginal births are possible but have risks.
(With inputs from Dr Shilpi Srivastava, consultant, lactation counsellor, childbirth educator & physiotherapist, Motherhood Hospital, Noida)
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