Breech and the bicornuate uterus

A bicornuate uterus has two sections divided by a septum, or wall of tissue. The halves are smaller than the womb with a single "room." Babies may grow too big to flip head down in the bicornuate uterus, even as early as midpregnancy. A bicornuate uterus might be called a heart-shaped uterus.  

Its best to do the 1st Principle of Spinning Babies from as early in pregnancy as you can. Proactive women may begin bodywork or balancing exercises before pregnancy to improve the chance of a full-term, head down baby.

Chiropractic, soft-tissue work and your own forward-leaning inversions may help release the broad and round ligaments. Specific stretches and exercises can release your psoas muscles. Read the Three Principles of Spinning Babies for Breech. The reason to do balancing activities is to give the uterus the most room available for baby to settle head-down as early in pregnancy as possible. 

Along with Balancing Activities for Breech,

Drink 3-4 quarts of clear fluids a day, such as pure water, Red Raspberry Leaf tea, Chamomile tea, Hibiscus tea. Milk is considered a solid as it turns to cheese in your stomach. See what you want to do, Do as much as you can arrange for the next 10 weeks. Pay attention to maternal positioning, Rest Smart, etc. The most important time for fetal positioning is in the second trimester, not the third.
 

In Ina May Gaskin's first birth book, Spiritual Midwifery,  there is a description, in the back section, of a woman with a bicornuate uterus and a story of how her various births went. You may appreciate the stories.

Read this blog posting from Dr. Stuart Fishbein on the  Business of Being Born site. Dr. Fishbein says, "Unicornate uteri often result in breech and preterm labor as you have noted. I am not aware that there is an increased risk of rupture in your case. Some women deliver vaginally with this problem and sometimes the labor is dysfunctional due to the shape of the uterus or associated malformations of the cervix and end up with a C-Section. If your doctor is supportive of VBAC and your baby cooperates with size and position, then you may give it a go. And you are right, there is not much literature other than anecdotal cases, so common sense and nature must prevail."  - Dr. Fischbein

Here's an email from a reader,

Hi Gail,

I love your website and so appreciate all of the information you have provided. I've been doing the exercises from your site since 30 weeks because I have a bicornuate uterus and an anterior placenta, making my child very susceptible to breech. (As was the case with my last son) I am trying to figure out if these exercises have been working with your belly mapping techniques but I am uncertain if my assessment is correct.

Using a traditional stethoscope I am picking up the heartbeat really, really low and a little to the right of center. And the only place I ever feel movement is really, really low on the left side.
At the same time I feel, what seems like a head under my right rib, but that doesn't seem like it can be right since the heart beat is so low.

Would you gather from this information that my child is literally folded in half, head down with his butt under my placenta under the right rib? This is how I am imagining it must be.

I am 35 weeks and my doctor is already pressuring me to think about a c/s if the baby is still breech.

I'd really like to know that I'm doing the Belly Mapping correctly so I can relax. Any input you can provide would be greatly appreciated!

Thanks.

Hi,

I'm sorry I can't tell your baby's position from your email description. The bicornuate uterus adds a dimension beyond the straight forward descriptions upon which Belly Mapping depends.   If you were local I'd be happy to feel your belly, though I may not be as accurate as usual due to your anterior placenta. An ultrasound may be warranted.

Myofascial release is a type of soft tissue body work that may help your baby.  A technique called Abdominal Release, also called Diaphragmatic Release, is specifically helpful, as would be a Standing Release or also called a Sacral Release.

Find a person who knows these techniques that works regularly with pregnant women. Some chiropractors also know these techniques. The chiropractor can also do other things that would help. If they aren't working regularly with pregnant women, they may not be as effective, but still may be worth seeing.

For a bicornuate uterus, the best time for helping fetal position is before 30 weeks. However, every bicornuate is different. I am sorry I can't be specific in your case. There may be time to help baby be head down - and indeed, your baby may already be head down. I can't tell from your guess. I can only guess!

Dr. Michel Odent has a great idea about the importance of fetal catacholmine levels rising in labor. He asks that women who need cesarean births not schedule their cesareans before labor begins on its own, unless there are very clear indications - other than a breech or transverse position, for instance.

A healthy  mom can go to the hospital when labor begins and have a surgical birth if needed. Having a cesarean after labor begins on its own can help assure that the birth hormones are heightened. Birth hormones, such as the stress hormone, catacholamine, protect the baby somewhat from  from respiratory problems related to the lack of labor hormones at the time of birth by surgery. Also, waiting til labor protects the baby from a possiblity of an early birth (late prematurity) which is related to a higher infant mortality rate in the first year.

So even if you schedule, waiting until a few days after your due date is more protective than scheduling before your due date. You may have to negotiate with your doctor about such a personalized plan.  The challenge will be in having the OR and staff available when you begin labor. If you live in a rural area this will be challenging compared to living near a city hospital where they have 24-hr in-house staff able to conduct a cesarean before you give birth to a breech baby.

Vaginal Birth with a Bicornate Uterus

If you would like to explore vaginal breech birth with your local doctors that may also be an option if the baby is breech and not transverse. Having a bicornate uterus is not a reason not to try for a natural, physiologically supported vaginal breech birth. If the baby can make the lateral flexion into the pelvis the baby has a good chance of being born well vaginally. If the baby doesn't have room to make the move into the pelvis, labor would have offered other advantages of preparing the baby's lungs for birth, reducing the chance of one of the complications of cesarean birth, poor fluid absorption from the lungs after birth. It is labor, not "squeezing" that facilitates good absorption of fetal lung fluids. All the safety observations for breech birth apply, of course. And all the expectations for good outcomes when "hands-off the breech" and knee-chest maternal positions are observed.