In reading many studies and websites devoted to turning breeches, one thing is clear: there is no one way that will definitely contribute to turning a fetus from breech presentation to vertex presentation. Thus, the reason for the myriad of methods.
Some care providers are not comfortable with attempting to turn a baby who is presenting breech and therefore choose to perform a cesarean section. Expectant parents who are interviewing care providers should clarify the care provider's position on this issue. The incidence of breech presentation at term is overall about 3 - 4 % and in those whose birth weight is greater than 2.5kg the incidence is 2.5 - 3 %. The incidence of breech presentation is higher in preterm pregnancy (at 32 weeks the incidence is 14%).
The following are some methods for turning breech babies that have achieved some success. As with all practices during pregnancy, the care provider should be consulted prior to attempting any practice to turn the breech baby.
Postural inversion (lying with the hips propped up 9-12 inches higher than the head, stomach empty, and done three times per day for up to 20 minutes at a time) after the 30th week: approximately 88.7-96% success rate in nearly 1000 patients. This was reported in OB/GYN News Vol.12, No.1.
POSTURAL INVERSION VARIATION: SLANT BOARD
Begin at 32-35 weeks gestation; do three times daily for 10-15 minutes each time, on an empty stomach, and the baby is active. Prop one end of an ironing board securely on a sofa or chair 12 to 18 inches high (or may use slant board). Lie down, bend knees but keep feet flat on board. Relax, breathe deeply, avoiding tension in the body. Gravity drops the baby's head into the fundus, tucks it, and baby can then do a somersault to a vertex position. This has an 87% success rate if done by the 37th week.
Indirect moxa or acupressure on Bladder 67 (also called Zhiyin, this can also start contractions, so use caution). It is highly recommended that an experienced acupuncturist or shiatsu therapist do this for your client. See "Moxibustion for Correction of Breech Presentation A Randomized Controlled Trial" Francesco Cardini, MD; Huang Weixin, MD JAMA - November 11, 1998. This article concluded that for 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.
By the 36th week, external version can be done by an experienced practitioner. Research evidence in support of the efficiency of external cephalic version at term to reduce the number of breech presentations, as well as the number of CS is most powerful in the published recent literature.
Upon admission for external cephalic version, maternal vital signs, blood work and confirmation of fetal presentation is done by ultrasonic examination. The client has been NPO (or has had nothing to eat or drink for 8 hours) and a non-stress test (NST) is done. To promote relaxation of the uterus and decrease the possibility of uterine spasms, the client is given terbutaline or a continuous infusion of a tocolytic such as ritodrine. Under ultrasound guidance, the fetus is manipulated transabdominally from breech to vertex. After the procedure, another NST is performed, sandbags may be applied for a period of time around the baby to deter return to the breech presentation and the mother may be instructed to count fetal movements to ensure fetal well-being.
This procedure is offered to patients at 37 weeks unless they have some of the following contraindications to the procedure. Contraindications may include the following:
- Antepartum Hemorrhage
- Ruptured Membranes
- Multiple Pregnancy
- Severe fetal abnormality
- Caesarean Section necessary for other indications
- Previous Caesarean Section
- Poor fetal growth
- Rhesus Isoimmunization (Anti-D globulin is given to Rh negative mothers before attempting external version due to possibility of fetal-maternal hemorrhage).
Swimming in a warm pool can help the baby turn because of the almost effortless stretching and crouching involved. Perhaps doing some bobbing (crouching on bottom of pool in deep water and then pushing off and reaching hands up high as the woman breaks through the water) would be a useful exercise. Increasing amniotic fluid by drinking plenty of water seems to help any method of trying to turn a breech baby as it gives the baby more buoyancy to turn Being in deep water may also squeeze the fluids in your tissues into your bloodstream and increase the volume of amniotic fluid.
While doing a pelvic rock on all fours, to pull the baby out into the sling that the abdominal muscles make and allowing for more rotation room, apply cold to the back of the baby's head. The cold can be in the form of a cold pack or even a bag of frozen peas or corn!
Mothers have attempted to turn a breech by placing headphones on the abdomen in the fundal area and playing hard rock or "head banger" music. The baby went vertex very soon after! Presumably the baby didn't appreciate the music and turned to get away from it.