breech birth - an overview
Hearing the words “your baby is breech” is a devastating blow to many expectant parents. For many, it means an automatic Cesarean surgery. Delivering a breech baby is the skill that time forgot, and many (if not most) providers are not trained in it, despite the fact that 3-4% of babies are breech at full term. Breech babies are just one variation of normal. It is not inherently dangerous for babies to be in breech position. What is dangerous is unskilled providers attempting to manage a breech birth.
A future post will address the various methods you may use to try and turn a breech-presenting baby (bottom down) to cephalic-presenting (head down). This post will focus on the basics of physiological breech birth itself, specifically in upright positions. Optimal positions for physiological breech birth are all-fours, lunging, standing, or squatting.
This video is from Breech Without Borders and demonstrates the 10 mechanisms, or movements, of upright physiological breech birth as described below.
One of the great things about breech birth is that you can tell what is happening with the baby on the inside by watching what is happening on the outside. The following ten movements of physiological breech birth assume that the birthing person is in an upright position and there are no deviations.
First the baby’s bum or feet emerge. Usually the baby will be in a sacrum-transverse (ST) position, meaning their butt is facing the birthing person’s thigh.
As the baby’s trunk is born, they rotate into a sacrum-anterior (SA) position. That is, they will emerge facing the birthing person’s tailbone.
The baby’s legs should release spontaneously, if they are not already born.
With the legs released, you should see a chest crease, or “cleavage.” This indicates that the baby’s arms are not trapped. If you see tightly stretched skin near the baby’s armpit, one or both arms are likely trapped.
Next you will see the baby do some tummy crunches and arm curls to flex their head and spine.
The baby’s arms will then release spontaneously.
If the birthing person’s perineum looks full and bulging, that means the baby’s head is in a flexed position - which is what we want!
The head will release spontaneously.
If someone else caught the baby, now pass them up to the birthing person.
Allow the umbilical cord to remain intact, especially if resuscitation is needed.
The most important thing to remember with breech birth is to keep your hands off unless there is clear evidence of deviation from the movements listed above. If you do notice a deviation, correct it using the appropriate maneuver. Once the movement is restored, hands back off. Doing the wrong thing is often worse than doing nothing. As Mary Cronk said, “Sit on your hands if you must.”
Occasionally there are deviations, such as one or both arms being stuck above the pubic bone. Maybe the baby’s condition seems to be declining. There are various maneuvers one can perform in these situations. If you are interested in learning about the maneuvers used during vaginal breech birth, I highly encourage you to visit Breech Without Borders’ YouTube channel. Breech Without Borders also has many other resources available for parents, midwives, OB-GYNs, and birthworkers.
I am not a medical professional. The information in this post is not intended as medical advice. Please consult with your intuition and your healthcare provider about what is right for you and your family.
