Turning Breech, Techniques, Risks, and Success Rates.
Being confronted by a breech presentation can be very worrisome for an expectant mother and her partner. There is a great deal of conflicting information to sort through and all the various risks to take into consideration. This article tries to decipher what information is available. It discusses the western medical perspective and the acupuncture alternative that is both safe and effective.
Between 3-4% of single pregnancies will present as breech beyond 37 weeks, 90% of these will be delivered by caesarean section.
A Breech presentation is where a baby instead of head first is bottom or feet first.
Footling breech occurs when one or both legs are extended from the hip and knees.
A Frank breech occurs when both legs are flexed at the hips and extended at the knees.
Complete breech is when both legs are flexed at the hips and knees
Kneeling breech – the baby is in a kneeling position, with one or both legs extended at the hips and flexed at the knees; this is extremely rare, and is excluded from many classifications.
You may be more at risk for a breech if you have these predisposing factors.
- The mother was a breech baby
- The mother had previous breech pregnancies
- The mother has some structural anomaly of the uterus.
The orthodox approach by Western medicine is to have the woman under go External Cephalic Version (ECV). This is where a doctor manually turns the baby head down through the abdominal wall. It can cause discomfort in the mother, and she may be given an epidural to help relax her through the procedure.
The average success rate is 58% with a 6% complication rate. Broken down further, success rates of ECV is around 40% for first time pregnancy but increases to 60% in women who have had more than one pregnancy.
Women should not have a version if there is a history of placenta abruption or placenta abruption is suspected. Other contraindications include severe pre-eclampsia or signs of fetal distress. Care must be taken if the woman has low amniotic fluid, if the baby’s head is hyperextended or if the cord is wrapped around the babies neck.
Serious complications can happen and that is why ECV are performed in a hospital setting where an emergency c section delivery can take place if needed. Though rare, there is a 0.24% risk of placenta abruption or stillbirth. Other complications include cord prolapse, vaginal bleeding or water breaking. There is around 1 emergency C section for every 200 attempts at versions. The experience and skill of the care giver also plays a major role in the successful outcome of an ECV.
In Australia, as in most of the world, breech babies are delivered by planned C section at 39 weeks. We are living in a climate where rates of caesarean are rising. Also on the rise is evidence of increasing complications of multiple C Sections. Many reasons have been put forward explaining the rise in numbers. Some include that obstetricians have less opportunities to develop the skills necessary for complex labour like breech presentation.
Interventions and technology can further reduce the confidence of health care providers when caring for woman experiencing normal labour and birth. The ever present fear of litigation make intervention and surgery accepted medical practice for breech presentation.
From this we understand that delivering breech babies has become a lost skill for most obstetricians. Studies show that when performed under the hands of an experienced practitioner, planned vaginal breech is just as safe as a planned caesarean section. Without the consequence risks of multiple C sections. These rates refer to low risk pregnancy only.
Traditional Chinese Medicine
In turning breech, studies show promising and safe results with TCM. We can expect a 75.4% success rate when performed in the 34th wk for a period of 7-10 days. Though optimum time is around 34 weeks this procedure is still effective as late as 38/39 weeks. With positive outcomes increasing if the woman has had more than one pregnancy.
The treatment procedure discussed here involves the application of a moxa stick to Zhiyin UB-67 bilaterally (both feet) for 20 minutes, once a day for ten days. This point is found near the outside corner of the little toe. Please refer to the diagram below.
Your practitioner will apply and demonstrate the first treatment. A course of treatments needs to be administered for 10 days. The process is safe enough to teach the woman to do to herself. Self administering the treatment makes it cost effective.
- The woman, dressed in loose clothing will be seated in a comfortable seated or supported lying position.
- The moxa stick is lit and heats up the little toe by a pecking motion. Approximately one centimetre away from the toe.
- The stick is moved up and down towards the toe in this pecking motion. Continue until the toe becomes hot. The stick is then removed until to toe has cooled down. Then it is repeated for the duration of time.
Duration: 20 mins each toe. If the baby turns the treatment continues but only for 10 mins a day. Please refer to the video demonstration below.
These are carried out by the woman or by her partner. The woman can do it to herself if she is flexible enough to sit with her feet beside. If she is not that flexible she can fashion a make shift moxa holder by hollowing out a potato and placing the stick firmly within it. Then she can light the stick, made stable by the potato she can heat up one toe at a time. Continuing treatment for 10 days.
It is important that you perform this in a well ventilated area. Moxa is made of mugwort and it has a strong pungent smell that will penetrate all your furnishings and curtains. You do not want that stuff in your lungs. The reason we use moxa is because its safe. It clumps together and you have to ash it like a cigar. There is a minimal risk of burning. A moxa burn can be quite nasty so be careful to not go any closer than 1 cm towards the toe. The nature of this heat keeps the targeted area warm for some time afterwards. The retained heat tends to build quickly. Be careful as what was a comfortable heat can get hot fast. Mugwort is difficult to extinguish. To safely smother the moxa stick you can extinguish the hot tip in a jar of sand or within a candle stick.
Optimal Fetal Positioning
Prevention is far better than cure. The best advice for expectant mothers and their partners is to encourage your baby to go into the ideal position before labor begins. Left occiput anterior position is the optimal birthing position for you and your baby.
From 34 weeks on be aware of your posture. Our car seats, chairs, lounge chairs, and constant sitting in this position and subsequent pelvic tilt encourage the baby to enter posterior position. A posterior position, is where baby’s spine is against the mother’s spine, resulting in a slow and difficult back labor.
Fortunately there are ways to help baby turn from posterior to anterior throughout pregnancy and labor. For instance, being on all fours during labor uses gravity to help baby move into optimum position.
Follow the link below for further information regarding optimal fetal positioning
The information on this site is provided with the intention that it can be used as a resource to offer women choices throughout pregnancy, childbirth and postpartum recovery. It is intended that this information is used in conjunction with western medical care and not as a substitute for medical advice.
Resources and websites
Debra Betts – Acupuncture and Acupressure in Pregnancy
Spinning babies helps baby get into position for birth. Helping baby into position fo birth may help support a natural child birth.
Finding a registered Acupuncturist
Bibliography and References
Journal of Chinese Medicine • Number 98 • February 2012 Should Acupuncture And Moxibustion Be Recommended For Breech Presentation? By: Andrea Aiello Steinlechner
Betts D. (2006). The essential guide to acupuncture in pregnancy and childbirth. Journal of Chinese Medicine: Hove.
Cooperative research group on moxibustion version (1984). ‘clinical observation on the effects of version by moxibustion’. Abstracts from the second national symposium on Acupuncture and Moxibution and Acupuncture Anaesthesia. All-China Society of Acupunctue and Moxibustion, Beijing, p150.
”What is the most appropriate mode of delivery for a singleton fetus at term in breech presentation in Australian and New Zealand hospitals?” Management of Breech Presentation at Term; The Royal Australian and New Zealand College of Obstetricians and Gynaecologists 1st Endorsed: February 2001 Current: March 2013 Review: March 2016
Frank breech, William Smellie, 1792 (Public Domain)