I wonder if breech births will be considered normal in ten or twenty years’ time, just as they were 20 years ago?

What is Normal?

Most babies are born head down in the cephalic presentation. A few individualists, about 4%, decide that head up, bottom down, is best for them. It may be because of the shape of the uterus, the position of the placenta, the position of the cord, or simply that they haven’t got around to turning until there wasn’t much room to do it. It is presumptuous for us to think we know better than the baby the best position for birth. We are outside, it knows the situation inside.

Most babies turn head down between about Week 30 and Week 36. Until that time there is plenty of room and they could be in any position. Some women are told at Week 31 or Week 32 that their baby is breech which is iniquitous. At that stage it is simply a baby that hasn’t turned yet. By about Week 35 you begin to think that this really is a breech baby.

Is Your Baby Really Breech?

The Hannah Trial

Until 2001 breech babies were born normally. In 2001 a report came out, The Hannah Trial, which suggested that it was safer for a breech baby to be born by caesarean. The methodology of this trial has subsequently been considered suspect and it only considered a caesarean and a breech delivery.  A breech delivery means the woman was flat on her back with legs in stirrups. What the trial did NOT include was a normal breech birth with the woman on her hands and knees with a midwife present as shown in the attached photos. Subsequent research has shown this is the safest way for a breech baby to be born.

However, when The Hannah Trial came out, instantly all breech babies were born by caesarean and, though midwives are fully trained in assisting a woman to give birth to a breech baby vaginally, many of them have little opportunity to practice their skills. Because of all the research advocating normal birth, hospital policy is beginning to change. Many hospitals are encouraging normal birth for breech babies and are developing specialist teams of midwives to be available when a breech baby is born, and this trend is continuing.

Am I allowed to have a breech birth?  What are my rights?

Some women are told they have to have a caesarean if the baby is breech.  If ever you hear the words ‘allowed’ or ‘have to’ it’s the time to ask questions.

You are legally allowed to do whatever you like, and being sensible you want to find out the facts and carefully consider the advice of your midwife or obstetrician.  Hospital protocols, national guidelines and evidence based care can sometimes be very different. Never be rushed into a decision. Always find out the facts first. Always make your decision out of knowledge and evidence rather than out of emotion. Remember it is YOUR decision, and these days more hospitals are supporting women in giving birth to their breech presenting babies normally. For example, St Thomas’ Hospital in London has set up a breech birth team so they can offer the best evidence based care to the mothers who give birth at the hospital.

Who can I talk to about having a breech birth?

If your baby is breech and you would like to talk it through with someone, there are three places you can go to:

1. Make an appointment with the supervisor of midwives or the consultant midwife at the hospital. She will give you more time than you have in your normal antenatal visit and will have more experience and seniority to sometimes be able to help you with a less choice. She will, however, be to an extent still be subjected to hospital protocols.
2. Call the AIMS helpline on 0300 365 0663. This is a wonderful free resource to help anyone with a birth related question.
3. Make an appointment with your nearest independent midwife who you can find on IMUK.org.uk . Independent midwives often have more experience than the NHS with breech babies as many women turn to them if it is difficult to find support in the NHS. After an hour’s appointment with an independent midwife you will be well informed and feel confident that whatever decision you make is the best choice for you.

How Can I Help My Breech Baby to Turn?

Sometimes your babies choice of position is in fact the right one for them.  However I understand that there are certain presures in our society to have a head down presentation.  With that in mind here are some options to help your baby turn:

1. External Cephalic Version

The hospital will offer an ECV (External Cephalic Version) to try to turn a breech baby. External because this is a manipulation that is done on the outside, Cephalic because it involves changing the position of the baby’s head, and Version because it is an attempt to turn the head downwards.

This is thought to be about 50% effective. Like every procedure it carries risks. The risk is that, in performing this forceful manoeuvre, the cord will be pulled, which will pull the placenta, which starts to detach and bleed. If this happens it is necessary to perform an immediate caesarean. That is why an ECV is not performed until Week 37 when the baby is concerned to have reached the average length of pregnancy.

Women who have trained in hypnobirthing have reported that using breathing and visualizations have helped keep them relaxed during this manipulation.

2. Acupuncture and Reflexology

There are other more gentle ways to encourage a breech baby to turn. Both acupuncture and reflexology are considered to be about 60% successful.

3. Talking To Your Baby

The most effective of all is hypnotherapy which is said to be about 80%.  It may be difficult to accept that talking is more effective than ‘doing something’, but research shows this to be the case.

I have found that it is very effective if a mother simply talks to her baby herself. After all hypnotherapy is only words. She strokes her bump gently from the top, going down the left hand side to the bottom, at the same time gently talking to her baby, suggesting that it might like to turn, that it’s easy to turn, that many babies are easily born head down, that she acknowledges it could be in the very best position for him/her.

4. Spinning Babies

The Spinning Babies website describes a number of ways to help your breech baby turn head down.

Useful Resources

	Breech Birth – What are my options? Author: Jane Evans One of the most experienced midwives in assisting women to give birth to their breech babies has written this informative and empowering book to inform women about the choices they have and help them decide what is right for them. Purchase here
	Breach Baby Audio By Katharine Graves Relaxation audio and suggestions for a head down presentation. Purchase here

Real Life Stories

We want to encourage people to think differently about a breech presentation.  You can still enjoy a natural birth.  Here are some fabulous breech birth stories:

• Twins born naturally using hypnobirthing with the second baby arriving bum first!
• Breach baby says no to c-section – this baby had ideas of it own!
• Another breach baby birth story.

Further resouces available on our website:

• Rebozo – additional freedom of movement means that it is easier for the baby to move into a different position.
• Hypnotherapy succesfully helps to turn breach baby.
• Download our breech baby resource sheet here.

Credits and References

• The breech baby images shown on this page our courtesy of Karyn Loftesness Photography
• Lancet report on the Hannah Trial Dr Mary E Hannah 2000

To have a doula to care for you at birth has become more usual over the last few years.

So what is a doula, and what does she do?

Doula is the Greek word for female slave, and it has been adopted to describe someone who supports a woman giving birth. She is not medically qualified, but a doula has done a full training and is knowledgeable about birth. She knows about the birth process and how to create an environment and state of mind to facilitate it. She knows how to make a woman feel comfortable and to help her and her partner feel confident . When a woman feels comfortable and confident, birth often proceeds more easily and is more likely to be a gentle and positive experience.

A doula will have more knowledge than the couple she serves of any procedure that is being proposed and of the possible outcomes. She will also know about any alternatives that a busy midwife or obstetrician might not have the time to explain fully, and she can help a couple ask the right questions that will help them make the right decisions for them. These decisions are important and can have implications for the health of mother and baby for many years to come.

She may have a knowledge of essential oils to calm the birthing room and flower remedies to help the mother release any fears she may have and relax. She may be trained in massage for birth, or other therapies.

Continuity of Care

Vitally a doula provides continuity of care for a woman giving birth. Without exception everyone agrees that continuity of care in pregnancy, labour and birth is the gold standard of care, but in general medical services are unable to provide this. There are a few exceptions, and pockets of excellence that are a shining example of what can be achieved, but in general when a woman goes into labour she meets a stranger.

Usually a doula will meet the mother two or three times before the birth and get to know her. They will discuss how she would like her birth to be, and her preferences in terms of care. The doula can explain to her things she may have heard but not understood, or not understood the full implications. A doula is on call whenever or wherever a woman goes into labour and will be with her throughout labour and birth. She will be able to suggest the most comfortable positions, and gently massage her back or stroke her arm or her abdomen. She will make sure the woman has a sip of water from time to time so she doesn’t get dehydrated, and offer her a snack to keep her energy up. Most importantly, she is simply there for her – all the time. A comforting a knowledgeable presence that helps put a mother’s mind at rest, allows her to relax, and the birth to proceed smoothly.

Support for the Father

But what about the father? It is enormously comforting for him to know there is someone else there who has more knowledge than him and who will boost his confidence as well as that of his partner. She can suggest little things he can do that would be helpful, and even allow him a rest if the birth takes place at night.

In a way you could regard the function of a doula as the role a midwife used to perform. These days, a midwife is a highly qualified medical professional whose area of expertise is normality. A century or so ago the midwife would have been a woman in the village with more experience of birth, maybe a knowledge of herbs to aid relaxation, and someone that everyone trusted, with a soothing and calming presence. In a busy modern hospital, a midwife simply does not have the time to just ‘be there’ for a labouring woman, much as she would love to. She has notes to write, checks to do, maybe she is caring for two women and has to allocate her time between them both. In recent years, the birth rate has gone up, but the number of midwives has remained the same. At the same time bureaucracy has gone through the roof, and midwives spend far more time writing notes and checking that the protocols have been adhered to. She would love to perform the traditional role of a midwife as well, but she simply doesn’t have the time.

A doula fills this gap. As midwives become busier and more medicalised, doulas become more popular. Many women find it extremely comforting to have a doula supporting her when she gives birth, and it is certainly something to be seriously considered.

Many doulas have also trained in hypnobirthing to better support a mother, and you will be given a list of KG Hypnobirthing teachers who are also qualified doulas when you do your KG Hypnobirthing Course to prepared you for the birth of your baby.