While the majority of babies will turn head down (cephalic) by 36 weeks of pregnancy, about 4-5% will choose a breech position. This means that they aren’t head down, having either their bottom down at the cervix or their feet. There are a lot of scare tactics and fear surrounding breech babies that often need to be dispelled. Perhaps you're reading this because you think or have been told that your baby is breech and are already freaking out a bit.
First, if you're panicking, take a deep breath. There isn’t something “wrong” with your baby. They aren’t being “stubborn” or complicated. While it’s not common, breech can be considered a variation of normal. It is not an emergency. He or she is healthy and for some reason, and possibly a very good one, they have naturally settled into a head up position. (For some visuals on various breech positioning, see here.)
Now after that breath, stop and pray. So often our first inclination is to anxiety and to doing all the things we can to control the situation when what would be of most benefit is submitting all of it to the Lord and putting our case and intentions before Him. Allow HIM to lead you. His plan for birth is for our good. His design for it is perfect and He didn't forget about the breech babies. His desire is to lead you into greater trust and surrender and joy. Before doing anything else, stop, breathe, pray, and remember that He loves you and your baby more than you can imagine.
For the majority of history, breech babies were born vaginally with low rates of complication. Up until the 1970’s catching breech babies and knowing what to look for as the baby is born to assess if help or intervention is needed was a standard skill taught to midwives and obstetricians alike. It wasn’t until the 1980’s that cesarean surgery for a breech baby entered the scene and then quickly became standard. During that time, training in breech skills was actually phased out of many obstetric trainings, leaving many providers without the necessary knowledge and skills to attend a breech vaginal birth safely, their only tool now automatic surgery, with the more numerous risks of that included.
Very slowly training in breech vaginal birth is returning. However, most women with a breech baby at full term who are working within the medicalized system will be recommended to schedule a cesarean.
If your baby is breech, first ask yourself what options you have.
Is your midwife or OB skilled in vaginal breech birth? Then go forward confidently and birth your baby that way! If they do not have the skills (or are not allowed by the government or hospital to use them), then consider whether there are other options for you and your baby to have a healthy, physiological breech birth and if you want to avail yourself of them.
This might look like:
Searching for and switching to a new midwife or OB confident and skilled in breech birth. (Search the directory here! Also ask local doulas, midwives, chiropractors, in local birth Facebook groups, Instagram accounts focused on breech birth, and more.)
Finding a better place to birth that honors vaginal breech birth, whether that's home, birth center, or another hospital
Hiring a traveling midwife who takes breech birth who is willing to come to you
Traveling to a place with more options for breech birth
Choosing to birth unassisted
If none of those options are worth it to you or are truly impossible, then you will need to accept that staying with that provider will likely mean accepting a cesarean surgery, and the short and longterm risks included.
Here are a few important points to consider as you navigate this issue:
Babies can move and change position right up to the day of birth. This is especially true for mothers who have had multiple children before. Your baby may be breech at 40 weeks but move head down at 40+1.
That said the majority of babies do settle into a position by 36 weeks and stay in that general position until birth. Staying active throughout the later weeks of your pregnancy, making sure you stay well hydrated so baby has plenty of fluid to move and adjust, and regular chiropractic visits are all ways to support your body and baby in getting into the best position for his or her birth.
Chances are quite high that you can absolutely birth a breech baby vaginally and safely. The risks of cesarean surgery for this birth and baby as well as the consequences to your future fertility and births should be weighed heavily against the risk of a vaginal breech birth.
Only a small percentage of breech babies need some intervention as they are born. The vast majority navigate the pelvis completely on their own without need for any intervention or manipulation. God didn't make a mistake when He designed birth and that includes accounting for breech babies!
Vaginal breech birth is not without some risk but neither is vaginal head-down birth. And certainly neither is cesarean surgery, which has even more numerous risks than both. Birth is not risk-free. Life is not risk-free. It should be up to the individual mother in her own unique circumstances to decide which risks she is comfortable with.
Interestingly enough, a breech baby born by cesarean still comes out breech! The techniques and skills an OB must use are somewhat similar to ones that should be known for a vaginal birth. In fact, learning those skills is a whole lot easier than learning how to do surgery!
Knowing your provider's skills and protocol for a breech baby long before it could ever be an issue is wise. Ask that question in interviews! If you've already hired someone, talk now about how they approach breech, their skill level, and what their recommendations would be if your baby is breech at full term. Make changes now if you are not comfortable with their answers.
A transverse lie is one in which the baby is basically lying sideways within the womb. It is very rare for a baby to get in and stay in this position at full term. If the baby is in this position at the time of birth, cesarean surgery does become necessary as, without the baby turning or being turned in that moment, they quite literally cannot fit out the birth canal.
If your provider is not willing to attend a breech vaginal birth but you are absolutely certain you want to stay with him or her, you can consider an external cephalic version (ECV) where the OB or midwife manually attempts to turn the baby from the outside into a head down position. Some babies may turn quickly and easily, others may not want to move at all and the ECV won’t work. There are both benefits and risks to this process worth considering and different providers do the process differently. Some are quite gentle while others are more forceful. If the only other option is cesarean, with its own greater number of risks, it seems reasonable to try this first.
RESOURCES ON VAGINAL BREECH BIRTH:
Okay, Okay...BUT HOW CAN I TURN MY BABY???
We know. We can say all these things but most mothers who find out their baby is breech will still want to know if there's anything they can do to help baby turn head down. Having a breech baby in this current culture adds a mental weight that gets lifted if they know their baby is settled into a head down position rather than breech.
Here's a list of things that can sometimes help a breech baby turn head down:
Webster chiropractic care (We would recommend twice a week if mom is nearing full term and baby is breech.)
Spinning Babies Breech Baby Protocol
Spending lots of time in hands and knees and/or forward leaning inversion positions.
Swimming and especially doing handstands in the pool! The effect of the movement and the water can be really effective.
Homeopathic pulsatilla (We would use 200 or 1M strength, with a full dose twice a day for at least 3 days, stopping sooner if baby noticeably turns.)
Acupuncture
Moxibustion (There's actually evidence to support this for breech birth. Just be sure the practitioner of this or acupuncture is not bringing any problematic spirituality into the session.)
Placing something cold (like a cold pack or frozen bag of peas) at the top of the womb and something warm near your pelvic area. The theory is that baby will naturally move their head away from the cool and toward the warmth.
Some mothers report going on the swings at a park encouraged their baby to turn!
Mother-Led "ECV" Some mothers are very in tune with their bodies and babies and feel comfortable and able to manually encourage the baby into a head down position themselves through intuitive maternal positioning and their own manual manipulation.
PRAYER! Do NOT discount the power of prayer, Mass, and sacramentals!
If You Choose Cesarean:
If you do decide that a cesarean is your best option, there are still choices within that to help you have the best birth possible for you and your baby. All of these are possible and reasonable options, however, MUCH depends on the OB doing the surgery and the hospital protocols. If they are not willing to budge on these things, then consider finding another option.
Waiting until labor begins to have the surgery should be a completely reasonable option to consider with a breech baby. With this choice, you know that at least your baby is physiologically ready to be born and they and God are choosing their birthday as would normally be the case. Baby will also still be getting some of the benefits of contractions and both of you will be experiencing at least some of the very benefits of the oxytocin and endorphin exchange and physiological bonding that labor supplies. The surgery can be performed once it seems you are close to pushing.
You can opt that no drape or a clear drape is used so that you can see the baby born. The drape can be immediately dropped and baby be given right to you to hold skin to skin on the surgical table. You can still wait until the cord is white to allow it to be clamped. You may still be able to have your doula present to support you through the surgery. You can do vaginal seeding on your own so that the baby is exposed to all the beneficial bacteria they were meant to have from the birth canal and establish a stronger, healthier microbiome. Again, many of these options are easily possible BUT whether or not they will be supported and done is another story. You will likely have to advocate very hard to get some of these things.
Always remember that ultimately any intervention is always up to you, including cesarean for a breech baby. If your provider is not respecting that or is not as skilled as you would like them to be, then consider switching if possible to one that is. You and your baby deserve to have the best possible birth and all options available to you.
While every woman is going to have a different comfort level with a breech vaginal birth, she should at least know that it is almost always a valid option and have that option open and presented to her. Ideally, she should have doctors and midwives available if she wants them who are comfortable with this variation of normal. Respecting God's design for birth means doing what we can to honor and restore physiology and help every mother and baby have the closest possible experience to His intentional physiological design.
May God grant you a beautiful, holy, healthy birth...whichever way your baby is turned.