February 7, 2025 • 26 mins
The episode dives into the topic of breech babies and the complexities surrounding their deliveries, offering insights on positioning, potential solutions, and historical context. With a focus on empowering expectant parents, the discussion emphasizes the importance of understanding breech presentations and the options available for delivery.
• Understanding the breech position and its prevalence
• Exploring the various reasons why babies may remain breech
• Discussing creative options for encouraging babies to turn
• Detailing the process and effectiveness of external cephalic version
• Analyzing the historic shift in breech delivery practices
• Encouraging informed discussions about breech delivery options
Reach out digitally by text, by messenger, by however you want. Reach out to somebody and just say been thinking about you. Hope you have a good one and we will see you next time. Bye.
Visit our website, here: https://birthlearning.com/
Follow us on Facebook at Birth Learning
Follow us on Instagram at @birthlearning
Show Credits
Host: Angie Rosier
Music: Michael Hicks
Photographer: Toni Walker
Episode Artwork: Nick Greenwood
Producer: Gillian Rosier Frampton
Voiceover: Ryan Parker
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:10):
Welcome to the Ordinary Doula Podcast with
Angie Rozier, hosted by BirthLearning, where we help prepare
folks for labor and birth withexpertise coming from 20 years
of experience in a busy doulapractice Helping thousands of
people prepare for labor,providing essential knowledge
(00:40):
and tools for positive andempowering birth experiences.
Speaker 2 (00:47):
Hello and welcome to the Ordinary Dealer Podcast.
I am your host, angie Rozier,and I am glad to be with you
here today.
So our topic today is going tobe about breech babies and
breech deliveries.
I've had a couple interestingand different from each other
breach deliveries and with myclients in the last couple
months.
So this has been on my mind alittle bit and it's something
(01:12):
that I think it's a lot ofdoulas run across for sure and
it's kind of an interestingphenomenon.
So I want to give a couplelittle facts about breach, the
breach position, a couple littlefacts about breach the breach
position.
Breach means the baby's head isnot down right, it's not
heading out, it's the head is up.
(01:32):
And when the head is up,there's a variety of positions,
even among breach, that the babycan be in.
We call a head down baby avertex baby, we call a head up
baby a breach baby.
So so the head is up, not down.
There are a variety ofpositions, even among that.
There are frank breech, whichthe bum, like the baby, is
totally folded in half at thehips and so their bum is
(01:54):
presenting.
First there's babies that arefootling breech, where they have
the kind of um, there's what'scalled complete breech.
They're kind of sittingcrisscross applesauce in the
pelvis or footling breech, onefoot maybe lower than the other,
but the point is their head iskind of headed in the wrong
direction.
It's interesting to know about3% to 4% of pregnancies.
(02:20):
At the end of pregnancy we'retalking, you know, 36 weeks and
beyond about 3% to 4% of babiesare going to be in a breach
position.
So it's, you know, somethingyou run into.
You may experience it or youmay know someone who experienced
that.
It's not terribly uncommon, butthree to 4%, we're gonna.
We're gonna see it.
(02:43):
This can be due to a lot of.
Whenever something's going on,I always just instinctively ask
like why, why, why, why arebabies breached?
And there's a lot of differentreasons for that, but it's hard
to pinpoint the exact reason orreasons why it could be a lot of
fluid or a little bit of fluid.
(03:03):
Those have different medicalterms.
A lot of fluid or a little bitof fluid, those have different
medical terms.
So you know, if you're hearingmedical terms hydramnios and
then you have high or low fluid,that can cause a baby to have
the ability to do a whole lot ofmoving and maybe be head up.
(03:27):
Other reasons could be the shapeof the uterus.
Sometimes the uterus, just theshape of the uterus, encourages
the baby to be that way.
It could have to do with theshape of the pelvis, it could be
where the cord is placed or theplacenta.
If it's a low lying placenta inthe front, sometimes we have an
increased likelihood of thatbreech position.
But sometimes the cord kind ofacts as a tangle and, based on
whatever the baby's movementsare during pregnancy, sometimes
(03:49):
the baby gets tangled in thecord and kind of gets tied up in
a breech position.
Sometimes people who have onebreech baby might have
subsequent breech babies.
So there's a few differentreasons.
One of them even talks aboutstress like the element of
stress, and I have a client whoanecdotally for years has said
(04:12):
she believes that breech babies,there's an emotional component
to breech babies.
So this theory and this doeshave some research and study
behind it that the increasedlikelihood of stress physical,
emotional, mental stress theincreased likelihood of stress
physical, emotional, mentalstress can tighten the lower
segment of the abdomen or of theuterus and so the baby's not
comfortable, like going down.
It's kind of tight up there or,sorry, tight down there so that
(04:35):
they they kind of end up headup.
So that's funny, end up head up.
So there's several reasons.
None of them are super linear,obvious and we don't always know
why babies are breached.
But we have, about by 36, 37weeks, about three to 4% of
babies remain breached.
There are several different waysto try to turn a breached baby.
(05:00):
Maybe you've heard of these.
Some of them are veryevidence-based, some of them are
not.
None of them are 100% effective.
None of them are even 50%effective sometimes.
Sometimes we're hoping for 50%.
So some of those efforts to turna baby, some of these are very
old practices.
One of them is we call, likethe ironing board trick that
(05:21):
goes by different namessometimes, but kind of an
inversion, where you take anironing board trick that goes by
different names sometimes, butkind of an inversion, where you
take an ironing board justbecause most people have one.
It's pretty sturdy, and you putthe ironing board um, it's flat
, right, the legs aren't up,it's flattened but you put the
ironing board up on a couch andthen the pregnant person lies so
that their head is near thefloor, their feet, hips are up
(05:44):
on the couch, kind of, but onthe ironing board holding them
and spend you know there'sdifferent recommendations, but
spend several minutes, 15, 20minutes in that position several
times a day.
So this is an effort withgravity to help that baby to
turn.
And pregnant people no, peoplereally spend their time upside
down or inverted for very long,but this is an effort to try to
(06:05):
get babies to turn positionally.
Another one is kind of doing aninversion, a deep, exaggerated
inversion, and you'd want helpin all of these interesting
maneuvers.
You want somebody there tosupport you as you're getting in
and out of these positions withthe ironing board and with this
(06:25):
deep inversion where on a couchhopefully it's not a super high
up couch, but on a couch likeyou're kneeling on the couch and
you're leaning down onto thefloor beneath the couch, a baby
(06:47):
belly right in between your legsand that like is a deep
inversion, again with gravityand position, to help get babies
to turn.
Spending time in water Somepeople have had success with
this like not just a bathtubwater but like swimming pool
water and a large body of wateror a large amount of water, and
maybe do headstands like do someflips do some inversions in the
water and maybe do headstandslike do some flips, do some
inversions in the water.
Some people have had luck doingthat, getting a baby to switch.
(07:09):
Other ones can be sensoryefforts and that can be
encouraging babies to turn usingsenses such as light,
temperature, sound.
So if you put, you know like gotoward the light baby.
So we want to put a light downtowards the bottom of the
abdomen, abdomen, where ofcourse their eyes are going to
sense the light.
Eyes are at the top.
If they're breech, hopefullythey're going to be curious.
(07:32):
They can sense light by thisage, 36, 37 weeks, and hopefully
we'll kind of get curious andgo toward that light.
Evidence-based no, can it work?
Possibly Same thing withtemperature.
Babies don't like cold.
So a recommendation could be toput cold on where you don't
want the baby's head to beSomething that the baby can
(07:52):
retract from or go away from.
So that might be a little coldpack on the top of the belly
where the baby's head is, andthe baby might move away from
that.
You know, it'd be funny to havea bag of peas just sitting,
frozen peas sitting on top ofyour belly for a while.
Also, sound, playing some youknow I've seen reports of
playing wild crazy music low onthe abdomen where you want the
(08:13):
baby to go, or kind, sweet,tender, relaxing music, you know
, whatever it is you want, youanticipate that baby being drawn
to.
So there's some sensory efforts.
There's some slightly morescientific efforts, such as
Mokshabushan, which is anEastern medicine effort with
(08:36):
have a little like an incensestick it looks almost like, and
between pinky toes, and thethought is that that helps turn
on some hormones that duringpregnancy related.
That may help a baby to turn.
Another effort is a chiropracticadjustment, keeping the pelvis
nice and aligned and sometimesbabies are in a breech position
(08:57):
because the uterus is torquedbased on tightness of muscles or
fascia or tendons, ligaments.
You know the round ligament hasa lot to do with, do with how
the baby's sitting in the pelvis, so making sure those are
released and the pelvis is linedup.
Sometimes, once we get thatpelvis lined up with a
chiropractic adjustment, theuterus can relax as a muscle and
(09:19):
it's not holding the baby tightin whatever position the baby
might be if it's in a breechposition.
The Webster technique is atechnique that chiropractors use
specifically to help babiesturn.
I have had clients use thisseveral times With no luck.
I've had clients use it onceand on the way to the parking
lot after the chiropractic visitthey feel a pretty incredible
(09:41):
turning.
So those are some other effortsto try to turn babies, to try
to turn babies, and then we'rekind of moving up the order of
invasiveness.
I guess you could call it,although ironing boards and deep
inversions.
They feel invasive to yourbrain after you do that for a
little bit, while Another onethat the medical community uses
is called an ECV.
(10:04):
That stands for externalcephalic version.
So external, of course.
On the outside cephalic is thehead.
The baby's head Version is amove.
Now I cannot tell you how manyof my clients it's so dang cute
over the years have called it anaversion.
They're going to have anaversion, I'm going to the
hospital for an aversion.
So an aversion is a strongdislike towards something and it
(10:28):
just cute as can be and cracksme up when people say I'm having
an aversion today at 7am at thehospital or whatever.
So it's just a version, we'rejust aversion, is moving
something.
So ECV, external cephalicinversion.
This is some maneuvers thatcare providers do, obs do this,
midwives do this and or assistwith it, have assistance.
(10:49):
This may be discouraging butthe evidence does tell us.
It has about a 50% chance ofworking.
So it's not like you know, thisis kind of the last thing to
try and it has the best chance,but it's not a great chance, but
about a 50% chance of an ECVworking.
So ECV is done in a hospital.
(11:09):
You work with your provider onwhen this can be done.
There's different schools ofthought.
Do we do it at 36 weeks, 37weeks, 38 weeks?
Babies are smaller.
At 36 weeks the likelihood theymay turn is better.
But if things don't go well andwe have to deliver that day or
quickly, we want a baby maybe tobe a little bit older, like
it's kind of tricky.
So work with your care provider, get all the evidence, um, all
(11:33):
the, get all your questionsanswered as you make a decision.
If you are faced with an ECVaversion, not an aversion, maybe
you have an aversion toaversion but um, kind of get,
get some you know good talkingpoints done with your provider
(11:55):
if that's kind of what you'relooking at.
So that's done in a hospitalsetting.
I've been with many clientsduring that.
Sometimes it's done in a laborand delivery room, sometimes
it's done in a triage room,sometimes it's done in a labor
and delivery room near the ORbut the person is given usually
they're given a muscle relaxer,usually it's tributylene, um,
they get you kind of prepped, um, they lube up the belly pretty
good.
I have had people get fentanylfor this because it is
(12:18):
uncomfortable.
I've had people get epiduralsfor this, like they'll get an
epidural, so that the becausethe uterus, once you crank on it
like they're going to with anaversion, it just kind of
stimulates it right, and so itwants to respond by contracting
and we're trying to move thebaby in it.
So when it contracts and getssuper hard it's difficult.
So they may do some, take someefforts to soften up that muscle
(12:40):
of the uterus.
But this is done usually withfour hands.
Baby's heart rate is beingmonitored and it's uncomfortable
.
I guess that's anunderstatement to say that it's
uncomfortable.
I've had the sweetest, kindestclients say I just wanted to
punch them.
Others have said man, that isintense.
That is so intense Because yourbody wants to respond right,
(13:03):
it's very uncomfortable.
So four hands are on and I'veseen the providers doing it like
they are hot and heavy,sweating by the end sometimes,
not that it takes very long, butit's a lot of effort for them.
So they feel where the baby is.
They typically like the baby todive forward, so follow their
face kind of a thing.
So they're going to generallyyou have two hands on top, two
(13:24):
on bottom, so lifting the buttsometimes I have to lift that
cute little bum out of thepelvis a little bit help that
head to dive forward so they'reon the top of the uterus, on the
top of the fundus, from theoutside encouraging that baby to
take a dive, lifting it out.
So having the butt go to theside and then up and the head go
down, so kind of doing a littletwist and a turn.
(13:45):
Remember 50% effectiveness rate, 50% chance of it working.
So can be discouraging goinginto that, but it is definitely
something to try, something tonote.
With a version, the hospitalstaff is ready to deliver baby
quickly if needed.
They'll generally do this withan OR ready right, so they know
(14:05):
that they have staffing and thatan operating room is ready.
An OR ready right, so they knowthat they have staffing and
that an operating room is readyIf things don't go well, if the
baby doesn't respond well,they're going to kind of be
ready to deliver a baby prettyquickly.
And interesting to know thatthis is safe for VBACs.
If you're somebody who has hada prior cesarean, so you have an
(14:25):
oar uterine surgery of any kind, you have a scar on your uterus
.
It's studies have shown that itis safe for people to have a
version, an external cephalicversion, even if they have had a
prior C-section or abdominalsurgery on their uterus.
So, uh, that said, those areways to help turn a breech baby.
Um, I want to go a little bitinto the history of this because
(14:48):
in mainstream, right in ourmainstream medical world, a
breech baby most often means acesarean delivery.
If all the things we try andreally one of the best things to
try is time, sometimes justrelaxing about it, relaxing our
hearts, our minds, our bodies,and giving that baby time, they
(15:08):
can turn right at 37, 38, even39 weeks.
I had one client one time tonsof fluid, her babies.
I think she was having herthird or fourth baby and she was
very familiar with her body andshe could just sit in the tub,
get her babies to turn head downon her own, just because she
could kind of guide them downwith she had tons of fluid, she
was very well aware of where herbabies were and her babies were
(15:29):
turning up till the day ofdelivery, but that's a little
less common.
But for so many people, having abreached baby equals a
C-section, right?
So maybe you weren't wantingthat, you weren't planning on
that and it feels like thechoice is out of your hands.
Sometimes when you look online,it kind of is interesting to me
.
Sometimes you know a lot is outof your hands.
Sometimes, when you look online, it kind of is interesting to
(15:51):
me.
Sometimes you know a lot of thearticles will say, yeah, try
for a vaginal breech delivery.
Really, that's pretty hard toget Like, it's hard to find a
provider who does that.
And so let's talk about some ofthe reasons why I was.
Years ago I was doing a birthwith one of my very favorite
midwives.
She's since retired, but shewas incredible and she was a
nurse before she was a midwifeand we're I don't remember the
(16:12):
the incidence of the delivery wewere doing, the client that we
were with, but we were talkingabout breach deliveries and she
said you know, 30 years ago,when I was training to do this
so this probably would have beenin the 90s, early 90s, maybe
late 80s she said we did breechdeliveries all the time.
There would be like five a week.
(16:33):
She's at a pretty busy hospital.
She said we would have five aweek.
It was very common, like it wasnothing about it, right, it was
okay, that baby was born breech, no big deal.
You might speak to older womenwho are 60, 70, who you know.
(16:54):
They went there when they werehaving their babies.
They had a breech delivery andnobody knew it was breech until
that baby was born, right, like,oh, look cool, a breech
delivery, no big deal.
Whereas now, if that baby'sbreech, like oh no, let's, we
can try these things.
It probably won't work, let'sjust schedule a cesarean is the
theme of the day now.
So let's understand that itused to be.
This is like a generation ago,right, we have forgotten that
(17:16):
this was normal.
It is no longer normal, but itused to be normal.
Doctors used to be trained inhow to deliver breech babies
because that's what they woulddo.
Used to be trained in how todeliver breech babies because
that's what they would do, right, like they would have a certain
percentage.
Three to 4% of all babies wereborn via you know that breech
(17:42):
position, and that's no longerthe case anymore.
So the craft, the art, theskill is kind of fading.
Doctors aren't as adept at it,they're not practiced in it,
they're not taught it very well,if at all.
Right, if if at all, a lot ofthe training may just become
from um a video or something inmedical school, so kind of
interesting that it's just kindof a lost art.
And part of what helped thatbecome a lost art was a
(18:02):
combination of things.
But in 2000 there was a studycalled the term breach trial and
it was a study of a kind of asmall number of people that came
out in the year 2000.
So we are about a generationago that said we do not
recommend they tested.
I think it was don't quote meon this, but I think it was 100.
(18:25):
I can't remember.
I'm not even going to say thenumbers cause I don't remember
them.
They weren't crazy big numbersbut they tried.
Um.
They followed the outcomes ofsome breech deliveries and some
cesarean deliveries with breechbabies right, vaginal breech and
cesarean deliveries and theycame out with a study and pushed
ACOG the next year to make astatement about it that it would
(18:47):
probably be better that umbreech babies are born by
C-section.
They could mitigate some risks.
Um, and today 86%.
I think that's a little low inmy mind, 86% of babies who are
breech are born by c-section.
Um, and kind of interestingthat that means there's 14
(19:12):
percent of babies being bornbreech.
I want to know where, like in myexperience throughout the
country there's unless it's outof hospital, there's not a whole
lot of hospitals that will um,have you, you know, let you
deliver a breech baby in the thestates that I've worked in, we
can.
I can come up with like twodoctors maybe in each state who
aren't you know it's not likethey're close together or
(19:35):
anything that we'll considerdoing a breech if everything's
fine.
So difficult to find a providerto do that.
Also, at the time C-sectionrates were on the rise.
We know they've been around 32%or thereabouts for the same
amount of time.
C-section rates were on therise, you know, we know they've
been around 32% or thereaboutsfor the same amount of time.
Interestingly enough, right Ifwe're going on over 20 years of
that C-section rate in theUnited States hanging around
(19:56):
that 32, 33%, which varies bystate and breach deliveries
contribute to that right.
When we quit doing vaginalbreach, deliveries which by and
large were, were safe and if youlook at the actual numbers.
Yes, the risk is there, butthis, but this study came out
and said if there's any risk atall, it's not worth taking right
(20:17):
.
So kind of dive into what therisks are.
It's kind of interesting toknow what they are.
And and also at this time, ifyou look at the logistics, the
bookkeeping, the scheduling ofdelivering a cesarean delivery
(20:37):
with a breech baby, it's a loteasier.
There was one doctor at thistime that said if you have a
defendable way, a defendableoption, why would you not do it?
So what she was talking about.
This doctor and this was 25years ago said if you have a
defendable in court right forand if this becomes a litigious
situation, you have a defendableoption, why would you not use
(20:58):
it?
Why would you assume any riskat all?
Any risk is too great a risk.
So those risks include so risksto breach baby's deliveries
include head entrapment, whichis actually, if you look at the
numbers, extremely rare Prolapsecord, because those smaller
parts of the body can be lowerand they're not filling up the
whole um space, the loweruterine segment, and so a cord
(21:20):
if the water breaks could comedown by feet or knees or um
whatever.
That's why the Frank breechdelivery when the baby's just
folded in half the butts comingfirst.
That mimics the head as best asother parts.
You know the other better thanother parts of delivery, so just
kind of interesting.
And ACOG did make a statementshortly after that that, you
(21:41):
know, kind of shifted somepolicy and over time we don't
even have doctors trained to dothat anymore.
There's a memoir that I haveread several times that I
absolutely love.
It's called Listen to Me.
Good, it's about a midwife whodelivered babies out of hospital
, so home birth deliveries fromthe 1940s to the 1980s.
She was in the deep South andit's fascinating to read.
(22:03):
And one of my favorite parts isshe delivered plenty of breech
babies.
Didn't scare her, she just okay, baby's breech.
Here we go.
And this would scare, I think,even our most well-trained
breech, who deliver breachdeliveries today, which are far
and few between.
She said my favorite kind of abreach is a footling breach
(22:24):
because I can take that one footback up, grab the other foot
and pull that baby out.
Wow, like that's.
That was pretty wild to me, butthat was normal not that long
ago and she had a very goodrecord.
She and I think she did 3000deliveries over 40 years in
Alabama and had not lost a baby.
(22:45):
No, sorry, excuse me, she hadnever lost a mother.
Actually there was a couple ofbabies that that had died in the
course of her practice.
But, um, kind of interestingwhere we were and where we are
now.
So keep that in mind.
Also, the time, the money andthe skill involved to this, the
skill set became low, um, andhow to deliver breech babies.
(23:08):
The time in the OR is short andthe money in the OR is better.
So you can see how it just kindof naturally went that way.
So I guess the message I want topeople to have here and in the
next episode I'm going to giveyou three, as because I've
attended, you know, had somegreat breach deliveries lately.
So I'm going to tell threelittle stories that are recent
breach delivers for me.
(23:29):
But I guess the point is to doyour research and to find out
what type of breach.
If you find yourself with abreech baby, how can we
encourage movement?
What type of breach is it?
What providers in your area?
Get creative, think outside thebox, what providers might
support that and how do you feelabout having a cesarean?
(23:51):
So we know the risks of breachand they can be low.
But you know what?
Cesareans have risks too, andthey have great risks to mom and
baby too.
So we kind of weigh all therisks as we make a decision.
Anyway, just kind of interesting, a little bit of history lesson
here.
Here's where we are today.
We got to work with what wehave.
I'm not saying it's wrong, I'msaying it's interesting.
(24:11):
Like cannot tell you how manytimes my clients oh, breech,
okay, we're having a cesareandelivery.
You know that's pretty common.
That's where we're at today.
But there are those and homebirth midwives among them, which
I will talk about a story in mynext episode that deliver
breech babies have trained to doit Still, the training is out
(24:32):
there.
It's not in medical schools butthe training can be still had
by those who want to um thatthat it's not a lost art all the
way right it might be in ourmainstream medical community.
So listen to the next episodefor um, some specific breach
stories.
Hopefully your baby um is headdown, keeps things easy for you
and it heads on out the way thatit's.
(24:53):
That makes it a little biteasier.
So a little bit of tidbit factsthere about um, the
breachedness of babies.
Hope that that helps or isinteresting or, um, gives you a
little bit of backgroundinformation on where we were and
where we are now and how we gothere.
So, as I wrap up, today, asalways, make a connection with
someone, make a human connectionwith someone, and maybe it's
(25:14):
digital.
Reach out digitally by text, bymessenger, by however you want.
Reach out to somebody and justsay been thinking about you.
Hope you have a good one and wewill see you next time.
Bye.
Speaker 1 (25:39):
Thank you for listening to the Ordinary Doula
podcast with Angie Rozier,hosted by Birth Learning.
Episode credits will be in theshow notes Tune in next time as
we continue to explore the manyaspects of giving birth.
Welcome to the Ordinary Doula Podcast with
Angie Rozier, hosted by BirthLearning, where we help prepare
folks for labor and birth withexpertise coming from 20 years
of experience in a busy doulapractice Helping thousands of
people prepare for labor,providing essential knowledge
(00:40):
and tools for positive andempowering birth experiences.
Speaker 2 (00:47):
Hello and welcome to the Ordinary Dealer Podcast.
I am your host, angie Rozier,and I am glad to be with you
here today.
So our topic today is going tobe about breech babies and
breech deliveries.
I've had a couple interestingand different from each other
breach deliveries and with myclients in the last couple
months.
So this has been on my mind alittle bit and it's something
(01:12):
that I think it's a lot ofdoulas run across for sure and
it's kind of an interestingphenomenon.
So I want to give a couplelittle facts about breach, the
breach position, a couple littlefacts about breach the breach
position.
Breach means the baby's head isnot down right, it's not
heading out, it's the head is up.
(01:32):
And when the head is up,there's a variety of positions,
even among breach, that the babycan be in.
We call a head down baby avertex baby, we call a head up
baby a breach baby.
So so the head is up, not down.
There are a variety ofpositions, even among that.
There are frank breech, whichthe bum, like the baby, is
totally folded in half at thehips and so their bum is
(01:54):
presenting.
First there's babies that arefootling breech, where they have
the kind of um, there's what'scalled complete breech.
They're kind of sittingcrisscross applesauce in the
pelvis or footling breech, onefoot maybe lower than the other,
but the point is their head iskind of headed in the wrong
direction.
It's interesting to know about3% to 4% of pregnancies.
(02:20):
At the end of pregnancy we'retalking, you know, 36 weeks and
beyond about 3% to 4% of babiesare going to be in a breach
position.
So it's, you know, somethingyou run into.
You may experience it or youmay know someone who experienced
that.
It's not terribly uncommon, butthree to 4%, we're gonna.
We're gonna see it.
(02:43):
This can be due to a lot of.
Whenever something's going on,I always just instinctively ask
like why, why, why, why arebabies breached?
And there's a lot of differentreasons for that, but it's hard
to pinpoint the exact reason orreasons why it could be a lot of
fluid or a little bit of fluid.
(03:03):
Those have different medicalterms.
A lot of fluid or a little bitof fluid, those have different
medical terms.
So you know, if you're hearingmedical terms hydramnios and
then you have high or low fluid,that can cause a baby to have
the ability to do a whole lot ofmoving and maybe be head up.
(03:27):
Other reasons could be the shapeof the uterus.
Sometimes the uterus, just theshape of the uterus, encourages
the baby to be that way.
It could have to do with theshape of the pelvis, it could be
where the cord is placed or theplacenta.
If it's a low lying placenta inthe front, sometimes we have an
increased likelihood of thatbreech position.
But sometimes the cord kind ofacts as a tangle and, based on
whatever the baby's movementsare during pregnancy, sometimes
(03:49):
the baby gets tangled in thecord and kind of gets tied up in
a breech position.
Sometimes people who have onebreech baby might have
subsequent breech babies.
So there's a few differentreasons.
One of them even talks aboutstress like the element of
stress, and I have a client whoanecdotally for years has said
(04:12):
she believes that breech babies,there's an emotional component
to breech babies.
So this theory and this doeshave some research and study
behind it that the increasedlikelihood of stress physical,
emotional, mental stress theincreased likelihood of stress
physical, emotional, mentalstress can tighten the lower
segment of the abdomen or of theuterus and so the baby's not
comfortable, like going down.
It's kind of tight up there or,sorry, tight down there so that
(04:35):
they they kind of end up headup.
So that's funny, end up head up.
So there's several reasons.
None of them are super linear,obvious and we don't always know
why babies are breached.
But we have, about by 36, 37weeks, about three to 4% of
babies remain breached.
There are several different waysto try to turn a breached baby.
(05:00):
Maybe you've heard of these.
Some of them are veryevidence-based, some of them are
not.
None of them are 100% effective.
None of them are even 50%effective sometimes.
Sometimes we're hoping for 50%.
So some of those efforts to turna baby, some of these are very
old practices.
One of them is we call, likethe ironing board trick that
(05:21):
goes by different namessometimes, but kind of an
inversion, where you take anironing board trick that goes by
different names sometimes, butkind of an inversion, where you
take an ironing board justbecause most people have one.
It's pretty sturdy, and you putthe ironing board um, it's flat
, right, the legs aren't up,it's flattened but you put the
ironing board up on a couch andthen the pregnant person lies so
that their head is near thefloor, their feet, hips are up
(05:44):
on the couch, kind of, but onthe ironing board holding them
and spend you know there'sdifferent recommendations, but
spend several minutes, 15, 20minutes in that position several
times a day.
So this is an effort withgravity to help that baby to
turn.
And pregnant people no, peoplereally spend their time upside
down or inverted for very long,but this is an effort to try to
(06:05):
get babies to turn positionally.
Another one is kind of doing aninversion, a deep, exaggerated
inversion, and you'd want helpin all of these interesting
maneuvers.
You want somebody there tosupport you as you're getting in
and out of these positions withthe ironing board and with this
(06:25):
deep inversion where on a couchhopefully it's not a super high
up couch, but on a couch likeyou're kneeling on the couch and
you're leaning down onto thefloor beneath the couch, a baby
(06:47):
belly right in between your legsand that like is a deep
inversion, again with gravityand position, to help get babies
to turn.
Spending time in water Somepeople have had success with
this like not just a bathtubwater but like swimming pool
water and a large body of wateror a large amount of water, and
maybe do headstands like do someflips do some inversions in the
water and maybe do headstandslike do some flips, do some
inversions in the water.
Some people have had luck doingthat, getting a baby to switch.
(07:09):
Other ones can be sensoryefforts and that can be
encouraging babies to turn usingsenses such as light,
temperature, sound.
So if you put, you know like gotoward the light baby.
So we want to put a light downtowards the bottom of the
abdomen, abdomen, where ofcourse their eyes are going to
sense the light.
Eyes are at the top.
If they're breech, hopefullythey're going to be curious.
(07:32):
They can sense light by thisage, 36, 37 weeks, and hopefully
we'll kind of get curious andgo toward that light.
Evidence-based no, can it work?
Possibly Same thing withtemperature.
Babies don't like cold.
So a recommendation could be toput cold on where you don't
want the baby's head to beSomething that the baby can
(07:52):
retract from or go away from.
So that might be a little coldpack on the top of the belly
where the baby's head is, andthe baby might move away from
that.
You know, it'd be funny to havea bag of peas just sitting,
frozen peas sitting on top ofyour belly for a while.
Also, sound, playing some youknow I've seen reports of
playing wild crazy music low onthe abdomen where you want the
(08:13):
baby to go, or kind, sweet,tender, relaxing music, you know
, whatever it is you want, youanticipate that baby being drawn
to.
So there's some sensory efforts.
There's some slightly morescientific efforts, such as
Mokshabushan, which is anEastern medicine effort with
(08:36):
have a little like an incensestick it looks almost like, and
between pinky toes, and thethought is that that helps turn
on some hormones that duringpregnancy related.
That may help a baby to turn.
Another effort is a chiropracticadjustment, keeping the pelvis
nice and aligned and sometimesbabies are in a breech position
(08:57):
because the uterus is torquedbased on tightness of muscles or
fascia or tendons, ligaments.
You know the round ligament hasa lot to do with, do with how
the baby's sitting in the pelvis, so making sure those are
released and the pelvis is linedup.
Sometimes, once we get thatpelvis lined up with a
chiropractic adjustment, theuterus can relax as a muscle and
(09:19):
it's not holding the baby tightin whatever position the baby
might be if it's in a breechposition.
The Webster technique is atechnique that chiropractors use
specifically to help babiesturn.
I have had clients use thisseveral times With no luck.
I've had clients use it onceand on the way to the parking
lot after the chiropractic visitthey feel a pretty incredible
(09:41):
turning.
So those are some other effortsto try to turn babies, to try
to turn babies, and then we'rekind of moving up the order of
invasiveness.
I guess you could call it,although ironing boards and deep
inversions.
They feel invasive to yourbrain after you do that for a
little bit, while Another onethat the medical community uses
is called an ECV.
(10:04):
That stands for externalcephalic version.
So external, of course.
On the outside cephalic is thehead.
The baby's head Version is amove.
Now I cannot tell you how manyof my clients it's so dang cute
over the years have called it anaversion.
They're going to have anaversion, I'm going to the
hospital for an aversion.
So an aversion is a strongdislike towards something and it
(10:28):
just cute as can be and cracksme up when people say I'm having
an aversion today at 7am at thehospital or whatever.
So it's just a version, we'rejust aversion, is moving
something.
So ECV, external cephalicinversion.
This is some maneuvers thatcare providers do, obs do this,
midwives do this and or assistwith it, have assistance.
(10:49):
This may be discouraging butthe evidence does tell us.
It has about a 50% chance ofworking.
So it's not like you know, thisis kind of the last thing to
try and it has the best chance,but it's not a great chance, but
about a 50% chance of an ECVworking.
So ECV is done in a hospital.
(11:09):
You work with your provider onwhen this can be done.
There's different schools ofthought.
Do we do it at 36 weeks, 37weeks, 38 weeks?
Babies are smaller.
At 36 weeks the likelihood theymay turn is better.
But if things don't go well andwe have to deliver that day or
quickly, we want a baby maybe tobe a little bit older, like
it's kind of tricky.
So work with your care provider, get all the evidence, um, all
(11:33):
the, get all your questionsanswered as you make a decision.
If you are faced with an ECVaversion, not an aversion, maybe
you have an aversion toaversion but um, kind of get,
get some you know good talkingpoints done with your provider
(11:55):
if that's kind of what you'relooking at.
So that's done in a hospitalsetting.
I've been with many clientsduring that.
Sometimes it's done in a laborand delivery room, sometimes
it's done in a triage room,sometimes it's done in a labor
and delivery room near the ORbut the person is given usually
they're given a muscle relaxer,usually it's tributylene, um,
they get you kind of prepped, um, they lube up the belly pretty
good.
I have had people get fentanylfor this because it is
(12:18):
uncomfortable.
I've had people get epiduralsfor this, like they'll get an
epidural, so that the becausethe uterus, once you crank on it
like they're going to with anaversion, it just kind of
stimulates it right, and so itwants to respond by contracting
and we're trying to move thebaby in it.
So when it contracts and getssuper hard it's difficult.
So they may do some, take someefforts to soften up that muscle
(12:40):
of the uterus.
But this is done usually withfour hands.
Baby's heart rate is beingmonitored and it's uncomfortable
.
I guess that's anunderstatement to say that it's
uncomfortable.
I've had the sweetest, kindestclients say I just wanted to
punch them.
Others have said man, that isintense.
That is so intense Because yourbody wants to respond right,
(13:03):
it's very uncomfortable.
So four hands are on and I'veseen the providers doing it like
they are hot and heavy,sweating by the end sometimes,
not that it takes very long, butit's a lot of effort for them.
So they feel where the baby is.
They typically like the baby todive forward, so follow their
face kind of a thing.
So they're going to generallyyou have two hands on top, two
(13:24):
on bottom, so lifting the buttsometimes I have to lift that
cute little bum out of thepelvis a little bit help that
head to dive forward so they'reon the top of the uterus, on the
top of the fundus, from theoutside encouraging that baby to
take a dive, lifting it out.
So having the butt go to theside and then up and the head go
down, so kind of doing a littletwist and a turn.
(13:45):
Remember 50% effectiveness rate, 50% chance of it working.
So can be discouraging goinginto that, but it is definitely
something to try, something tonote.
With a version, the hospitalstaff is ready to deliver baby
quickly if needed.
They'll generally do this withan OR ready right, so they know
(14:05):
that they have staffing and thatan operating room is ready.
An OR ready right, so they knowthat they have staffing and
that an operating room is readyIf things don't go well, if the
baby doesn't respond well,they're going to kind of be
ready to deliver a baby prettyquickly.
And interesting to know thatthis is safe for VBACs.
If you're somebody who has hada prior cesarean, so you have an
(14:25):
oar uterine surgery of any kind, you have a scar on your uterus
.
It's studies have shown that itis safe for people to have a
version, an external cephalicversion, even if they have had a
prior C-section or abdominalsurgery on their uterus.
So, uh, that said, those areways to help turn a breech baby.
Um, I want to go a little bitinto the history of this because
(14:48):
in mainstream, right in ourmainstream medical world, a
breech baby most often means acesarean delivery.
If all the things we try andreally one of the best things to
try is time, sometimes justrelaxing about it, relaxing our
hearts, our minds, our bodies,and giving that baby time, they
(15:08):
can turn right at 37, 38, even39 weeks.
I had one client one time tonsof fluid, her babies.
I think she was having herthird or fourth baby and she was
very familiar with her body andshe could just sit in the tub,
get her babies to turn head downon her own, just because she
could kind of guide them downwith she had tons of fluid, she
was very well aware of where herbabies were and her babies were
(15:29):
turning up till the day ofdelivery, but that's a little
less common.
But for so many people, having abreached baby equals a
C-section, right?
So maybe you weren't wantingthat, you weren't planning on
that and it feels like thechoice is out of your hands.
Sometimes when you look online,it kind of is interesting to me
.
Sometimes you know a lot is outof your hands.
Sometimes, when you look online, it kind of is interesting to
(15:51):
me.
Sometimes you know a lot of thearticles will say, yeah, try
for a vaginal breech delivery.
Really, that's pretty hard toget Like, it's hard to find a
provider who does that.
And so let's talk about some ofthe reasons why I was.
Years ago I was doing a birthwith one of my very favorite
midwives.
She's since retired, but shewas incredible and she was a
nurse before she was a midwifeand we're I don't remember the
(16:12):
the incidence of the delivery wewere doing, the client that we
were with, but we were talkingabout breach deliveries and she
said you know, 30 years ago,when I was training to do this
so this probably would have beenin the 90s, early 90s, maybe
late 80s she said we did breechdeliveries all the time.
There would be like five a week.
(16:33):
She's at a pretty busy hospital.
She said we would have five aweek.
It was very common, like it wasnothing about it, right, it was
okay, that baby was born breech, no big deal.
You might speak to older womenwho are 60, 70, who you know.
(16:54):
They went there when they werehaving their babies.
They had a breech delivery andnobody knew it was breech until
that baby was born, right, like,oh, look cool, a breech
delivery, no big deal.
Whereas now, if that baby'sbreech, like oh no, let's, we
can try these things.
It probably won't work, let'sjust schedule a cesarean is the
theme of the day now.
So let's understand that itused to be.
This is like a generation ago,right, we have forgotten that
(17:16):
this was normal.
It is no longer normal, but itused to be normal.
Doctors used to be trained inhow to deliver breech babies
because that's what they woulddo.
Used to be trained in how todeliver breech babies because
that's what they would do, right, like they would have a certain
percentage.
Three to 4% of all babies wereborn via you know that breech
(17:42):
position, and that's no longerthe case anymore.
So the craft, the art, theskill is kind of fading.
Doctors aren't as adept at it,they're not practiced in it,
they're not taught it very well,if at all.
Right, if if at all, a lot ofthe training may just become
from um a video or something inmedical school, so kind of
interesting that it's just kindof a lost art.
And part of what helped thatbecome a lost art was a
(18:02):
combination of things.
But in 2000 there was a studycalled the term breach trial and
it was a study of a kind of asmall number of people that came
out in the year 2000.
So we are about a generationago that said we do not
recommend they tested.
I think it was don't quote meon this, but I think it was 100.
(18:25):
I can't remember.
I'm not even going to say thenumbers cause I don't remember
them.
They weren't crazy big numbersbut they tried.
Um.
They followed the outcomes ofsome breech deliveries and some
cesarean deliveries with breechbabies right, vaginal breech and
cesarean deliveries and theycame out with a study and pushed
ACOG the next year to make astatement about it that it would
(18:47):
probably be better that umbreech babies are born by
C-section.
They could mitigate some risks.
Um, and today 86%.
I think that's a little low inmy mind, 86% of babies who are
breech are born by c-section.
Um, and kind of interestingthat that means there's 14
(19:12):
percent of babies being bornbreech.
I want to know where, like in myexperience throughout the
country there's unless it's outof hospital, there's not a whole
lot of hospitals that will um,have you, you know, let you
deliver a breech baby in the thestates that I've worked in, we
can.
I can come up with like twodoctors maybe in each state who
aren't you know it's not likethey're close together or
(19:35):
anything that we'll considerdoing a breech if everything's
fine.
So difficult to find a providerto do that.
Also, at the time C-sectionrates were on the rise.
We know they've been around 32%or thereabouts for the same
amount of time.
C-section rates were on therise, you know, we know they've
been around 32% or thereaboutsfor the same amount of time.
Interestingly enough, right Ifwe're going on over 20 years of
that C-section rate in theUnited States hanging around
(19:56):
that 32, 33%, which varies bystate and breach deliveries
contribute to that right.
When we quit doing vaginalbreach, deliveries which by and
large were, were safe and if youlook at the actual numbers.
Yes, the risk is there, butthis, but this study came out
and said if there's any risk atall, it's not worth taking right
(20:17):
.
So kind of dive into what therisks are.
It's kind of interesting toknow what they are.
And and also at this time, ifyou look at the logistics, the
bookkeeping, the scheduling ofdelivering a cesarean delivery
(20:37):
with a breech baby, it's a loteasier.
There was one doctor at thistime that said if you have a
defendable way, a defendableoption, why would you not do it?
So what she was talking about.
This doctor and this was 25years ago said if you have a
defendable in court right forand if this becomes a litigious
situation, you have a defendableoption, why would you not use
(20:58):
it?
Why would you assume any riskat all?
Any risk is too great a risk.
So those risks include so risksto breach baby's deliveries
include head entrapment, whichis actually, if you look at the
numbers, extremely rare Prolapsecord, because those smaller
parts of the body can be lowerand they're not filling up the
whole um space, the loweruterine segment, and so a cord
(21:20):
if the water breaks could comedown by feet or knees or um
whatever.
That's why the Frank breechdelivery when the baby's just
folded in half the butts comingfirst.
That mimics the head as best asother parts.
You know the other better thanother parts of delivery, so just
kind of interesting.
And ACOG did make a statementshortly after that that, you
(21:41):
know, kind of shifted somepolicy and over time we don't
even have doctors trained to dothat anymore.
There's a memoir that I haveread several times that I
absolutely love.
It's called Listen to Me.
Good, it's about a midwife whodelivered babies out of hospital
, so home birth deliveries fromthe 1940s to the 1980s.
She was in the deep South andit's fascinating to read.
(22:03):
And one of my favorite parts isshe delivered plenty of breech
babies.
Didn't scare her, she just okay, baby's breech.
Here we go.
And this would scare, I think,even our most well-trained
breech, who deliver breachdeliveries today, which are far
and few between.
She said my favorite kind of abreach is a footling breach
(22:24):
because I can take that one footback up, grab the other foot
and pull that baby out.
Wow, like that's.
That was pretty wild to me, butthat was normal not that long
ago and she had a very goodrecord.
She and I think she did 3000deliveries over 40 years in
Alabama and had not lost a baby.
(22:45):
No, sorry, excuse me, she hadnever lost a mother.
Actually there was a couple ofbabies that that had died in the
course of her practice.
But, um, kind of interestingwhere we were and where we are
now.
So keep that in mind.
Also, the time, the money andthe skill involved to this, the
skill set became low, um, andhow to deliver breech babies.
(23:08):
The time in the OR is short andthe money in the OR is better.
So you can see how it just kindof naturally went that way.
So I guess the message I want topeople to have here and in the
next episode I'm going to giveyou three, as because I've
attended, you know, had somegreat breach deliveries lately.
So I'm going to tell threelittle stories that are recent
breach delivers for me.
(23:29):
But I guess the point is to doyour research and to find out
what type of breach.
If you find yourself with abreech baby, how can we
encourage movement?
What type of breach is it?
What providers in your area?
Get creative, think outside thebox, what providers might
support that and how do you feelabout having a cesarean?
(23:51):
So we know the risks of breachand they can be low.
But you know what?
Cesareans have risks too, andthey have great risks to mom and
baby too.
So we kind of weigh all therisks as we make a decision.
Anyway, just kind of interesting, a little bit of history lesson
here.
Here's where we are today.
We got to work with what wehave.
I'm not saying it's wrong, I'msaying it's interesting.
(24:11):
Like cannot tell you how manytimes my clients oh, breech,
okay, we're having a cesareandelivery.
You know that's pretty common.
That's where we're at today.
But there are those and homebirth midwives among them, which
I will talk about a story in mynext episode that deliver
breech babies have trained to doit Still, the training is out
(24:32):
there.
It's not in medical schools butthe training can be still had
by those who want to um thatthat it's not a lost art all the
way right it might be in ourmainstream medical community.
So listen to the next episodefor um, some specific breach
stories.
Hopefully your baby um is headdown, keeps things easy for you
and it heads on out the way thatit's.
(24:53):
That makes it a little biteasier.
So a little bit of tidbit factsthere about um, the
breachedness of babies.
Hope that that helps or isinteresting or, um, gives you a
little bit of backgroundinformation on where we were and
where we are now and how we gothere.
So, as I wrap up, today, asalways, make a connection with
someone, make a human connectionwith someone, and maybe it's
(25:14):
digital.
Reach out digitally by text, bymessenger, by however you want.
Reach out to somebody and justsay been thinking about you.
Hope you have a good one and wewill see you next time.
Bye.
Speaker 1 (25:39):
Thank you for listening to the Ordinary Doula
podcast with Angie Rozier,hosted by Birth Learning.
Episode credits will be in theshow notes Tune in next time as
we continue to explore the manyaspects of giving birth.
Popular Podcasts
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
24/7 News: The Latest
The latest news in 4 minutes updated every hour, every day.
Therapy Gecko
An unlicensed lizard psychologist travels the universe talking to strangers about absolutely nothing. TO CALL THE GECKO: follow me on https://www.twitch.tv/lyleforever to get a notification for when I am taking calls. I am usually live Mondays, Wednesdays, and Fridays but lately a lot of other times too. I am a gecko.