Heads up

The ups and downs of pregnancy can at times correspond quite literally to the position of your baby. During development, a fetus will naturally rotate multiple times while there is an abundance of room in the uterus. As the baby grows and womb real estate becomes tighter, most little ones gravitate toward a vertex orientation where the head is downward and the legs are up—the ideal placement for a vaginal delivery. However, approximately 4 percent of full-term babies situate themselves in a head up, bottom down position called breech presentation, which has the potential to make a vaginal birth more difficult.
A breech baby doesn’t mean you have to trash your labor ball or ditch your mid-wife just yet though. The positioning may complicate your plan, but won’t necessarily result in a C-sentencing. For starters, it’s often possible to turn a wrong-side-up baby using either medical or alternative techniques. And if you have a stubborn sitter who won’t switch, you can still have an open discussion with your care provider about your labor options.
Let’s take a look at a few methods to get baby situated headfirst and then consider ways to accommodate a breech baby who won’t budge.
Make adjustments
Chiropractic care can offer a slew of benefits during pregnancy, and in the case of breech presentation, it can make all the difference. A chiropractic adjustment dubbed the Webster Technique offers a noninvasive option for turning breech babies that is safe and gentle for all pregnant women. Erik Kowalke, DC, who specializes in pregnancy and pediatric development at his practice Higher Health Chiropractic in Wyoming, Michigan, explains: “We [chiropractors] don’t directly treat the breech baby, but we address misalignments and dysfunctions in the woman’s pelvis and sacrum. When everything is functioning properly, it offers the best position possible for the baby.” The Webster Technique carries little risk, since a balanced pelvis naturally allows your little one to turn without using any force directly on the fetus.
It’s best to get checked by a chiropractor early in your pregnancy, before your babe settles into breech. “Pregnant women have a hormone called relaxin in their body which allows their ligaments to really relax. The more the ligaments relax, the more things start to shift and move out of place,” explains Kowalke. Research has shown that chiropractic care also reduces labor times. (Kowalke’s wife, who was under his care throughout her third pregnancy, was in labor for a whopping hour and 45 minutes. Not bad, huh?)
Seek out experts
Finding doctors and midwives in your area who are familiar with turned-around tots might take some time, but it will definitely make your experience easier in the long run. Charlotte Sanchez, CPM, childbirth educator and midwife at Atlanta Midwife in Georgia, has worked with many breech babies and even performed home breech births. But before any of her clients make it to term, she recommends a regimen of at-home exercises aimed at rotating a fetus with gravity.
Sanchez urges women who don’t get results from breech poses to consider an external cephalic version (ECV) with a medical professional. During an ECV, a doctor will use ultrasound to see what might be interfering with a fetus’ movement. While monitoring the heartbeat, the doctor uses his hands outside the stomach to push and flip the baby. The procedure can be uncomfortable, so you’ll usually be given a muscle relaxer or sedative before the procedure to help take the edge off. ECVs have about a 50 percent success rate. “Not all breech babies will turn,” explains Sanchez. “It could be the size of the baby, the size of the woman, and it also could be other reasons, like a short cord.”
Keep an open mind
If you feel like you’ve exhausted the list of turning tactics but your baby is still sitting pretty with her feet down, it’s time to start thinking about the right (possibly revised) labor plan for you. A breech birth plan should be written in pencil, since at this point it is clear that the one inside the bump is calling the shots, but don’t discount your say at this stage in the game. “I think it helps a mom to be engaged in her choices,” says Brad Bootstaylor, MD, FACOG, a perinatologist and adjunct clinical professor at Emory University. Just this July, Bootstaylor delivered three vaginal breech births. “This is what I tell my patients: Breech is normal,” he says.
The type of breech position your baby has assumed can have a lot to do with your odds of having a delivery the old-fashioned way. “There are certain types of breech that are very safe to deliver vaginally,” explains Bootstaylor. Frank breeches (bottom down, feet up), which make up about 75 percent of breech presentation babies, mimic the placement of a head-down baby and are easier to deliver, says Bootstaylor. Footling breech (feet down) and complete breech (bottom down, knees bent with feet near the bottom) positioning may prove more problematic. After determining the type of breech, doctors take into consideration other factors, like baby’s weight and your past birthing experiences.
Talk to your doctor about whether you’re a good candidate for vaginal birth, but also have a solid plan “C” for the off chance you’ll need an emergency Caesarean. Make sure to discuss what kind of OR experience you’d like to have and consider searching for practices that perform family-centered procedures such as placing baby on mom’s chest immediately and letting dad have the honor of cutting the cord. “You can have a C-section, but still make it a birth,” shares Bootstaylor.
In the end, labor and delivery isn’t really the best part of the process. Finally seeing your baby—no matter how she got here—is the grand finale of all your hard work. While dealing with breech positioning may come with frustrations, the fact baby was feet first confirms what you knew all along: Your little one was head over heels for you from the beginning.