Through most of your pregnancy it doesn’t really matter what position your baby is in. Until she begins to run out of room to move, your baby will spin, kick, and change position constantly. You may notice that she favors a particular side or that you feel kicks and punches in certain areas more than others, but the way she’ll be born likely won’t be determined until you’re in labor. Eventually, usually sometime during the latter half of the third trimester, most babies will turn head down and stay that way until they enter the world. Some babies turn head down but then flip back. Some never turn (ahem, both of mine). When a baby has a body part other than her head down toward the cervix, this is known as breech presentation. About 3-4% of babies born at full term are breech.
There are three types of breech presentation:
Frank: Baby’s butt is aimed at the cervix and her legs extend up in front of her face.
Footling: One or both of baby’s feet are at the cervix and would be the first part to enter the birth canal.
Complete: Baby’s butt is aimed at the cervix. Her legs are crossed in front of her and her feet are near her butt.
Why are some babies breech?
Although you might never fully know the reason your baby is breech, research shows that you are more likely to have a breech baby if:
there is too much or too little amniotic fluid in the uterus
you have delivered prematurely in the past
you have a uniquely shaped uterus or growths in the uterus
there is a case of placenta previa
you’re having twins or more
this isn’t your first pregnancy
Throughout history, midwives were able to deliver babies with any kind of presentation. Although breech babies require a care provider to be a bit more hands on, it is not impossible to safely deliver a breech baby vaginally. However, usually it is safest and easiest for both mom and baby when a baby can be born head first. When the largest part of the baby (the head) is last to be delivered, complications can arise, such as a cord prolapse. This is when the umbilical cord is partially born before the baby. Pressure on the cord can decrease blood flow which limits the amount of oxygen getting to baby. With a skilled provider, risk is low.
Unfortunately, today the majority of care providers will not allow even the attempt of a vaginal delivery for a breech baby. About 93% of babies in a breech presentation at term are born surgically. Some modern midwives and midwife-minded OBs will consider allowing a mom to deliver vaginally or at least labor in hopes that baby will turn on her own, but these care providers are few and far between.
Most often, if your baby is breech, you’ll be asked if you want to try an ECV, or External Cephalic Version.
An ECV is the manual, external rotation of the baby. It is done by your care provider, typically in a hospital setting. The procedure can be painful, and so pain medication is often offered. ECVs are effective about 56% of the time. That is, the baby turns head down and does not flip back to breech presentation. Risks include your water breaking, abnormal heart rate for baby, vaginal bleeding, and cord prolapse. These complications nearly always result in a c-section. Extremely rare more serious complications include placenta abruption and stillbirth.
Most care providers agree that the best time to try an ECV is prior to 37 weeks, but after 34 weeks. Within this window, ideally your baby is big enough to stick in the position into which she’s being encouraged, but also still has the amount of wiggle room necessary to get there.
Alternatives to ECV
A knowledgable care provider will also share alternative techniques to get your baby to turn if an ECV isn’t appealing to you.
This is less of a turning technique and more a full childbirth education series focused on optimal fetal positioning. Check out the website for videos on positions moms can try to help turn breech babies and keep them that way. Spinning Babies is also an awesome resource for partner assisted comfort measures to use during labor.
This technique, a staple of Spinning Babies, tricks your baby into going head down while you lay on an incline with your bottom above your head. Typically women use an ironing board propped against their couch to get the right angle. It might not work the first time, but if this position is repeated about three times per day for about 15 minutes at a time, it might be enough to get baby to turn.
Find a chiropractor well versed in the Webster technique who has lots of experience and comfort working with pregnant women. Many women swear by seeing their chiropractor throughout pregnancy to help with anything from heartburn to round ligament pain. Although it’s tough to find solid statistics on the efficacy of this method, the anecdotal evidence is enthusiastically positive.
Like chiropractic care, many women believe acupuncture can assist with a host of fertility and pregnancy issues. The idea here is that acupuncture can create a better balance in the body, thereby opening up the energy paths needed for baby to turn. Again, the anecdotal evidence makes this technique sound like it’d be worth a try.
On a personal note
As a mama who has had two breech babies of her own due to a beautiful, abnormally heart-shaped uterus (aww), I believe 100% that babies choose the way they want to be born. Yours might turn head down and you might end up with bruised ribs from her kicks. Or, she might be more comfortable with her head tucked up so close to your heart you can’t breathe. Just remember, if you do end up birthing a breech baby, it’s more than ok. You’ll always get to remind her when she gives you attitude as a teenager (or toddler), “You were born butt first, you know.”