When should I be concerned about a breech position?
During the month before 30 weeks, many babies are breech. The breech baby is vertical, so the womb is “stretched” upwards. This makes it easier for the breech baby to flip to head down around 28-32 weeks. Breech is not an issue until 32-34 weeks, unless the womb has an unusual limitation in shape or size, such as a bicornate uterus. In this case, the baby needs to be head down much earlier than when the uterus has more room.
The medical model of care addresses the breech position between 35-37 weeks, when baby survival outside the womb won’t include special nursery care to breathe or suck. Physicians Oxorn and Foote, however, recommend helping babies turn head down at 34 weeks. Many home birth midwives suggest interacting with a baby at 30-34 weeks to encourage a head-down position (vertex).
Women who have had difficult previous births due to posterior, asynclitism, or a labor that didn’t progress, may want to begin bodywork and the Forward-leaning Inversion early in pregnancy (after morning sickness is gone and extra things like fetal positioning activities can be thought about).
The timeline for breech
This is a timeline of what to do and when to do it in order to help a breech baby move head down:
- Before 24-26 weeks, most babies lie diagonally or sideways in the Transverse Lie position.
- Between 24-29 weeks, most babies turn vertical and some will be breech.
- By 30-32 weeks, most babies flip head down and bottom-up.
- By 34 weeks pregnant, the provider expects the baby to be head down.
- Between 36-37 weeks, a provider may suggest an external cephalic version.
- Full term is from 37-42 weeks gestation, and about 3-4% of term babies are breech.
10-24 weeks gestation
This is the time when fetal position is generally determined, even though the baby’s final position isn’t typically set before 34 weeks gestation. How can this be? The body has a habit, so to speak, of how the soft tissues, ligaments, muscles, and alignment of the pelvis and whole body is set. The baby simply follows this basic pattern. By adding body balancing now, the baby has an increased chance of ideal positioning for labor at 34 weeks and beyond.
Routine good posture with walking and exercise will help most babies be head down as the third trimester gets underway. A 30-second inversion is good practice for everyone. Unless you have a medical reason not to, please consider the Forward-leaning Inversion. If you have a history of car accidents, falls, uncomfortable pregnancies, hormonal imbalance, or a previous breech or posterior baby, then begin the inversion and body work before or during early pregnancy.
Oxorn and Foote recommend external version at 34 weeks, but most doctors want to wait for the baby’s lungs and suck reflex to be more developed in case the maneuver goes wrong and starts labor or pulls the placenta off the uterine wall. There is often enough amniotic fluid for an easy flip before 35 weeks.
- Inversion: Use of maternal positions that put the mother upside down may help a baby use gravity to flip. Get i
nto the position you want your baby to be in. Inversions give a static stretch to uterine ligaments which, when followed by a swing back up to sitting tall over a neutral pelvis helps realign cervical ligaments and may make more room for the baby’s head. Start with a 30-seconds to 2 minutes of Forward-leaning Inversion.
- Breech Tilt: Follow the FLI with the Breech Tilt for 10-20 minutes. This allows you to tuck your chin while upside down on a similar slanted surface. Use an ironing board against the couch, for instance.
- Open-knee Chest: Open-knee Chest has been studied and shown to help breeches flip. I like inversion positions that allow the mother to tuck her own chin. Myofascial workers tell me this relaxes her pelvis, whereas extending the chin tightens the pelvis.
- Professional bodywork: Acupuncture and Moxibustion both have good statistics for flipping breeches. Find out if there’s a Spinning Babies® Aware Practitioner in your area.
- Therapeutic massage: There are muscle/fascia attachments at the base of the skull, respiratory diaphragm, inguinal ligament, and even the hip sockets! We are whole organisms, not machines with reproductive parts.
- Chiropractic: Neck adjustments do improve pelvic alignment, especially if accompanied by Myofascial Release. Not all chiropractors are trained in Myofascial Release, however.
Should manual external cephalic version be done earlier?
A few midwives recommend version (manually turning the breech baby to head down) at 30 –31 weeks. Anne Frye, author of Holistic Midwifery, reported a very low incidence of breech at term when her midwifery group manually rotated babies during this gestational age.
Attempting to turn the baby now is over a month before the medical model of turning breeches. Utmost gentleness must be the protective factor. If forcing a baby to turn harms the baby or placenta, the baby is too young to be cared for outside of the Neonatal Intensive Care Unit.
Midwives who turn babies now believe there is less chance of hurting a baby and proceed very carefully, stopping at once if there is resistance. Typically, there is less resistance from the uterus because there is more fluid and the baby is still very small.
Body work is suggested before attempting this, especially for first-time moms or women who had a difficult time with their first birth. There are risks to a manual version, so the baby should be monitored closely in between each 10-30 degrees of rotation.
If your baby is breech during this time your doctor or midwife will begin to talk about how to help the baby flip head down, and possibly about scheduling a manual version for 36-37 weeks. Getting body work and having acupuncture or homeopathy may help soften the ligaments and a tense uterus to either help the baby flip spontaneously or to allow more success in an attempt at a version.
Moxibustion has its highest success rate this week.
During this time, you can continue with the suggestions in the “Professional Help” page. Also, an obstetrician may suggest manually flipping the baby to a head down position at this time. A few midwives will also offer this, perhaps even earlier, at 30-34 weeks.
NOTE: Don’t let someone manually flip your baby without using careful monitoring of the baby’s heartbeat. Accidents can occur, even when there is good intention. The baby must be listened to and the version stopped immediately if the heart rate drops.
External cephalic version near the end of pregnancy
You may also agree to go through with a cephalic version at this time. The baby is in the womb with the cord and placenta and there is a small risk in turning the baby manually. This maneuver should be done with monitoring by experienced professionals, in a setting ready for a cesarean if needed.
There is about a 40-50% chance this will be successful. Sometimes the baby moves easily and sometimes the procedure is painful. I believe it’s important who performs it, and that ligament tightness would make this more uncomfortable. I suggest getting chiropractic, myofascial, acupuncture, homeopathy, or moxibustion (or all of these) before and after the version.
Rebozo sifting daily beforehand and just before the procedure would be relaxing and helpful, I believe. The Forward-leaning Inversion, when done repeatedly and correctly over time, may possibly help align the pelvis by correcting the utero-sacral ligament and its pull on the sacrum (one of several benefits).
Side-lying Release can help the pelvic floor be softer and more balanced to help make room for all the uterine connections to accommodate the baby. Follow up with more of the same, as some babies who flip will be more likely to have a hand near their face during birth, be posterior, or need a cesarean anyway, even if the version was successful.
Sometimes a woman and her caregiver don’t know the baby is breech until this point. Rarely does a baby flip breech this late in pregnancy either. It may be the bio-physical ultrasound exam that discovers the baby is breech.
An external cephalic version may yet be tried, depending on the fluid level and the flexibility of the uterus, the baby’s head position and location, a uterine septum, where the placenta is, etc. and can even still be successful.
Having the baby flip doing body balancing activities is still possible as well. Keep doing the activities listed above.
Though many breeches are born about 37-39 weeks gestation, some will happily go to 41 or even 42 weeks. For a head down baby, 41 weeks and 1 day is a common time for labor to begin on its own. It certainly can be for a breech, too.
If the mother has a tendency to be somewhat overweight, lower energy, or has known low thyroid, a longer pregnancy may be more likely, based on my observations. But well-nourished and peppy women can also go to a full pregnancy length. This gives a couple more weeks for the baby to mature.
Going into labor and then having a planned cesarean is recommend by Dr. Michel Odent, a breech expert from France. Going into labor spontaneously is safer for the breech vaginal birth, as well. Women who are trying to flip their baby often find it necessary to slow down the efforts and come to terms with a breech birth.
Even when facing a cesarean, its more nurturing to you and your baby to have time to plan a better cesarean, with skin-to-skin, delayed cord clamping, and breastfeeding on the operating room table, rather than put all your hope into a last minute flip. Last minute flips do happen, but not as often as cesareans for breech. Give yourself some time to adapt.
Postdates (after your due date) with a breech
With a breech, going all the way to 42 weeks may or may not be more of an issue. Some providers will have to end any plans for a vaginal birth by now. Midwifery statutes often limit midwifery care out of the hospital to 37-42 weeks (or 36-43, depending on where you live).
After 42 weeks, the baby’s skull bones are setting up more firmly and a vaginal birth is less favorable. I’ve been to a few breech births after 42 weeks gestation and everything went very well. But, I do sometimes wonder why a mom with a breech wasn’t going into labor if she had been getting regular bodywork for weeks. Could it be her normal time was 42 weeks? Or, perhaps labor was delayed because of a slow metabolism.
For a mother with a “sloshy” metabolism, I am inclined to transfer care to a kind hospital provider at about 41.5 weeks. Mom and baby need intelligent and experienced monitoring to rule out issues of post dates that may complicate labor.
Inducing a breech
Inducing a breech is not recommended in out of hospital settings. Even in the hospital, the risk rises. In some areas where breech is common, Pitocin/Syntocin inductions are done with outcomes that are good enough to keep the options open. Induction by herbs is also considered out of scope for breech.
We need to respect the breech and not stress the baby, especially in settings where we don’t have the rescue setup to solve any potential problems. Try body balancing and see if labor begins on its own. That would be a non-invasive, non-manipulating approach.
It is a rare possibility that the baby flips to head down during labor. I once assisted a midwife who’s laboring mother’s water had released. Her labor was mild and not picking up, so after 24 hours we transferred and found that the baby had flipped. The doctor thought we’d misdiagnosed, but the mother’s abdomen was so thin we could feel the baby’s knuckles and elbow and found the baby in the opposite direction after entering the hospital!
If the plan is to have a cesarean once labor begins, call the hospital and alert them of labor immediately, then head in right away. Breech births can go quite quickly and you want to be where people are ready to help you. If you plan to have a vaginal birth, don’t delay in getting to your birth location or getting your birth team to you.
While it can be totally normal to have a 24-hour or longer breech birth, many breech labors are quite short. Because the softer bottom is first, it may take you by surprise that you are progressing with such little pain (though this is not always true). Just don’t base your decision to get to the hospital on your pain levels!
After the birth
While the concern about breech position is during the birthing, when the baby is breech for most of the third trimester, their skull bones become shaped by the inside of the upper womb (the fundus). Craniosacral therapy can gently (and without using force) reshape the baby’s head, ideally during the month or two after birth.
A question about breech
Email from Wed, Feb 11, 2009:
…I’m 30 weeks and the baby is what I’d describe as oblique breech – his head is on my right side next to my belly button, his hips/butt are in my pelvis on the lower left side (my left) and his feet are in front of his face. I think he’s facing forward – towards my belly button. I’ve known this for weeks just because his big head is so hard I always bump that spot on accident. …. my first son was 9 lbs and born posterior, so I’m really hoping this baby is in the ideal position for delivery… so both of these things make me nervous that he won’t move. He has been in this position for a few weeks now. … Anyway, just wondering if I should worry and what, if anything, I can do to help him move now. My Midwife suggested a Chiropractor that can do some adjustments. I’d like to do the couch inversion too. Would it help for me to walk more? Also, should I sleep more on one side than the other? Thanks for your help! Great site!
Hi….It is common for babies to be breech at 30 weeks. However, now is a good time to take action, not so much that your baby is breech, but because your first baby was OP. You see, a pelvic misalignment and/or round ligament spasms (they often go together) can result in either a breech or a posterior fetal position. So, a breech will often flip to a posterior position and may stay that way unless you resolve the underlying issue. Maternal positioning is often not enough by itself to correct a posterior fetal position when there is a history of previous posterior or breech babies. While certainly most breech babies flip head down, it’s beneficial to help correct the symmetry of your uterine ligaments now, while the baby is still small enough to have plenty of room to flip head down once the reason for the previous posterior position is remedied. See some things a Chiropractor can do for breech and posterior by reading Professional Help.