SPECIAL CIRCUMSTANCES

BREECH DELIVERY

The ideal position for a straightforward labour is for your baby to be presenting head down and 'anterior' (with his spine facing out). Most babies turn head-down between the seventh and eighth month of pregnancy and many more follow as labour draws near.

In the majority of cases, if your baby is breech, this will be discovered at the end of your pregnancy, and you will have an opportunity to discuss with your consultant obstetrician beforehand how she should be born. Some consultants are of the opinion that it is best for a breech baby to be born by caesarean, but not all of them share this view.

If you choose to have your baby vaginally, it is important that the midwives who are helping you are skilled and experienced at vaginal breech deliveries.

The first stage of labour with a breech baby is not much different from one in which the baby is head-down, although it can be slower. Keeping upright and mobile will help labour progress. Some doctors, though, advise that you have an epidural, as a way of guarding against pushing too soon, and as insurance in case the need for a caesarean arises. Others feel that there are disadvantages to epidurals for a breech birth, such as making labour longer.

A good position for giving birth to a breech baby is on hands and knees, but if forceps are required you will be asked to lie in the lithotomy position (i.e. lying on your back with legs in stirrups). The baby's body is usually born fairly quickly, but once the body has been born (as far as the umbilicus) the baby's head enters the pelvis in a breech birth at this stage. It's important that the head comes out slowly. Some doctors like to use forceps as a way of controlling the speed with which the head is born and an episiotomy will be needed if forceps are used.

Turning Breech Babies

External Cephalic Version:

At the end of pregnancy, your obstetrician may suggest trying to turn your breech baby by external cephalic version. This means using her hands on your bump to turn the baby inside the other way round, sometimes using ultrasound as a guide. It can mean avoiding a caesarean, but the procedure is not without risk and some say it only works with babies who would have turned anyway.

Moxibustion:

Moxa is a herb known to us as mugwort. It has been used in China since ancient times, formed into cigar shaped sticks which can be burned slowly to release a low steady heat. They are used to stimulate acupuncture points generally and they can be used to turn breech babies. The Chinese claim an 80% success rate with them.

The sticks are lit and held by a partner either side of the acupuncture point at the root of the nail of the little toe. This point reputedly ha a deep pathway to the uterus. The treatment is given once a day for 15 minutes, and the baby can usually be felt wriggling. With this stimulus it can turn completely. The success rate is best from 34 weeks.

The technique should only be used in healthy pregnancy only and not if there is any history of bleeding, high blood pressure or in a twin pregnancy.

A study published in the journal of the North American Medical Association is the first to use scientific methods to measure results. The trial carried out on 260 first time Chinese mothers, found that three out of four babies turned. Consult the British Acupuncture Council for details of an acupuncturist, and check with your midwife first.