My Baby is Breech- What should I do next?

If your baby is breech near term you should start with gathering information from reliable sources. In my practice, I generally recommend the following advice. First, seek a supportive practitioner! An ultrasound should be performed to determine that there are no obvious abnormalities of the baby or the uterus. Ultrasound can give an estimate of fetal weight, head and feet position, location of the placenta and umbilical cord and general health of the fetal environment. If all appears normal then the option of acupuncture with moxibustion, chiropractic techniques, certain exercises and other noninvasive techniques can be attempted over the next few weeks. Should your baby remain breech then I would discuss the likelihood of success of an attempt at external version (The attempt to manually move a breech baby into the head-down position) around 37 weeks. Version is easier when the mother has had other children and the baby is in the complete breech presentation (sitting Indian style) than when in the frank breech presentation (diving pike position).

If version is unsuccessful or not a good choice for you then some decisions have to be made. I recommend sitting down, face to face, with an informed practitioner at this point to discuss the risks and benefits of all options. There are certain criteria which studies have shown that, when met, make a trial of vaginal birth in breech presentation a safe option. These include:

1) Estimated fetal weight between 2500 and 4000 grams

2) Frank or Complete Breech Presentation

3) An adequate maternal pelvis (formerly measured by x-ray but can be assessed by exam and is a subjective sizing of the opening of the bony structures of the pelvis)

4) Baby’s head must be flexed and not extended

5) No fetal abnormalities

6) 37 - 42 weeks

7) Spontaneous labor and a reassuring fetal heart rate.

8) Right mental “stuff”, meaning trust in your body and the process.

If these criteria are met then you have a very good chance of having a successful and safe vaginal delivery.

If all these criteria are not met then a c/section may well be the only safe option available. This conclusion is supported by the current literature and, although a woman cannot be forced to have surgery, it would be unwise to refuse in my opinion. However, if these criteria are met then you do have the option of asking to wait for labor and see how things progress. The biggest obstacle might be finding an able and willing practitioner as the skills and desire of doctors to conduct a vaginal breech delivery will slowly disappear in the next generation. I believe strongly that consumer demand for these birth choices is the only thing that might reverse this trend and encourage academic teaching and training programs to save these skills.

Resources & Essays

Raiders of the Lost Art by Dr. Fischbein

Berlin Wellness Group & Dr. Elliot Berlin

Spinning Babies

Coalition for Breech Birth