Thursday, December 9, 2010

Right Side Up - Breech Babies

The women in the above photo are trying to right a baby. This directionally challenged baby is coming bottom first. The method they are using to try to turn the baby, hard to decipher in this photo, is called moxibustion. Moxa, or mugwort, is heated and, like acupuncture, used over certain pressure points to induce heat to the region, and thereby blood flow. It works incredibly well for turning babies upside down, exactly where they need to be in order to be born.

Four percent of all babies present breech at term, or 37 weeks of gestation and beyond. How do you imagine that those four percent are born? Does the doctor or midwife, pull them out by their feet? What is the danger of a breech birth? Why do we never hear of babies born breech anymore?

A recent study in Tel Aviv has challenged the wisdom of late that breech babies should be born via Cesarean section. In the 'old days' the skills to deliver a baby coming breech, feet or butt first, were taught in medical school. After 2000, this was no longer the case. The Term Breech Study, the largest of its kind on breech births, found that breech babies delivered vaginally had a 1% increase of death in the first six weeks of life. The study also found that for mothers there were more benefits to a vaginal birth. From then on, the only doctors to attempt breeches were the old school doctors who had learned from experience that babies born breech, stubbornly do just as well as their head first counterparts. There were many issues with the 2000 Term Breech Study including research bias, and the fact that it's near impossible to randomize such a study.

The Tel Aviv study is urging medical schools to reintroduce the skills of delivering breech babies. Their research shows that there is no increase risk to a baby born breech vaginally and that mothers do better with morbidity and mortality when delivered vaginally. Professor Glezerman, a researcher on the trial, states that a C-section is no minor event in a woman's reproductive life, that it impacts future pregnancies, uterine health, and subsequent labors.
Although, not mentioned in the study, increasingly the research is pointing towards health effects of babies born by C-section as well. In one of the more recent findings, babies born by Cesarean section are at a higher risk of developing celiac disease. Another reason to avoid unnecessary surgery, who would want to assign anyone to a diet that prohibits bread, pasta, cookies!! Poor baby.

So how do you reconcile the lack of skill of the current docs with a pending breech birth? Look at the photo above for some inspiration - you make all efforts to turn the baby before delivery. Here are some tips to get you started:

  • Acupuncture/moxibustion is a powerful tool for breech babies. Do the moxa each day while squatting and making figure eights with your hips. I'm not kidding! One time I had an acupuncturist for a client, with a persistent breech presentation. She tried everything under the sun, before turning to her chosen profession, to turn her little girl. Two nights of these contortions and the babe turned!

  • Pulsatilla 200C one time. My little girl was breech until about 35 weeks. I never resorted to this, but I was ready to. It was suggested to make it a one time event, and to do it consciously. Light some candles, pour some tea, put your hips up, and take the pulsatilla. Engage with your baby, visualize his little head snuggled tight in your pelvis. This can be a really powerful way to turn a baby.

  • The breech tilt. This is an old recommendation, but really useful. The idea is to elevate your hips higher than your pelvis, to disengage the baby so that when you stand up, the baby will realign itself the proper way. You can do this by laying an ironing board angled against a coach and laying down, with your feet up and head on the floor. Or you can make a stack of pillows and put your hips atop the pillows. Do these for at least 15 minutes twice a day. Talk with your baby and shine a flashlight starting at the top and moving to the pelvis, "For now and always baby, follow the light."

  • Webster's Technique is a chiropractic technique that is often employed to help turn breech babies. It's not really 'turning' the baby, it's addressing tightness and torsion, among other issues in the mother's pelvis. Let's be fair after all, there are two players at work here, it's not just the baby choosing to be breech. Fibroids, cysts, and other issues in the mother's pelvic can force the baby into a breech position. Webster's technique can address some of these problems.

  • One of the interesting theories about why babies are breech is not a physical reason. There is a theory that babies who are breech do so out of a need to get their mother's attention. It's as if they are saying, "Hello, remember me, I need you to pay attention." It could be this lack of attention that is causing them to swim close to mama's heart, a gentle pull on it's strings, those tiny fingers dialing your number before you've even heard them cry. It's a sweet thought and one I found bore a lot of fruit for women who were breech beyond 35 weeks. It tended to happen to women who worked, worked, worked right up until the end, women undergoing a lot of stress, and women who maybe had some hesitancy about becoming a mother. Overall tension also produces lots of tension in the pelvic region, which can be a culprit in breech presentation. If you are breech these themes are worth exploring through journaling, art, conversation, etc...

  • If none of that works, there is always frozen peas. Put a pack of frozen veggies on your babies bum. They won't much like it and will soon get the picture that that's not where they should be hanging out and will head to, uh, warmer regions!

The most important thing with breech delivery is the skill and experience of the practitioner. If none of the above work, seek out someone experienced with breech births. These tend to be the older male obstetricians and older midwives. Trust your instincts, as always. And encourage medical schools to teach the skills of delivering babies who for some reason, want to land in this world, feet first.

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