Diary Of A Pregnancy

Your baby should normally settle into a position that is favourable for the birth by about 34-35 weeks of pregnancy. Most babies settle into a cephalic (head-first) presentation, but occasionally they are bottom-first, or breech. This can happen if your baby is big, if your pelvis is small or a slightly different shape from normal, or if your placenta is lying low in the uterus (placenta praevia, which fills up the space where your baby’s head would normally settle). Excessive fluid around your baby may mean he is more likely to keep changing position and so he could be breech when you start labor, or if there is not enough fluid he is less able to move and may get stuck in the breech position.

If you have had several babies, your abdominal muscles may not be strong enough to support your baby in a position which is suitable for a normal birth, and if you are expecting twins or triplets, it is more likely that one will be breech, even if the other is head-first. A scan in late pregnancy will usually show if your baby is breech, or the midwife may feel it when she examines you at your antenatal appointment. Your baby’s kicking may be lower down than expected, or you may become breathless and suffer heartburn towards the end of pregnancy, as his head pushes up under your diaphragm and compresses the base of your lungs. If you have had a breech baby before, there is an increased chance that this baby will be breech too. Very occasionally, the midwife will realize your baby is breech when she examines you internally in labor, although this is rare nowadays because scans usually detect it earlier.

Breech babies sometimes have difficulty during labor and can become distressed, so most doctors advise a Caesarean to ensure your baby is born safely, although recent research from Canada and Egypt suggests that a Caesarean for breech is only necessary when there are other medical indications. However, if your baby is discovered to be breech before you go into labor, you do have the right to try for a normal labor so that your baby can be born vaginally, although the doctor may actively attempt to discourage you. If you insist, you will normally be advised to compromise by having your baby in hospital, although the choice of place of birth remains yours. In the UK, an independent midwife will usually agree to care for you at home if you choose to pay for this service, or if you prefer NHS care and wish to stay at home, a midwife is legally required to attend you (interestingly, doctors have the right to refuse!).

A commonly offered medical treatment to try to turn the baby is external cephalic version (ECV), an abdominal procedure performed by the doctor at around 35-37 weeks of pregnancy. You are usually given an intravenous injection to relax you and the baby will be scanned to ensure he is still breech; this will also confirm the position of your placenta to ensure that it is safe to try to turn your baby. The obstetrician will then carry out an abdominal ‘massage’, which takes about ten minutes and should not be painful, although it can be uncomfortable. Afterwards, you and your baby will be monitored for a few hours to make sure that you are both in a satisfactory condition to go home. However, the success rate of turning babies to head-first is only about 50 per cent and complications such as fetal distress, because the baby becomes entangled in his cord, or premature labor due to stress on your uterus, can occur. Complications developing at the time of the procedure would require you to have an immediate Caesarean, so ECV is always performed in hospital. ECV is not offered if you have high blood pressure, diabetes or if you have had any bleeding in later pregnancy.

The only other medical option for breech babies is a Caesarean section. If you are expecting twins, and one is breech, attempts to turn him are not possible as the two babies may get tangled up together. If you have already had a baby, it will depend what the previous birth was like since some complications, such as your pelvis being too small to allow the baby through, can occur in a subseqient labor. If your placenta is lying low in the uterus, it is impossible for your baby to be born vaginally, as there is a risk that you may haemorrhage uncontrollably. If you have had assisted conception (IVF), you may not wish to risk a vaginal birth, althoagh this may be very disappointing for you.

Moxibusticn, a traditional Chinese technique to turn a breech baby to head-first, has become increasingly popular and some midwives now offer this as an alternative to ECV. It is also performed by acupuncturists, although you should try to find one who has specific experience of obstetrics. Chinese medicine is based on energy lines, called meridians, which flow around the body linking one part to another. There are numerous focus points along these meridians and one point in particular, the Bladder 67 point, oe the outer edges of the little toes, is thought to link with the uterus. Moxa sticks of dried mugwort, a herb, are used as a heat source to stimulate this point, triggering changes in the hormone levels and slightly relaxing the uterus. The baby’s heart rate also increases and this, together with the extra ‘give’ in the uterus, helps the baby to turn to head-first. Some therapsts perform the procedure for you, while others will show you what to do and send you home to do this for yourself. The treatment needs to be done for 15 minutes, twice a day, for up to ten treatments (five days), although if you think the baby has turned you should stop until you have had his position checked.

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