Turn Baby Turn – Methods of turning a breech baby

One of the most common things I get asked by my clients is in relation to turning a breech baby. So I thought I’d jot my knowledge, thoughts and experiences down here to support more women in how they might encourage their breech baby to turn into a “head first” position ready for birth.

I know I’m pointing out the obvious here, so forgive me, but I always feel it’s best to point out the obvious than risk someone being uncertain: “Breech” is when baby’s bum is in the lowest part of the uterus, and the head in the highest part.

But, did you know there are different kinds of breech? Baby can have their legs tucked up and in, legs crossed, legs up by their eyes, sometimes they are kneeling. Some of these are unbelievably rare but it is fascinating what they get up to in there!

So how common is a breech baby?

It really depends on how far along in your pregnancy you are. Over 30% of babies are breech at 28 weeks. At 40 weeks (full term in the UK), this drops right down to 3%. So, as you can see, most babies will get themselves into a head first position all on their own with no input from us!

It’s worth mentioning that if baby’s bum is lower than their head, and you haven’t reached 37 weeks yet, you could say that your baby isn’t breech. They simply haven’t turned yet.

There are a few reasons why a baby might *still* be in a breech position later on in a pregnancy. Some of these include:

  • Sometimes the position of the placenta inside the uterus naturally nudges baby into a breech position.
  • The shape of the individual woman’s uterus may encourage baby to be breech.
  • Lots of amniotic fluid (the water around baby) giving baby lots of buoyancy to move around more than ‘usual’.
  • Growing a ‘smaller’ baby. All that extra room allowing baby to roam free!
  • As baby grows and space becomes limited inside the uterus, baby may simply have “run out of time” (and space) to turn.

Why do we want to turn baby? What’s the problem with a baby being breech?

Actually, really and truly, there’s no problem with a breech baby when it comes down to it. It’s “different”, but it’s definitely still “normal”. Your baby might be breech because it’s the best position FOR THEM. Who are we to say we know better?

When you are carrying a breech baby near the end of your pregnancy, whilst you always have the option to give birth vaginally, almost always a woman will be offered methods of turning her baby into a head first position. And if this method is unsuccessful and baby remain breech, almost always an elective (planned) caesarean birth will be recommended by your care providers.

But, you might be surprised to hear that a generation ago, the vast majority of breech births were delivered vaginally. This is by no means medical advice, but I believe my aunty had 2 (individual, not twins) breech babies, both born at home!

So, what caused the change in practice that we want breech babies to turn before we can consider a vaginal birth?

In 2001, a study called The Hannah Trial compared the relative safety of vaginal breech birth compared to caesarean birth for babies who were breech. The research outcomes found that caesarean birth was safer than breech vaginal. The impact of this study was worldwide, instant and dramatic: with mothers being encouraged to have their breech babies turned into head first, or born via caesarean birth.

Now this sounds clear and distinct, but it’s not without controversy and debate. Some methods of the study have been questioned and there are thoughts amongst some that the results cannot therefore be relied upon. A large number of midwife and obstetric researchers now believe that the results of the study are of very little value. Whilst it might seem easy and necessary to overturn the results in favour of breech vaginal birth, the study had far reaching and unexpected results on the skillset of midwives and obstetricians: Because worldwide so many hospital policies changed to avoid breech vaginal birth, lots of maternity staff are now much less skilled, confident and experienced when it comes to breech birth.

There are signs that change is coming, particularly in France and Canada, in support of vaginal breech birth. But it is a slow and arduous change.

If you have a breech baby on board at 36 weeks, you have the following options:

  • Vaginal breech birth
  • Attempting to turn your baby into a head first position
  • Elective caesarean birth

It is not the purpose of this post to talk about the pros and cons of each of these (that is another post entirely, and a long one at that) nor to give medical advice. I’ll pop some links at the end if you want more info. I just wanted to give you some background info before we head into (sorry, terrible pun) the different methods that can be used to try to turn baby.

In true Lionheart Hypnobirthing style, I’ll start with the simplest things first (those things that have little if any complications associated with them). But, of course, you can do these methods in whatever order that you prefer:

Relaxation

By far the easiest, less invasive and most enjoyable method that might encourage baby to turn….simple relaxation! Now, hear me out with this one, it might be simple, but it can be enormously effective. You see, your uterus is a big bag of muscle. And when we are stressed and tense (perhaps because we are nearing the end of our pregnancy and baby is *still* breech!), our body reacts – especially our muscles – accordingly. If your uterine muscles are tense, imagine being your baby inside: that tight tense enclosure making it harder to move round. Much less space available too when your muscles are tense, again giving baby less room to move round if they wanted to.

Relaxation is different for everyone. But you need to spend time every day, with your body well supported, perhaps some relaxing music on, perhaps in the bath, shoulders dropped, breathing fully and deeply. If you want one of my relaxation audios to help, send me a message.

Hypnotherapy

Despite the fancy name, hypnotherapy is simply the use of positive words AKA “talking”! With this method, I’m asking you to talk to your baby and ask them to turn. Perhaps something like “Now baby, I know you might be very comfy as you are, and you might be in the best position for you, but it would be very helpful if you could turn around please. It’s easy to turn. go on, have a go”. As you do so, put you hand on the top of your bump and gently rub your bump from the top down to the bottom, along the left-hand side. Now, this may sound “cray cray” I know, but the number of messages that I get from women who say “baby turned!” is unbelievable. It may be pure coincidence. It doesn’t really matter. Baby turned! And, interestingly, Dr Benna Waites, in her book titled Breech Birth, found that hypnotherapy was over 80% successful at turning a breech baby.

You can team this method with the above relaxation for a simple means of giving baby extra room, extra encouragement and extra opportunity to turn.

Maternal Positioning

There are a couple of “exercises” you can use to encourage baby to turn. Usually those that involve leaning forwards are good and that move your centre of gravity.

Stand and rotate your hips round (AKA gyrating!) as though you are hula hooping. Yes really.

Swimming is good, plus it’s a welcome distraction and the water can be relaxing on your muscles too.

Being on fours positions can also nudge baby to turn. Rocking back and forth on your hands and knees is good and from here you can bring your chest lower towards the floor (cradle your head with your arms) and keep your bum and hips in the air. Aim for 20 minutes per day, a few times a day. But you may need to build up to this.

Again, relax your shoulders and breathe fully and deeply.

Now, being totally honest, there isn’t a great body of evidence that this “works”, but anecdotally lots of my clients report success. At the very least, I’m not aware that any of this can do any harm whatsoever. So, it’s always worth a go in my opinion. Just make sure these movements are comfy for you. If they’re not, it might be best to stop.

Moxibustion

Now, I am no expert on this so I’m just going to tell you the basics so you know it is a choice for you.

Moxibustion is a traditional Chinese method that can be used to turn a breech baby to head first. It is usually done around 34–36 weeks of pregnancy. It’s a form of acupuncture, but instead of needles, moxa sticks (dried herbs) are used to heat specific energy points on your toes. The heat is absorbed into the points and transferred via energy channels, triggering hormone changes which relax the muscles in your uterus to allow extra “give”, and increasing your baby’s activity, encouraging him to turn. Now, I’m not sure what you’re thinking about this, but research suggests moxibustion is about 66% successful, which is better than ECV (see below). Might be worth a go!

Whilst moxibustion is gentle and generally safe, there may be some mums who it is not suitable for, so speak to your midwife, doctor or moxibustion specialist first to check.

Reflexology

Reflexology has been found to be 60% effective in turning a breech baby. Again, I am not specialised in reflexology. Very simply, reflexology is a gentle and non-invasive holistic therapy that works on the notions that reflex points for every part of the body are mapped out on the feet. A qualified reflexologist applies gentle pressure to these reflex points, aiming to restore balance and induce relaxation. It’s that relaxation effect again!

And lastly…

External Cephalic Version

An ECV is the medical and manual way that a breech baby can be turned into a head first position. An experienced obstetrician, using their hands placed externally on the woman’s abdomen, manoeuvres baby round using firm pressure. A “forwards somersault” of baby is usually attempted first and, if not successful, a “backwards somersault” may be then be tried. 

It is usually undertaken between 36 and 37 weeks gestation (but check with your individual hospital) as this strikes the balance between giving baby plenty of opportunity to turn themselves, but before baby has become engaged (very low) in the pelvis.

An ultrasound scan is almost always performed beforehand to confirm baby is breech, and to rule out anything that might mean the ECV should not go ahead, like a uniquely-shaped uterus, a low-lying placenta or “too little” amniotic fluid.

Some hospitals give a muscle relaxant (as an injection under the skin usually) before the ECV in order to relax the uterus. Once again, see how muscle relaxation is key! The muscles being relaxed allows baby as much space as possible to move, soft supple muscles will make it much easier for the doctor to manipulate and manoeuvre baby underneath, and the procedure should be more comfortable for you.

Baby’s heart rate is monitored before, during and after the procedure.

There are risks associated with an ECV though; including tightening/knotting of the cord, separation of the placenta from the uterus and rupture of the membrane (unintentional breaking of the waters). All of which can be very serious. If the placenta were to start bleeding during the procedure, or any other risk became significant, a caesarean birth would be needed immediately. So, it can be a good idea to take an overnight bag to an ECV appointment because of this.

ECV success is about 60%, though there are large variations as the success rate largely depends on the expertise of the person performing it. It would be a good idea when deciding about whether to have an ECV or not to ask what their success rate is.

If you choose to have an ECV, your hypnobirthing and relaxation skills can still be very worthwhile. Before the procedure begins, ask for time to prepare yourself. Close your eyes, drop your shoulders and breathe fully and deeply throughout the procedure. Really concentrate on your breath. It can be a good idea to listen to a relaxation script or relaxation music too during the procedure. Bring to a visualisation to your mind that you find soothing – perhaps a place you have been to, or want to go to, that distracts you and brings a sense of calm and relaxation to you.

My clients Gemma and Frankie, who had an EVC plus hypnobirthing to successfully turn baby Elliot.

What next?

If any of these methods prove successful in turning a breech baby, then marvellous. Simply await labour (whilst relaxing, reviving and, of course, reading your Lionheart Hypnobirthing manual!). But what if these methods don’t turn baby, or you don’t want to try any of them? It gets a bit more muddy, but know you have options and you are still the decision-maker.

Legally you can do what ever you feel is right – whether that be a vaginal breech birth or a caesarean birth. But, I have had women tell me “I’ve been told I have to have a caesarean” or “they won’t let me have a vaginal breech birth”. Please know that this is not true.

Do some fact finding. Listen to and consider the advice of your midwife and obstetrician. Ask for a second or even third opinion if you feel it is needed. Find out how experienced your hospital is at attending breech births – some have a dedicated breech birth team (yes to this!) offering incredible support, guidance and clinical expertise to couples having a breech baby, whilst some hospital have very little current experience.

If you find yourself unsupported/anxious/unsure, it might be a good idea to contact AIMS (Association for Improvements in the Maternity Services) (https://www.aims.org.uk/). They are a charity so their support and guidance is free.  You could book an appointment with the consultant midwife at your hospital who can listen and support you, but please know that they are still tied to hospital protocols. Or, for totally impartial information and support, you could book an appointment with an Independent Midwife experienced in breech births. You can find one here: IMUK.org.uk

Good luck!

Links:

Dr Sara Wickham (2020) https://www.sarawickham.com/research-updates/new-research-on-upright-breech-birth/

AIMS (2005) https://www.aims.org.uk/journal/item/hands-off-that-breech

Royal College of Obstetricians and Gynaecologists (2017) https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/breech-baby-patient-information-leaflet.pdf

Jane Evans – Breech Birth, What are my options (paperback)

Lionheart Hypnobirthing was founded by Rachel Akehurst – Hypnobirthing Teacher (Dip). Rcahel is a former Midwife (BSc Hons) and Health Visitor (MSc). Rachel is passionate about giving parents-to-be the support, reassurance, techniques and knowledge to assist a calm and confident birth. Ensuring the best start for you – and your baby. Rachel’s face to face and online classes can be viewed here: www.lionhearthypnobirthing.com

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