Can You Flip a Breech Baby in the Womb?
The internet abounds with strategies for turning a baby head down, but only one is more effective than doing nothing at all.
Can You Flip a Breech Baby in the Womb?
When I was about 35 weeks pregnant, I propped my blue-and-white ironing board against the seat of my couch. Then — assisted by my spouse, several cushions and a video tutorial — I clambered onto my back on the board, feet on the couch, head toward the floor, hoping the uncomfortable angle would convince my unborn child to do a 180-degree turn inside my uterus so that her head was facing down.
The position was based on my chiropractor’s suggestion to turn breech babies — who are situated in the womb so that their feet, buttocks or limbs are facing the cervix instead of their head. While this position is not recommended by physicians, it isn’t frowned-upon either. My doctor only suggested I use a sturdy board and avoid falls.
Most babies settle into a head-down position between 35 and 37 weeks of pregnancy, so that their head emerges first during a vaginal birth. But in approximately 4 percent of pregnancies, the baby remains in the breech position; and as they grow, flipping into a head-down position within the confines of the womb becomes tricky.
In 2000, researchers compared the breech birth experiences of nearly 2,100 women across 26 countries, and found that — while delivering a breech baby vaginally wasn’t dangerous for mothers — those babies had a significantly higher risk of dying or complications compared with those who were born via planned C-section. Unlike those born headfirst, a breech baby has higher odds of getting its head stuck in the birth canal during labor.
“Compression of the head during delivery can also cause trauma to the brain, bleeding in the brain or cord prolapse leading to death,” said Dr. Christine Greves, M.D., an ob-gyn at the Orlando Health Winnie Palmer Hospital for Women and Babies in Florida.
That 2000 study led the American College of Obstetricians and Gynecologists and other groups of clinicians to recommend that women with breech babies deliver them via a scheduled cesarean.
But as with any surgery, C-sections can come with potential complications; and studies performed abroad suggest that most women prefer to deliver vaginally. But will breech-baby-flipping strategies you may have read about online or heard about in parenting circles — such as contorting yourself into uncomfortable poses or lying upside down on an ironing board — actually work? Here, some of the most common strategies expecting parents use to flip a breech baby in the womb; and why only one actually holds water.
Fetuses float every which way throughout most of a pregnancy. But as they pack on pounds in the third trimester, their movements grow more restricted — and they’re less likely to flip over completely, regardless of which position they’re in. “It’s only around the 35-week mark that we’ll tell a woman their baby is breech,” said Dr. Susan Lareau, M.D., an ob-gyn and assistant professor of obstetrics, gynaecology and reproductive sciences at the University of Pittsburgh. “At that point, we present them with the options of an external cephalic version or a scheduled C-section.”
An external cephalic version is a procedure where a trained clinician pushes on the surface of a pregnant belly to manipulate the baby into a head-down position before birth. It’s performed in a hospital, and the baby’s heartbeat is tracked throughout for signs of distress.
In 2018, a retrospective study of nearly 3,000 women with breech babies found that an E.C.V. successfully flipped babies in about half the 2,614 patients who attempted it, and 85 percent of them went on to deliver vaginally with few complications. A 2015 Cochrane systematic review of eight studies also found that the method was effective since more than half of the 1,308 attempts succeeded. “When you review the medical literature, the only thing that’s been demonstrated to truly work is the external cephalic version,” said Dr. Greves.
Complications are rare, though women have said that the procedure can feel uncomfortable or somewhat painful. Some clinics give women an epidural or other pain medication before performing an E.C.V. In less than 5 percent of cases — typically if it’s a second pregnancy — the baby will flip back to their breech position after the procedure.
An E.C.V. may not be an option for some, especially if you have low amniotic fluid levels, an anterior placenta (where the placenta attaches to the front wall of the uterus, which can make it hard for a doctor to feel and manipulate the baby), a history of abnormal bleeding or other pregnancy complications, such as pre-eclampsia.
Acupuncture And Moxibustion
I spent several evenings watching Netflix Originals while waving a burning, cigar-like stick of moxa, a traditional herb, over my baby toes. The herb (also called mugwort or Folium Artemisiae argyi) is used in traditional Chinese medicine to warm specific trigger points on the body, such as one on the outside of the little toe. This treatment is often used in conjunction with acupuncture on these trigger points.
According to Judith Schlaeger, Ph.D., a certified nurse-midwife and assistant professor of nursing at the University of Illinois in Chicago, traditional medicine principles say that activating this spot using fine needles (acupuncture), pressing on it with thumbs or rollers (acupressure) or warming it (a practice called moxibustion) is thought to improve energy flow and circulation to the uterine muscles.
But no solid research has confirmed whether any of these practices work, as most such studies have been designed inconsistently and are small. Some, for instance, use different kinds of moxa, others combine the herbal treatment with acupuncture, or use inconsistent control groups or women in varying stages of pregnancy.
“There’s no consistent protocol that’s been determined to be effective,” Dr. Schlaeger said, who published a review of 16 randomized clinical trials on moxibustion for breech babies in 2018.
That being said, there are few side effects and it’s cheap, according to Dr. Schlaeger. “Generally speaking, there’s no reason not to try it.”
Chiropractic Manipulation And Massage
Some chiropractors offer a combination of gentle abdominal massage and adjustments to the lower back to encourage a baby to turn. The moves are known as the Webster technique and are thought to act by easing tension in the uterine ligaments or muscles that may be restricting a baby’s movements in the womb.
But only a handful of case studies describing individual patients’ experiences report success or failure. In one instance, the Webster technique failed to help a 23-year-old first-time mom, perhaps because she had low levels of amniotic fluids. If you’re thinking of trying such techniques, according to the study authors, check with your doctor first.
In addition to reclining on my trusty ironing board (a position known as the breech tilt), I practiced pelvic tilts (where you lie on the floor with a wedge-shaped pillow under your hips) and the open knee-chest position (where you rest on your elbows and knees and bring your head to the floor, kind of like a downward dog on your knees).
A 2012 Cochrane review of six studies, one of the most recent reviews on the topic, compared the outcomes of 417 women with breech babies and found that postural adjustments did little to flip their fetuses. Only two of the studies, which were published in 1987 and 1999, showed a small potential benefit of the knee-chest position and pelvic tilts — but the 170 women included in these studies began exercises as early as 30 weeks into their pregnancy, so it’s possible that even if they hadn’t done such exercises, their babies would have flipped into the correct position on their own.
While none of these postural techniques is likely to harm you or your baby, Dr. Lareau said, you should always consult with your doctor before trying any kind of manipulation. And you definitely shouldn’t try to perform a cephalic version at home. But making (even unsuccessful) efforts can help you feel more in control of your body.
“Most of us, myself included, want to feel like we’re doing something about an issue,” Dr. Lareau said. “But I do always want women to understand that if it doesn’t work, it’s not because they didn’t do it right or they’re a failure. It’s just that the exercises are not that effective.”
As for me, the ironing board technique, moxa and chiropractic care weren’t enough to coax my baby to flip. And my ob-gyn determined that I wasn’t a candidate for an E.C.V. because I had low amniotic fluids. In the end, my daughter was born via a scheduled C-section. But weeks of effort and discussing the outcomes helped me feel confident (both as a patient and as a parent) that the surgery was the right move.
“Can You Flip a Breech Baby in the Womb?” by Jyoti Madhusoodanan © 2020 The New York Times Company
Jyoti Madhusoodanan, Ph.D., is a science journalist and mom to a toddler.
This story was originally published on 26 March 2020 in NYT Parenting.