per naixements sense violència / por nacimientos sin violencia/ for childbirth without violence
         per naixements sense violència / por nacimientos sin violencia/ for childbirth without violence    

Breech Presentation

It is already known that a baby breech presentation for many mothers is experienced as a frustration since, every so often mothers feel trapped being offered the only and “best option” of a caesarean section.

 

Less and less, mothers get the opportunity to deliver their breech babies physiologically, and when they decide to have a vaginal delivery it is often at their own risk.  Mostly at their peril in an obstetric unit where few technicians are skilled in vaginal breech births. (Banks, 1998).

 

Las comadronas sabemos muy bien nuestros límites de actuación y nunca planeamos atender un parto de nalgas a domicilio, no forma parte de nuestras competencias (ICM, 2017; WHO, 1997), aunque sí es nuestro deber estar entrenadas para atender un parto de nalgas en caso de emergencia (Ministerio de Sanidad y política social, 2009; ICM 2013; Keighley, 2009). Sin embargo tenemos el deber de ofrecer a las mujeres opciones basadas en la evidencia.

 

Midwives know our limits very well and never plan to attend a breech birth at home, since this is within our sphere of practice (ICM, 2017, WHO, 1997). However, it is our duty to be trained and skilled to deal with a breech delivery in an emergency (Ministerio de Sanidad y política social, 2009; ICM, 2013; Keighley, 2009). Furthermore, we have a duty to provide women with evidence-based choices.

 

Currently, since 2017, it can be said that vaginal delivery with breech presentation is safe, provided there is verticality and absolute maternal freedom of movement. This type of birth (vs breech vaginal birth with the mother lying down) is associated with a more rapid second phase, reduction in the number of maneuvers required, reduction in maternal and neonatal injuries and reduction in the number of cesarean deliveries (Louwen et al, 2017) and the same if the mother is on all fours (Bogner, 2014). Vaginal breech birth does not represent an increased risk to the health of the child at the level of development and educational attainment in the long term, compared with cesarean birth (Sun Bin, 2016). Despite this, there are few trained and expert professionals knowing how to assist breech birth. It is often offered as an option only if the woman agrees to have epidural analgesia, which clearly increases the risk (Louwen et al, 2017).
 

I have often experienced the courage, determination and willpower of many women who want a physiological birth but feel trapped into having an unavoidable C-section. They try everything to help their breech babies turn around to a cephalic presentation (head down).

 

Although the External Cephalic Version (ECV) is a fairly safe, effective maneuver (50%) (Impley et al, 2017, RCOG, 2017, Hofmeyer et al, 2015, Hutton et al, 2015), and valid for many women; some feel it is too invasive for them and they want to try other options before going for it.

 

Thousands of years of history of Chinese medicine - and now also diverse scientific evidence -  supports the use of moxibustion on certain parts of the body to stimulate the baby to turn around by itself (Xun et al, 2009; Van den Berg et al, 2008, You et al, 2008, Coyle et al, 2005) with positive results running at approximately 50%.
 

Studies have also been carried out to help  breech babies turn around through postures and/or exercises, but the results are not conclusive (Hofmeyr and Kulier, 2012).
 

However, I have been working on breech presentations by using deep body awareness; my results so far have found a 85% success rate using moxibustion combined with a series of 3 short, simple exercises and a maximum of 10 days of treatment (Sàrries Zgonc, 2011). I teach the mother to do the exercises correctly and to apply moxibustion; she performs the daily treatment on herself at the time of day she feels most relaxed.

 

I usually work with the mothers when they have already reached 36 weeks of pregnancy to give the baby the chance to turn around by itself. I would never work on a breech presentation earlier than this, unless the mother expressly asked me to, since I like to respect the needs and rhythms of the baby, while always taking into account the emotional needs of the mother which can also play an important role.