In a healthy pregnancy, the infant will assume multiple positions before settling into one during the third trimester. At or around 32 weeks gestation, the majority of infants have resolved to be head down. At 34 weeks, only 7% of infants are breech, and as labor approaches, only 3% remain breech at term. There are three methods for diagnosing breech presentations: ultrasound imaging, the position of the fetal pulse, and external palpation. During a typical prenatal examination, most medical professionals palpate the uterus to determine whether the fetus is head down or transverse. Early diagnosis is essential for preventing a surprise breech presentation during labor; therefore, it is prudent to confirm with your care provider at 32 weeks, as this will allow you time to attempt to turn your breech infant naturally.
Different kinds of breech presentation:
- Frank breech occurs when only the baby’s buttocks approach the cervix, his knees are not bowed, and his legs reach up to his head. This is the most common breech presentation and the baby’s head comes closest to occupying the pelvic opening. With a competent attendant, a vaginal Frank breech birth may be possible.
- Incomplete breech occurs when one knee, one foot, or both knees exhibit.
- Footling breech occurs when one or more legs enter the delivery canal first and appear to be standing erect during labor. This is the second most prevalent form of breech presentation, but it is the least likely to be delivered vaginally due to the possibility of umbilical cord complications.
- Complete breech position occurs when the baby’s pelvis and legs are flexed, but the feet do not extend below the baby’s bottom. This is the least prevalent form of breech presentation, but it can be delivered vaginally with a skilled attendant.
Options that have a breech presentation
When faced with a breech presentation, options include attempting to rotate the infant to the vertex-head down position, attempting a trial of labor to birth vaginally, or opting for a planned cesarean section. Some hospitals and physicians may not permit a trial of labor and instead offer only a premeditated cesarean section. The most preferable delivery method is a vaginal birth with the baby facing vertex-head down; therefore, attempts can be made to rotate the infant from breech to vertex position. The majority of women prefer to deliver a transverse infant without a cesarean section.
The longer a baby persists in a breech position during pregnancy, the more difficult it becomes to induce head-down rotation. This is because the fetus is growing and there is less amniotic fluid for movement. After 32 weeks of gestation, midwives recommend beginning to encourage a breech infant into a head-down position by attempting various rotation exercises or techniques.
Natural exercises to reposition a breech infant
Some mothers may find it simple to get their babies to pirouette, while others may find it challenging. The following self-care exercises should be combined with medical, midwifery, and chiropractic care. It is essential for mothers to know how to turn a breech infant naturally; however, it is important to discuss any technique with your doctor to rule out any medical contraindications.
These exercises are intended to assist by extending taut pelvic ligaments, dislodging the baby’s bottom if it is firmly lodged in the pelvic rim, and encouraging rotation of the baby from a breech position using gravity. Before beginning any gravity-based exercise, it is essential to wait two hours after a meal to prevent an irritated stomach.
Warming up may begin by adopting a hands-and-knees position and then repeatedly rocking the pelvic up and down while arching the back like a “scared cat” and returning to normal. Follow this by repeatedly swaying your pelvis back and forth with a “happy dog” exercise, such as flicking your tail. The objective here is to thoroughly loosen everything up before employing gravity.
In the knee chest exercise, while on your hands and knees, you recline for 10 minutes with your head and chest on a bolster. This forward arching creates more space due to gravity, which is excellent for releasing a baby’s bottom from your pelvic rim. This may be repeated three to four times per day to assist turn your infant.
The forward inversion exercise makes use of gravity from a greater height. This will assist in stretching the pelvic region and encourage your infant to pivot. This position rapidly brings blood and pressure to the cranium, so you may wish to begin with three daily brief intervals. Ensure that you have a spotter to assist you in entering and exiting this position. Begin by getting on your hands and knees on your bed. Place your palms on the floor in front of you and lower your forearms to the floor so that they are level. Avoid injury by keeping your knees securely on the edge of the bed. When you are done, carefully raise your body onto your knees.
Breech tilt inversion is when a person lies on their back at an angle with their head lower than their pelvis. This can be accomplished with a wooden plank or an ironing board with one end set on a nonslip surface and the other end on a sofa, bed, or chair. Alternately, you could use an inversion table, which is favored and highly recommended because the angle can be adjusted and increased for greater gravity each time. In addition, while on your back with this inclination, you can place a heated rice sock near your pubic bone and a cold compress on the top of your uterus to stimulate baby’s movement. Start with 10 to 20 minutes, three times per day, or when your infant is most active.
If, after completing the exercises, you experience an increase in baby movement or cervix pressure, you may want to get an ultrasound or see your healthcare provider to confirm that the baby has rotated. Sitting on a birth ball or taking a lengthy, vigorous walk can assist the baby’s head in settling into the pelvis if the answer is affirmative. Conversely, if the exercises alone do not produce the intended results, do not become disheartened. Sometimes a combination of exercise and other techniques is required to achieve a desirable outcome. In addition to the techniques enumerated here, there are numerous other viable options.
Various techniques are used to shift a breech infant
The Webster Technique is a chiropractic adjustment to the sacrum and pelvic that reduces uterine ligament torsion twisting and rigidity. Consequently, by regulating the pelvic muscles, the infant can assume a more favorable position for labor and delivery. According to a study published in the Journal of Manipulative and Physiological Therapeutics, the Webster Technique has an 82% success rate during the eighth month of pregnancy.
Moxibustion is a technique of traditional Chinese medicine in which an acupuncturist uses the heat from smoldering mugwort to stimulate an acupuncture point located near the outer side of the little toe. A randomized, controlled study revealed that moxibustion treatment for one to two weeks increased embryonic activity and vertex presentation at delivery.
Performing some headstands and inversions in the water may be beneficial. Your infant may reposition himself in order to keep up with you when you’re inverted. This makes this technique mechanistic, as it encourages him to move and prevents him from being so immobile.
Seeking assistance from your physician
When both exercises and techniques have failed to turn the infant, it is time to seek professional assistance. This assistance may consist of attempting a manual external version, planning an experimental labor with a competent attendant, or planning a cesarean section.
External Cephalic Version is performed by a doctor or midwife after 36 weeks gestation by repositioning the infant with hand modulation and rotation, similar to a deep abdominal massage. Ultrasound is used to locate the placenta, the exact position of the fetus, and the level of amniotic fluid. Typically, doctors use medication to relax the uterus, applying pressure to elevate the glutes from the pelvic rim with one hand while placing the other hand on the head to encourage a rotational flip. To ensure the baby’s welfare, the pulse rate is monitored throughout the procedure. According to the American College of Obstetrics and Gynecology, the success rate is close to 50%; however, the closer you are to your due date, the more difficult it may be to use this technique. Sometimes nothing seems to work to shift the infant, which may be due to a short umbilical cord, cord entanglement, or uterine abnormality.