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The Four Different Types of Breech

  1. Frank- bottom first with legs extended towards baby's trunk
  2. Complete- legs folded so that feet are very close to the buttocks
  3. Footling- one or more feet coming into the pelvis first-the bottom is above the brim and the feet are below, at 37 weeks the knees may be bent so that the baby seems to be sitting on the top of the pelvis dipping his feet into the pelvic tunnel.
  4. Kneeling- both knees are coming first, the feet are folded up behind the baby's thighs.

According to Gail Tully of spinningbabies.com, a baby in an oblique or transverse lie is not a breech position and should not be labeled as such. Babies who are oblique (in the diagonal) or transverse (lying across, sideways) cannot get through the pelvis in this position.  If the "breech" baby doesn't have his or her buttocks over or in the pelvic brim (whether feet are between the brim and baby's buttocks or not), then the baby may not be truly breech. This can lead to confusion about the safety in laboring. Find more information go to http://www.spinningbabies.com/baby-positions/breech-bottoms-up/about-breech.

How to Help Spin or Turn the Baby

The following will include techniques to help encourage a breech baby to “turn” or “spin”.  These techniques also help for posterior or transverse lie positions.  Any mother can also choose to be proactive and may implement a daily practice of these techniques long before your baby’s position may become an issue.  Remember to combine these techniques with the bodywork techniques in order to create balance and tone so that your baby has enough space in your womb to “turn” or “spin”.

  1. The Forward–Leaning Inversions http://www.spinningbabies.com/techniques/the-inversion
  2. The Pelvic Tilt http://www.spinningbabies.com/techniques/activities-for-fetal-positioning/pelvic-tilts
  3. The Breech Tilt http://www.spinningbabies.com/techniques/activities-for-fetal-positioning/breech-tilt
  4. The Sacral Release http://www.spinningbabies.com/more-info/for-pregnancy/weekly-activities

What are your options if you find yourself pregnant with a breech positioned baby and you want to ensure (whether baby flips or not) you can find a care provider who will be trained in breech delivery?   Well the good news is there are options.  The bad-ish news is that they may be somewhat limited due to the fact that, according to Gail Tully, “nearly all American doctors have poor training in breech skills, and many midwives are untrained in breech.”

Tips to Help Locate a Breech Birth Care Provider:

  1. The chief of staff of Labor and Delivery at a big hospital
  2. A country doctor
  3. The rare breech-skilled, home-birth midwife
  4. A birth activist, doula or childbirth educator may know the name of someone with breech skills
  5. Some woman and couples make the decision to travel far to a doctor or midwife experienced in natural breech birth

Unfortunately these names are not likely to be advertised in this manner due to the current climate surrounding breech birth and the high cost of potential legal costs.  Even when a breech birth goes smoothly and mommy and baby are healthy, midwives and doctors can face severe opposition for supporting a mother’s vaginal breech birth. 

What Makes a Care Provider Experienced With Breech Birth?

  1. Having experience delivering breech babies
  2. Having a good knowledge of the physics and cardinal movements of breech birth
  3. Knowing when to keep hands off during the birth of a breech baby and when and how to help the shoulders and head without pulling.

Lastly, when choosing a care provider experienced in breech birth make sure you have an understanding of the types of breech presentation they are trained in delivering.  In my personal situation I found a care provider who was trained and experienced in breech delivery, however what I did not find out until I was in labor was that he would only deliver a specific breech presentation vaginally.  If I am ever to find myself in this situation again, I WILL be driving to Summertown, Tennessee to birth my baby at The Farm Midwifery Center.  Knowledge is power.  Educate yourself and know your options. 

Please continue educating yourself on the importance of Optimal Fetal Positioning by visiting www.spinningbabies.com and purchasing “The Belly Mapping Workbook” by Gail Tully, BS, CPM, CD author of SpinningBabies.com

Also see Causes of Breech Positioning & How to Prevent It

 

 

 

Published in Labour

I became interested in fetal positioning during the end of my own pregnancy.  Since the birth of my son I have continued to gain knowledge, a deeper understanding and an appreciation for the importance of fetal positioning.  I believe all care providers and birth workers need to have an understanding of the importance of fetal positioning and translate this knowledge and the importance of it to their expectant clients/patients. 

 

This article will serve two purposes, to help those women who find themselves in the “breech predicament” and to educate women on how to best avoid ever having to deal with a breech presentation. I firmly believe this knowledge will help Mothers and families make informed decisions and choices for themselves, their baby and their family, while avoiding feeling bullied by the “system”.

When it was confirmed that my son was in the footling breech position during the last couple weeks of my pregnancy, I began to closely follow the work of Gail Tully, Midwife and Author of SpinningBabies.com and have since been fortunate enough to attend her Spinning Babies workshop.

 

The Spinning Babies view on the common cause of breech presentation: the possible asymmetry of the uterus. Uterine symmetry depends upon pelvic alignment and ligaments of equal length. Bring balance and tone to the womb and the baby will spontaneously move into the best position in the space available to them.

 

So what does this mean? First lets focus on balance and symmetry. If a woman has an asymmetrical or “out of balanced” uterus this can make it more difficult for baby to get into a head down position as this asymmetry may create a smaller space in the womb. How does a uterus become asymmetrical? An asymmetrical uterus can be caused by our modern life experiences i.e. driving a car, sitting at desk for long periods at a time, wearing high heels, stress from the hustle and bustle of our daily lives, poor posture, pregnancy, etc.

 

Now let’s look at uterine tone, a uterus either too tight or too loose in muscle tone can also influence fetal positioning. The tone of a symmetrical womb will have an influence on fetal position. According to Spinning Babies there are 3 Principles: Balance, Gravity & Movement that will help address the issues involved to help create both a balanced and symmetrical uterus leading to optimal fetal positioning.

 

Other causes for breech presentation can include:

 

  • Too much or too little amniotic fluid. 
  • Baby or babies sometimes growing larger than the available room to flip head down.
  • The anatomical shape of the womb.
  • Position of the placenta.
  • A short or wrapped umbilical cord.
  • Time in pregnancy that birth occurs.
  • Birth anomaly although this is very rare.  

 

According to Gail Tully, “No more than 10% of full term breech babies have a physical reason for staying breech.”

What proactive steps can you take to help turn your breech baby?  First and foremost let’s discuss Optimal Fetal Positioning. OFP describes the activities that can help balance your body and guide your baby to a position that encourages a straightforward birthing experience. 

The sooner a mother begins OFP the better chance she has in balancing her body and encouraging baby into a good position for labor. I would start OFP techniques as soon as I am planning on becoming pregnant. If you are already pregnant and are finding yourself reading this article, I would begin the techniques today. The sooner these techniques are started the better. 

 

Try to incorporate the following activities into your daily life either prior to pregnancy or as soon as you learn you are pregnant as a way to create a balanced womb.

 

Posture

Make your belly a hammock for your baby. Try to maintain your belly in a relaxed forward or down position rather than pointing up.  Please visit http://spinningbabies.com/more-info/for-pregnancy/rest-smart-posture for more information.

 

Move Freely

Taking brisk walks can relax the PSAOS muscle pair, which, when tight can hold your womb and baby up. Do hip opening stretches and pelvis-balancing exercises in yoga, swim or dance.

 

Rest

Make a nest of pillows and lay nearly belly down, with the lower leg positioned behind you and upper leg resting over high pillows. Remember to alternate on each hip with a pillow between your knees and ankles. Always protect your belly and the small of your back with pillows.

 

Bodywork

If you are experiencing discomfort during pregnancy whether “false labor” or a general sense of discomfort, it could be an indication of bodywork need. Many “Baby Spinners” (those trained in the Baby Spinning Techniques) use a combination of these techniques: --Chiropractic adjustments (Webster Maneuver), craniosacral therapy, diaphragmatic release, sacral release, acupuncture, moxibustion, homeopathy, maya uterine massage, prenatal yoga and/or Reiki treatments.

 

Birth Support

Research shows that doula support is the most effective labor intervention. A doula can provide helpful tips and education for labor progress while providing continuous emotional support for the mother. 

 

Continue reading: Types of Breech Births & Tips to Spin and Turn Baby

Published in Fetal Development
Tuesday, 27 November 2012 10:21

The 52-hour Journey of our Breech Birth

 

Here we are...a place I hoped we’d never be... it’s 3:30am and time to discuss a hospital transfer...

I’ve been out of the birthing pool for just over two hours and am laying on our couch wrapped in all the towels and blankets we could find. I’m freezing cold and shivering as I hear my midwife say, “It’s time to discuss the options.” We had previously selected a specific hospital for transfer – if needed – but that no longer seems to be our best option so we run down a list of nearby hospitals. The house suddenly turns into a command center. Both of my midwives and my doula are walking around the first floor of our townhouse calling hospitals to see who is on-call and how they will handle my case.

You see...I’m breech. Well, my baby is breech, and I’ve been in labor for 48 hours now. I’m 7 centimeters and entering transition as we decide to make the transfer. All the nearby hospitals say they will do an automatic C-section if I’m brought in, but I don’t want a C-section. I know I can deliver my baby vaginally even with a breech presentation. The midwives begin calling OBs directly. They know of one female OB in the area that will allow moms to deliver vaginally for breech presentations, but she says she won’t take me because it’s my first baby. The odds are against me. It isn’t looking like I’ll be able to deliver vaginally after all. I’ve worked so hard these past two days to get to where I am and can’t believe I’ll have to be cut. The feelings of defeat begin to set in. There is one more possibility though. It’s a male OB that is in another county. It’s an hour drive to get to him. We make the call and wake him. I’m not expecting him to say anything different than the others, but within a few minutes my midwife enters my living room and says, “He’ll take you! I told him you were breech and wanted to deliver vaginally and he said to bring you in.” Thank you God! Off we go...

It’s after 4:00am, and my midwife is driving at the head of the pack. We’re on the Florida Turnpike with a general idea of where the hospital is. We’re relying on her memory for what exit to take. My husband is driving me, and my parents are following us. Behind them is my doula. It’s a four-car caravan in the middle of the night driving north for my last chance to deliver our baby naturally.

Surprisingly, I remember most of the drive. My pain is more intense and constant than it has been. I’m shivering cold and telling my husband to turn off the A/C one minute and taking everything off and asking for the A/C colder the next. I can’t get comfortable. I ask him to slow down. Each and every bump makes the contractions all the more difficult to manage. I’m screaming in pain. I’m in and out of sleep the entire ride.

My parents must think I’m crazy. I didn’t prepare them for this. They don’t know that there’s plenty of time before the baby arrives. They must be scared that I’ll have the baby in the middle of the road. I had told them I’d go to the nearest hospital if I needed a transfer. That hospital is a 3-minute drive from my house to the emergency room entrance. But I can’t go there. I can’t walk in there knowing that I won’t be given a chance to birth my baby. I have to make this journey to the one place where I have a shot at a natural birth.

About an hour later, we arrive at the hospital and I am admitted. The OB enters my room and does an internal exam to check how I’m doing. I’m still 7 centimeters. He then announces, “This is an automatic C-section.” In that moment the last bit of hope that I had remaining of delivering my baby naturally disappeared.
~
Over 48 hours ago, my mucus plug released, and my contractions started at 6 minutes apart. I wasn’t expecting it to happen like that. I know plenty of women who lose their mucus plug and don’t go into labor for days or even a week. I settled into the couch downstairs and kept timing the contractions to be sure this was the real thing before I woke anyone up. It was 4:00am, and I was certain I’d meet my baby within this day.

Two hours later, my contractions were going strong at about 4 minutes apart. I woke my husband with the good news and texted my midwife to give her a heads up. I began what turned into a marathon of vomiting. My contractions continued. My midwife and doula came by. Halfway through the day, I was 1 centimeter dilated and 100 percent thinned. Seemed unreal, but I knew better than to let the actual number disappoint me. It could be worse, so I took it in as progress.


My midwife left to return later in the day. My doula stayed. I rode out the contractions sitting on my recliner with my husband on his knees in front of me. The warmth of his hands on my thighs alleviated my pain more than he could understand. I slept, if only for a few seconds, between each contraction. My midwife returned. Time passed. I showered. Then, it was nighttime. I thought, “This should do it. I am more of a night person anyway. I’ll feel more relaxed and make good progress once the sun is down and I’m surrounded by darkness.” We all spent this first night together as my contractions continued. The TV was on, and although I was not focused on it, I was relieved that it was helping the time pass for everyone else. Everyone (except for me) took a few hours to nap. In the morning, I was 3 centimeters—progress, but a long way to go still. My midwife and doula left for several hours. My husband was exhausted. I decided to call my mom and ask her to come stay with me while everyone rested. I didn't tell her over the phone that I’d been in labor for over 24 hours already, but she suspects something is going on.

I continued to vomit and feel tremendous strain as I got every bit of liquid bile out of my stomach. The next time I went to the bathroom, I saw a dark colored discharge that I hadn’t seen before. I was concerned it might be meconium. I called my midwife. My other midwife was closer to my home and got there quicker to check my discharge. It was meconium. My contractions continued. My mom spent the day with me while I continued to labor. She left in the early evening to return later on with my father, who stayed upstairs without my ever seeing him. Nighttime arrived for a second time as my midwife and my doula returned. All were present now along with my husband, who was able to get some rest upstairs. They were concerned about the marathon vomiting and were trying to get me to drink and eat as much as I could keep down. I managed to keep down some drinks and miso soup, but only temporarily.

My pain was increasing. The sleep I'd gotten between each contraction over the last day and a half gave me the stamina to continue. But the pain was increasing, and I needed to try something else. I asked for my birthing pool. My husband and doula prepared the water. I got in. It was absolutely magical! I was so happy to be in the water. I was so impressed with how much pain relief it provided. I enjoyed this stage of my birthing process as much as one could while experiencing the mounting contractions. My contractions intensified and my body temperature began to fluctuate. This was one of my concerns (the other was fear of having a migraine during labor). As a thyroid cancer survivor, my body’s temperature tends to fall lower than normal. I was hot from the birthing pool, but my entire body was shivering.

I had been in the birthing pool for some time, and it looked like my midwives felt things were moving along. I heard them preparing for the birth. They started to set up the table with all the birthing supplies they would need when the baby was born. My midwife wanted to check me again while I was still in the water. I was now 5 centimeters. Five centimeters! Five centimeters...unreal. I had the stamina to continue. I was not giving up. But I became aware of the time. I saw that we were about to hit the 48-hour mark. And I started to worry about what that meant...

My emotions began to speak. Internally, I called upon every woman that had ever birthed naturally. I asked for their support, their wisdom, their guidance and their presence. I called upon the spirit world to give me the strength that I needed in this moment. I found myself getting upset as I silently screamed for help. I heard myself saying, “Where are you?” as if the generations of women birthers had forgotten to come for me. I called on my own birth experience, as I was born weighing almost 12 pounds to a 5-foot mother who birthed me without drugs or interventions. “It’s in my genes! I can do this!” And as I was going through this catharsis internally, my baby’s heart rate started to rise.


I was no longer in the comfort of the birthing pool. I was cold, wet, and shivering, wrapped in all the towels and blankets we owned, laying on the couch as I heard the words I never wanted to hear. “It’s time to discuss the options.” “Options,” I thought, “what options? I don’t want options. I want to birth my baby. That’s my only option.” But I trusted my midwife wholeheartedly. She didn’t use the words, but I knew if she was saying this, then it really was time to discuss a transfer. And a hospital transfer was what we did at 4:30 in the morning, just over 48 hours from the time my contractions started on that early Tuesday morning.
~

It’s now almost 6:00am on Thursday morning, and my one last chance at a vaginal delivery has just announced that I should be given an automatic C-section. You see, my baby is not just breech, but a bit transverse. My water has broken, and I have meconium present. I’ve been vomiting for days, and apparently I broke a fever on the drive up. My baby’s heart rate continues to reach peaks that are too high and begins to plunge below the norm, and let’s get real...I’ve been in labor for two days now and am still at 7 centimeters.

As the sound of the word “C-section” rolls off the OB’s lips, I hear my husband’s voice. He’s speaking with full certainty and with a clarity that I’ve never before heard from him. He says to the OB, “We drove an hour for YOU!” My heart stops. My leg kicks my husband. I’m not breathing. I’m thinking, “Shut up!” Such few words, but so much is implied. I’m even beginning to feel fear. I think it’s because I don’t want my husband to lose his temper with the OB. I think it’s because I don’t want this OB to be upset with us since we need him on our side. But the truth is that those words have solidified our destiny. What I feel is the power of those words and how in that split second my life has taken the path that I was born to take...

The OB doesn't skip a beat. He says, “OK, let’s see what she can do” and leaves the room. He too must have felt the power of those words. By now my concept of time is nonexistent. All I know is that I’m in the hospital room with my husband, midwife, and doula. The hospital nurse also comes in and out. She insists I lay on my back. I beg to be able to sit up. My midwife turns me on my side. I’m no longer vomiting, but the pain is unbearable. I’m hardly awake. All I remember is darkness and the voices of my birth team. They say I’m doing great, but deep inside I am waiting for my C-section. You see, I begin to believe that it’s over. It’s not so much that I believe that I can’t do it, but I feel the C-section knocking at my door. It’s in the air. It’s seducing me, and I surrender to it – emotionally, I give in.

The OB returns, and I’m 8 centimeters now. I fall back to sleep and don’t hear if there is a decision made. More and more time passes as I wait. I’m confused. Why are my husband, midwife, and doula encouraging me? Why do they want me to keep bringing my breath and energy down? Why do they want me to keep laboring? Don’t they know I’m having a C-section? Don’t they feel the devastation that I’m feeling? Aren’t they in as much disbelief as I am in? I’m awake for so little time between contractions that I can’t ask them why they are saying all those things to me. I remain confused and continue waiting to be taken away to the OR.

I manage to get some words out and ask the infamous, “How many more?” referring to contractions. I know there is no answer, but I can’t help asking. I hear the OB's voice pierce through the darkness: “Do you want an epidural?” Before I even get a chance to consider, he says “No? Ok.” It’s as if he doesn’t want me to have one. He asked, but wasn’t really offering. That’s interesting. And why did he say, “No?” Don’t I need one for my C- section? I fall back to sleep before I can think this through.
~
I’m lying on my left side facing my husband and midwife. They are holding my hand and touching my thigh. I see their faces go blank. I feel the fear that just came over them. I suspect it has something to do with what I just felt. I see them staring at the external monitor—there is no heartbeat. I know what has happened and do my best to get the words out. My baby’s heart didn’t stop. I look at my midwife and say, “I PUSHED! I can’t not push! I HAVE to PUSH!”


It was such a divine feeling. My body had to push. It wasn’t mental or even physical. It was divine. I was moved by spirit to push. My body knew exactly when and how. It was time for my baby to be born...


Because of the baby’s breech position, I knew I’d be checked again. Everyone had made it clear that they needed to be certain that I was a full 10 centimeters before pushing to avoid the baby’s head getting trapped once the body had come through butt and feet first. A possible complication with breech births since the head is bigger than the body. The hospital nurse checks me, but neither my husband nor my midwife feel confident with her so we wait for my OB. My contractions stop and in those moments I feel a rush of life and absolute ecstasy come through me. After all we’ve been through, after giving in emotionally to a C-section, after more than two days of natural labor...the moment is finally here. I am going to PUSH my baby out!

About 7 minutes later, at 7:55am on Thursday morning, I give birth to a baby boy weighing 5 lbs, 14 ounces and measuring 19 inches long. He is born in front of an audience. Seems that the rumors had spread across the hospital that there was going to be a vaginal delivery of a breech presentation, and the hospital staff wanted to witness something they thought they’d never see. My husband recalls hearing a few of them say, “She’s going to do it natural? But they didn’t teach us natural birth for breech presentations in medical school!” to which he responded, “Watch her do it”. And I did it. Our son came out butt cheek, foot, and testicle first. A strange sight indeed, but a true testament to all that birth can be when allowed to take its natural, raw course.
 


My son is about to turn one and is as healthy and full of life as can be. Over this first year of his life, I have come to fully understand the power of those words my husband spoke. Those words that he spoke for me when I couldn’t speak them for myself. Those words that set us on course for a natural, vaginal delivery when we came as close as one can possibly come to getting a C-section. It was those words that paved the way for me to slip right through the massive “C-section Net” that catches so many of us. It was those very words that saved me. Not just from getting a C-section, but also from losing a piece of myself that I know I’d never get back. Had I ended up with a C-section that day, an essential piece of me would have died on that operating table. You may not understand, but I know I would have lost the very piece that makes me who I am. I would not have been aligned with what I know to be truth. The self-betrayal would have cut so deeply that I would have remained wounded for life far deeper than the scar I would have had on my abdomen. I would have been changed in a way so profoundly that I would not have survived the experience as myself. It would have affected my mothering, and it would have affected my marriage. My life would not be as it is. I would not be as I am – as I was born to be.

We live at a time when it’s the norm to make people feel comfortable about what happens in their lives. A time when we allow people to feel like they’ve done everything they possibly can even if things don’t go their way. But I feel we do each other a disservice in doing this. I didn’t need my birth team to make me feel ok with getting a C-section...I needed them to hold my vision of a natural, vaginal birth when I couldn’t do it for myself. I needed my husband to speak my truth when I couldn’t. I needed to be able to surrender to the devastation of having a C-section at the depths of my inner being while my birth team held my destiny in check so that I could peek out from within the disparity I was feeling and still feel the presence of the possibility of having a natural birth.

We are survivors. With that said, we adapt to what comes our way and make peace with it in order to continue to live. I assume I would have done some form of this had I ended up with a C-section and would today be a profoundly altered version of myself. But in all honesty, I thank my midwives, my doula, my OB, my baby, myself and most of all, my husband, each and every day because I don’t have to do that. It is because of this that I know birth. It is because of this that I know birth in the way that I was born to know it. It is because of this that I know myself.

As I prepare for my son’s first birthday I feel into the gift my husband and I gave him on his BIRTH-day. I remind myself of what we transmitted to our son with every choice we made and I remind my son to never betray himself as we did not betray ourselves throughout his birthing journey.

 

Published in Birthing Stories

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