Head over heels with a newborn

Up to 5 per cent of all babies are breech births, which means extra anxiety for parents-to-be, writes SYLVIA THOMPSON

THE LAST few weeks of pregnancy are an anxious time as the mother and father to-be await the arrival of their baby. When the baby’s head is facing downwards in the womb, this is a clear indication that labour is close. But, what happens when the baby’s head is not engaged and the baby’s bottom is facing downwards?

Up to 5 per cent of all babies are found to be in this position which is called the breech position. And while it doesn’t matter if the baby is breech earlier in the pregnancy, when it comes to about 37 weeks, it may result in the baby being born by Caesarean section.

There are different breech positions. The first and most common is when the baby has its bottom first with the feet up by the head. The second is when the baby has its feet first and the third is when the baby is sitting on its heels. There is also a very rare kneeling breech when the baby is in a kneeling position.

Once a baby has been confirmed to be breech – the midwife or obstetrician can feel the soft bottom near the pelvis and the baby’s head somewhere in the upper abdomen – the first option is to try to turn the baby.

Many maternity hospitals have breech clinics specifically set up so that the obstetrician can do what’s called an External Cephalic Version (ECV) which essentially means turning the baby by hand while the woman lies in a comfortable and relaxed position.

“We advocate turning a baby that has been found to be breech,” says Dr Declan Keane who runs the breech clinic at the National Maternity Hospital in Holles St, Dublin. “It’s most likely to be a success if the woman is on her second or subsequent pregnancy as the uterus will be less firm. We scan first to estimate the size of the baby. Drugs can be given to relax the uterus [although we tend not to give them] and then you try to turn the baby.”

Keane says that turning a breech baby works about four times out of 10 for first-time mothers and six or seven times out of 10 for mothers on their second or subsequent baby. “We will turn the baby at 37 weeks because this gives the baby as much time as possible to turn itself and also there is a small risk that turning might stimulate labour and if it does, the baby is at full term at 37 weeks,” he explains.

Margaret Hanahoe, community midwife in the National Maternity Hospital, has written an information leaflet on breech babies. In it, she describes reasons why a baby might be in a breech position. These include a fibroid in the pelvis, placenta praevia (when the placenta lies over the cervix at the end of pregnancy), twins, excessive amniotic fluid, unusual shape of the woman’s pelvis or if the woman has weakened or very tight abdominal muscles. “But, the majority of breech babies occur in healthy women with healthy babies,” she says.

Usually midwives don’t deliver breech babies. In the maternity hospital system, breech babies are referred to a breech clinic where an obstetrician, together with the mother-to-be, will decide on the type of delivery.

Outside of the breech clinic, there are a number of other approaches used to turn a breech baby. Homeopaths prescribe a single dose of the homeopathic remedy, pulsatilla, to stimulate the baby to move. In acupuncture, there are specific points used to stimulate the baby to turn. Some women will also use precisely positioned moxa sticks (tightly rolled dry leaves of the mugwort plant which are heated and placed near acupuncture points) to stimulate the baby to move. One study has found that the use of moxa sticks and acupuncture is successful in seven out of 10 cases.

There is also a variety of carefully executed exercises and stretches that can encourage the baby to move. Regular swimming can also keep the body loose which in itself can encourage the baby to turn.

If the baby remains in the breech position, then the obstetrician and the parents-to-be must discuss the birth options. What type of birth is on offer to a mother whose baby is breech depends a lot on the preference and experience of the obstetrician.

“Women can deliver breech babies vaginally especially if they have previously had normal deliveries,” says Keane. “On a first baby though, there will be very few obstetricians who will deliver a breech baby vaginally. If a baby is found to be breech in labour, then more vigilance is required. Oxytocin is never given and the baby must be born with the force of the mother’s contractions,” he explains.

Julie Boyle was already in labour when it was discovered that her baby was breech. “I had dilated so quickly with no pain medication that when they realised the baby was coming bottom first, there was no alternative but to keep pushing. I was begging for an epidural but the baby was already on her way,” she explains. Her daughter, Isobel, was born 2.75kg within an hour of arriving in the National Maternity Hospital.

“I didn’t think you could push a breech baby out but I did. I didn’t tear that much and it wasn’t as uncomfortable as I thought it would be. I felt like superwoman afterwards.”

Childbirth expert Sheila Kitzinger gives detailed description of the stages of labour with a breech baby in her book, The New Pregnancy and Childbirth Book (Penguin). She explains how the buttocks are usually delivered first, followed by the baby’s legs. “Then, the baby turns so that the shoulders can emerge as easily as possible. The baby’s own weight draws the head down and its legs are then lifted to deliver the head,” she writes.

The difficulty for the mother is that she has to give birth to the biggest and hardest part of the baby’s body last rather than first.