The Ordinary Doula Podcast
Welcome to The Ordinary Doula Podcast with Angie Rosier, hosted by Birth Learning. We help folks prepare for labor and birth with expertise coming from 20 years of experience in a busy doula practice, helping thousands of people prepare for labor, providing essential knowledge and tools for positive and empowering birth experiences.
The Ordinary Doula Podcast
E67: Breech Babies and Birth: What You Need to Know
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.
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Show Credits
Host: Angie Rosier
Music: Michael Hicks
Photographer: Toni Walker
Episode Artwork: Nick Greenwood
Producer: Gillian Rosier Frampton
Voiceover: Ryan Parker
Welcome to the Ordinary Doula Podcast with Angie Rozier, hosted by Birth Learning, where we help prepare folks for labor and birth with expertise coming from 20 years of experience in a busy doula practice Helping thousands of people prepare for labor, providing essential knowledge and tools for positive and empowering birth experiences.
Speaker 2: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 to be about breech babies and breech deliveries. I've had a couple interesting and different from each other breach deliveries and with my clients in the last couple months. So this has been on my mind a little bit and it's something that I think it's a lot of doulas run across for sure and it's kind of an interesting phenomenon.
Speaker 2:So I want to give a couple little facts about breach, the breach position, a couple little facts about breach the breach position. Breach means the baby's head is not down right, it's not heading out, it's the head is up. And when the head is up, there's a variety of positions, even among breach, that the baby can be in. We call a head down baby a vertex baby, we call a head up baby a breach baby. So so the head is up, not down. There are a variety of positions, even among that. There are frank breech, which the bum, like the baby, is totally folded in half at the hips and so their bum is presenting. First there's babies that are footling breech, where they have the kind of um, there's what's called complete breech. They're kind of sitting crisscross applesauce in the pelvis or footling breech, one foot maybe lower than the other, but the point is their head is kind of headed in the wrong direction. It's interesting to know about 3% to 4% of pregnancies. At the end of pregnancy we're talking, you know, 36 weeks and beyond about 3% to 4% of babies are going to be in a breach position. So it's, you know, something you run into. You may experience it or you may know someone who experienced that. It's not terribly uncommon, but three to 4%, we're gonna. We're gonna see it.
Speaker 2:This can be due to a lot of. Whenever something's going on, I always just instinctively ask like why, why, why, why are babies breached? And there's a lot of different reasons for that, but it's hard to pinpoint the exact reason or reasons why it could be a lot of fluid or a little bit of fluid. Those have different medical terms. A lot of fluid or a little bit of fluid, those have different medical terms. So you know, if you're hearing medical terms hydramnios and then you have high or low fluid, that can cause a baby to have the ability to do a whole lot of moving and maybe be head up.
Speaker 2:Other reasons could be the shape of the uterus. Sometimes the uterus, just the shape of the uterus, encourages the baby to be that way. It could have to do with the shape of the pelvis, it could be where the cord is placed or the placenta. If it's a low lying placenta in the front, sometimes we have an increased likelihood of that breech position. But sometimes the cord kind of acts as a tangle and, based on whatever the baby's movements are during pregnancy, sometimes the baby gets tangled in the cord and kind of gets tied up in a breech position. Sometimes people who have one breech baby might have subsequent breech babies.
Speaker 2:So there's a few different reasons. One of them even talks about stress like the element of stress, and I have a client who anecdotally for years has said she believes that breech babies, there's an emotional component to breech babies. So this theory and this does have some research and study behind it that the increased likelihood of stress physical, emotional, mental stress the increased likelihood of stress physical, emotional, mental stress can tighten the lower segment of the abdomen or of the uterus and so the baby's not comfortable, like going down. It's kind of tight up there or, sorry, tight down there so that they they kind of end up head up. 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, 37 weeks, about three to 4% of babies remain breached.
Speaker 2:There are several different ways to try to turn a breached baby. Maybe you've heard of these. Some of them are very evidence-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%.
Speaker 2:So some of those efforts to turn a baby, some of these are very old practices. One of them is we call, like the ironing board trick that goes by different names sometimes, but kind of an inversion, where you take an ironing board trick that goes by different names sometimes, but kind of an inversion, where you take an ironing board just because most people have one. It's pretty sturdy, and you put the 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 and then the pregnant person lies so that their head is near the floor, their feet, hips are up on the couch, kind of, but on the ironing board holding them and spend you know there's different recommendations, but spend several minutes, 15, 20 minutes in that position several times a day. So this is an effort with gravity to help that baby to turn. And pregnant people no, people really spend their time upside down or inverted for very long, but this is an effort to try to get babies to turn positionally. Another one is kind of doing an inversion, a deep, exaggerated inversion, and you'd want help in all of these interesting maneuvers. You want somebody there to support you as you're getting in and out of these positions with the ironing board and with this deep inversion where on a couch hopefully it's not a super high up couch, but on a couch like you're kneeling on the couch and you're leaning down onto the floor beneath the couch, a baby belly right in between your legs and that like is a deep inversion, again with gravity and position, to help get babies to turn.
Speaker 2:Spending time in water Some people have had success with this like not just a bathtub water but like swimming pool water and a large body of water or a large amount of water, and maybe do headstands like do some flips do some inversions in the water and maybe do headstands like do some flips, do some inversions in the water. Some people have had luck doing that, getting a baby to switch. Other ones can be sensory efforts and that can be encouraging babies to turn using senses such as light, temperature, sound. So if you put, you know like go toward the light baby. So we want to put a light down towards the bottom of the abdomen, abdomen, where of course their eyes are going to sense the light. Eyes are at the top. If they're breech, hopefully they're going to be curious. They can sense light by this age, 36, 37 weeks, and hopefully we'll kind of get curious and go toward that light. Evidence-based no, can it work? Possibly Same thing with temperature.
Speaker 2:Babies don't like cold. So a recommendation could be to put cold on where you don't want the baby's head to be Something that the baby can retract from or go away from. So that might be a little cold pack on the top of the belly where the baby's head is, and the baby might move away from that. You know, it'd be funny to have a bag of peas just sitting, frozen peas sitting on top of your belly for a while. Also, sound, playing some you know I've seen reports of playing wild crazy music low on the abdomen where you want the baby to go, or kind, sweet, tender, relaxing music, you know, whatever it is you want, you anticipate that baby being drawn to. So there's some sensory efforts. There's some slightly more scientific efforts, such as Mokshabushan, which is an Eastern medicine effort with have a little like an incense stick it looks almost like, and between pinky toes, and the thought is that that helps turn on some hormones that during pregnancy related. That may help a baby to turn.
Speaker 2:Another effort is a chiropractic adjustment, keeping the pelvis nice and aligned and sometimes babies are in a breech position because the uterus is torqued based on tightness of muscles or fascia or tendons, ligaments. You know the round ligament has a lot to do with, do with how the baby's sitting in the pelvis, so making sure those are released and the pelvis is lined up. Sometimes, once we get that pelvis lined up with a chiropractic adjustment, the uterus can relax as a muscle and it's not holding the baby tight in whatever position the baby might be if it's in a breech position. The Webster technique is a technique that chiropractors use specifically to help babies turn. I have had clients use this several times With no luck. I've had clients use it once and on the way to the parking lot after the chiropractic visit they feel a pretty incredible turning. So those are some other efforts to try to turn babies, to try to turn babies, and then we're kind of moving up the order of invasiveness. I guess you could call it, although ironing boards and deep inversions. They feel invasive to your brain after you do that for a little bit, while Another one that the medical community uses is called an ECV.
Speaker 2:That stands for external cephalic version. So external, of course. On the outside cephalic is the head. The baby's head Version is a move. Now I cannot tell you how many of my clients it's so dang cute over the years have called it an aversion. They're going to have an aversion, I'm going to the hospital for an aversion. So an aversion is a strong dislike towards something and it just cute as can be and cracks me up when people say I'm having an aversion today at 7am at the hospital or whatever. So it's just a version, we're just aversion, is moving something.
Speaker 2:So ECV, external cephalic inversion. This is some maneuvers that care providers do, obs do this, midwives do this and or assist with it, have assistance. This may be discouraging but the evidence does tell us. It has about a 50% chance of working. So it's not like you know, this is 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 ECV working. So ECV is done in a hospital. You work with your provider on when this can be done. There's different schools of thought. Do we do it at 36 weeks, 37 weeks, 38 weeks? Babies are smaller. At 36 weeks the likelihood they may turn is better. But if things don't go well and we have to deliver that day or quickly, we want a baby maybe to be a little bit older, like it's kind of tricky. So work with your care provider, get all the evidence, um, all the, get all your questions answered as you make a decision. If you are faced with an ECV aversion, not an aversion, maybe you have an aversion to aversion but um, kind of get, get some you know good talking points done with your provider if that's kind of what you're looking at. So that's done in a hospital setting.
Speaker 2:I've been with many clients during that. Sometimes it's done in a labor and delivery room, sometimes it's done in a triage room, sometimes it's done in a labor and delivery room near the OR but 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 fentanyl for this because it is uncomfortable. I've had people get epidurals for this, like they'll get an epidural, so that the because the uterus, once you crank on it like they're going to with an aversion, it just kind of stimulates it right, and so it wants to respond by contracting and we're trying to move the baby in it. So when it contracts and gets super hard it's difficult. So they may do some, take some efforts to soften up that muscle of the uterus.
Speaker 2:But this is done usually with four hands. Baby's heart rate is being monitored and it's uncomfortable. I guess that's an understatement to say that it's uncomfortable. I've had the sweetest, kindest clients say I just wanted to punch them. Others have said man, that is intense. That is so intense Because your body wants to respond right, it's very uncomfortable. So four hands are on and I've seen the providers doing it like they are hot and heavy, sweating by the end sometimes, not that it takes very long, but it's a lot of effort for them. So they feel where the baby is. They typically like the baby to dive forward, so follow their face kind of a thing. So they're going to generally you have two hands on top, two on bottom, so lifting the butt sometimes I have to lift that cute little bum out of the pelvis a little bit help that head to dive forward so they're on the top of the uterus, on the top of the fundus, from the outside encouraging that baby to take a dive, lifting it out. So having the butt go to the side and then up and the head go down, so kind of doing a little twist and a turn. Remember 50% effectiveness rate, 50% chance of it working. So can be discouraging going into that, but it is definitely something to try, something to note.
Speaker 2:With a version, the hospital staff is ready to deliver baby quickly if needed. They'll generally do this with an OR ready right, so they know that they have staffing and that an operating room is ready. An OR ready right, so they know that they have staffing and that an operating room is ready If things don't go well, if the baby doesn't respond well, they're going to kind of be ready to deliver a baby pretty quickly. And interesting to know that this is safe for VBACs. If you're somebody who has had a prior cesarean, so you have an oar uterine surgery of any kind, you have a scar on your uterus. It's studies have shown that it is safe for people to have a version, an external cephalic version, even if they have had a prior C-section or abdominal surgery on their uterus. So, uh, that said, those are ways to help turn a breech baby.
Speaker 2:Um, I want to go a little bit into the history of this because in mainstream, right in our mainstream medical world, a breech baby most often means a cesarean delivery. If all the things we try and really one of the best things to try is time, sometimes just relaxing about it, relaxing our hearts, our minds, our bodies, and giving that baby time, they can turn right at 37, 38, even 39 weeks. I had one client one time tons of fluid, her babies. I think she was having her third or fourth baby and she was very familiar with her body and she could just sit in the tub, get her babies to turn head down on her own, just because she could kind of guide them down with she had tons of fluid, she was very well aware of where her babies were and her babies were turning up till the day of delivery, but that's a little less common.
Speaker 2:But for so many people, having a breached baby equals a C-section, right? So maybe you weren't wanting that, you weren't planning on that and it feels like the choice is out of your hands. Sometimes when you look online, it kind of is interesting to me. Sometimes you know a lot is out of your hands. Sometimes, when you look online, it kind of is interesting to me. Sometimes you know a lot of the articles will say, yeah, try for a vaginal breech delivery. Really, that's pretty hard to get Like, it's hard to find a provider who does that. And so let's talk about some of the reasons why I was.
Speaker 2:Years ago I was doing a birth with one of my very favorite midwives. She's since retired, but she was incredible and she was a nurse before she was a midwife and we're I don't remember the the incidence of the delivery we were doing, the client that we were with, but we were talking about breach deliveries and she said you know, 30 years ago, when I was training to do this so this probably would have been in the 90s, early 90s, maybe late 80s she said we did breech deliveries all the time. There would be like five a week. She's at a pretty busy hospital. She said we would have five a week. It was very common, like it was nothing about it, right, it was okay, that baby was born breech, no big deal. You might speak to older women who are 60, 70, who you know. They went there when they were having their babies. They had a breech delivery and nobody 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's breech, like oh no, let's, we can try these things. It probably won't work, let's just schedule a cesarean is the theme of the day now. So let's understand that it used to be. This is like a generation ago, right, we have forgotten that this was normal. It is no longer normal, but it used to be normal.
Speaker 2:Doctors used to be trained in how to deliver breech babies because that's what they would do. Used to be trained in how to deliver breech babies because that's what they would do, right, like they would have a certain percentage. Three to 4% of all babies were born via you know that breech position, and that's no longer the case anymore. So the craft, the art, the skill 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 of the training may just become from um a video or something in medical school, so kind of interesting that it's just kind of a lost art. And part of what helped that become a lost art was a combination of things.
Speaker 2:But in 2000 there was a study called the term breach trial and it was a study of a kind of a small number of people that came out in the year 2000. So we are about a generation ago that said we do not recommend they tested. I think it was don't quote me on this, but I think it was 100. I can't remember. I'm not even going to say the numbers cause I don't remember them. They weren't crazy big numbers but they tried. Um. They followed the outcomes of some breech deliveries and some cesarean deliveries with breech babies right, vaginal breech and cesarean deliveries and they came out with a study and pushed ACOG the next year to make a statement about it that it would probably be better that um breech babies are born by C-section. They could mitigate some risks. Um, and today 86%. I think that's a little low in my mind, 86% of babies who are breech are born by c-section. Um, and kind of interesting that that means there's 14 percent of babies being born breech.
Speaker 2:I want to know where, like in my experience throughout the country there's unless it's out of hospital, there's not a whole lot of hospitals that will um, have you, you know, let you deliver a breech baby in the the states that I've worked in, we can. I can come up with like two doctors maybe in each state who aren't you know it's not like they're close together or anything that we'll consider doing a breech if everything's fine. So difficult to find a provider to do that. Also, at the time C-section rates were on the rise. We know they've been around 32% or thereabouts for the same amount of time. C-section rates were on the rise, you know, we know they've been around 32% or thereabouts for the same amount of time. Interestingly enough, right If we're going on over 20 years of that C-section rate in the United States hanging around that 32, 33%, which varies by state and breach deliveries contribute to that right.
Speaker 2:When we quit doing vaginal breach, deliveries which by and large were, were safe and if you look at the actual numbers. Yes, the risk is there, but this, but this study came out and said if there's any risk at all, it's not worth taking right. So kind of dive into what the risks are. It's kind of interesting to know what they are. And and also at this time, if you look at the logistics, the bookkeeping, the scheduling of delivering a cesarean delivery with a breech baby, it's a lot easier. There was one doctor at this time that said if you have a defendable way, a defendable option, why would you not do it? So what she was talking about. This doctor and this was 25 years ago said if you have a defendable in court right for and if this becomes a litigious situation, you have a defendable option, why would you not use it? Why would you assume any risk at all? Any risk is too great a risk. So those risks include so risks to breach baby's deliveries include head entrapment, which is actually, if you look at the numbers, extremely rare Prolapse cord, because those smaller parts of the body can be lower and they're not filling up the whole um space, the lower uterine segment, and so a cord if the water breaks could come down by feet or knees or um whatever. That's why the Frank breech delivery when the baby's just folded in half the butts coming first. That mimics the head as best as other parts. You know the other better than other parts of delivery, so just kind of interesting. And ACOG did make a statement shortly after that that, you know, kind of shifted some policy and over time we don't even have doctors trained to do that anymore.
Speaker 2:There's a memoir that I have read several times that I absolutely love. It's called Listen to Me. Good, it's about a midwife who delivered babies out of hospital, so home birth deliveries from the 1940s to the 1980s. She was in the deep South and it's fascinating to read. And one of my favorite parts is she 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 breach deliveries today, which are far and few between. She said my favorite kind of a breach is a footling breach because I can take that one foot back up, grab the other foot and pull that baby out. Wow, like that's. That was pretty wild to me, but that was normal not that long ago and she had a very good record. She and I think she did 3000 deliveries over 40 years in Alabama and had not lost a baby. No, sorry, excuse me, she had never lost a mother. Actually there was a couple of babies that that had died in the course of her practice. But, um, kind of interesting where we were and where we are now. So keep that in mind. Also, the time, the money and the skill involved to this, the skill set became low, um, and how to deliver breech babies. The time in the OR is short and the money in the OR is better. So you can see how it just kind of naturally went that way.
Speaker 2:So I guess the message I want to people to have here and in the next episode I'm going to give you three, as because I've attended, you know, had some great breach deliveries lately. So I'm going to tell three little stories that are recent breach delivers for me. But I guess the point is to do your research and to find out what type of breach. If you find yourself with a breech baby, how can we encourage movement? What type of breach is it? What providers in your area? Get creative, think outside the box, what providers might support that and how do you feel about having a cesarean? So we know the risks of breach and they can be low. But you know what? Cesareans have risks too, and they have great risks to mom and baby too. So we kind of weigh all the risks as we make a decision.
Speaker 2:Anyway, just kind of interesting, a little bit of history lesson here. Here's where we are today. We got to work with what we have. I'm not saying it's wrong, I'm saying it's interesting. Like cannot tell you how many times my clients oh, breech, okay, we're having a cesarean delivery. You know that's pretty common. That's where we're at today. But there are those and home birth midwives among them, which I will talk about a story in my next episode that deliver breech babies have trained to do it Still, the training is out there. It's not in medical schools but the training can be still had by those who want to um that that it's not a lost art all the way right it might be in our mainstream medical community.
Speaker 2:So listen to the next episode for um, some specific breach stories. Hopefully your baby um is head down, keeps things easy for you and it heads on out the way that it's. That makes it a little bit easier. So a little bit of tidbit facts there about um, the breachedness of babies. Hope that that helps or is interesting or, um, gives you a little bit of background information on where we were and where we are now and how we got here. So, as I wrap up, today, as always, make a connection with someone, make a human connection with someone, and maybe it's digital. 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.
Speaker 1:Thank you for listening to the Ordinary Doula podcast with Angie Rozier, hosted by Birth Learning. Episode credits will be in the show notes Tune in next time as we continue to explore the many aspects of giving birth.