An Overview of Breech Births and Treatment using Acupuncture and Moxibustion
Breech Birthing – An Overview
In breech births, the position of the baby in the uterus changes so that the buttocks appear first, rather than the head. Breech birth usually occurs in cases of premature delivery. Other cases of breech birth include multiple pregnancy, i.e. triplets and twins, foetal anomalies; anencephaly, hydrocephaly, or other congenital abnormalities, uterine abnormalities, or excessive amounts of amniotic fluid.
Normally, at twenty-eight weeks gestation, all babies are at breech position. By forty weeks, the position of the baby changes and the number of breech presentations normally falls to around 3% to 4%.
Breech births are categorised into four main presentations; Frank breech, complete breech, footling breech, and kneeling breech. Around 65-70% of breech babies are in the Frank breech position. In this breech position, the baby’s legs remain flexed at the hips while the knees are extended, see figure 1.
In cases of a normal birth, the uterine contractions regularly, which cause the cervix to open. In breech deliveries, the baby remains in the oblique position. The baby’s bottom and head are more or less of the same size. As soon as the internal rotations start, the pelvic floor muscles cause the baby to turn its position. The baby now faces the inner thighs. The baby’s shoulders and hips follow suit and now faces the back of the mother.
The external rotations start at this time. The shoulders of the baby merge with the head within the pelvis. Uterine contractions and the muscular tones flex the baby’s head and the chin to the chest. The face emerges and finally, the baby’s head comes out.
Categories of Breech Births
1. Frank breech: Baby’s legs are flexed at hips and knees are extended. Feet are near the ears.
2. Footling breech: Baby’s bottom is at a higher position and either one or both feet come out first during delivery. This breech condition is common in premature deliveries. This position is extremely rare in full-term pregnancies.
Breech Birthing - Risks and Safety Factors
Breech Birth Risks
Breech birth deliveries can prove risky. In footling or kneeling breech, the umbilical cord could prolapse, as the baby may not fit in well within the dilated cervix. Water from the amniotic sac could compress the umbilical cord and the baby would be prevented from receiving any oxygen. Any delay in delivery could cause serious brain damage. An immediate Cesarean would be necessary.
Another risk of breech births is skull injuries due to fast passage of the head within the pelvis at the time of delivery. Babies in the normal head-down position undergo gradual moulding of the skull over the course labour. In breech births as the head comes out at last, there is no time for such moulding and the head has to pass out fast.
Birth attendants should be skilled and very knowledgeable about possible health complications and risks to the baby in breech births. The use of forceps should be discreet and at perfect positions. Otherwise, the baby could suffer serious complications of skull damage or to the spinal cord.
Safety Factors for Breech Births
Among the different breech births, Frank breech offers the most favourable position and complications in such deliveries are almost nil. Complete breech is also favourable to an extent, as sometimes, the baby will change position could go into a footling breech from a complete breech during labour. Kneeling and footling breeches are the most complicated and carry the highest risks.
A full-term frank breech delivery can be without any risk or complications if allowed to take place naturally. Only minor expert assistance could be required.
In cases of delivery of twins, if the first baby is delivered vaginally, the second baby can have a safe breech birth. Complications during breech birth are predominantly due to inefficiency and inexperience of birth attendants. Skilled midwives and attendants play a pivotal role in a successful breech delivery.
Process of Breech Birth
Breech deliveries cause the baby’s bottom to emerge out first from the vagina after descending through the maternal pelvis. In breech deliveries, the baby remains in an oblique position within the uterus at the start of labour. The baby faces the back within the mother.
The birth process starts with internal rotations. The pelvic floor muscles start contractions, which cause the baby to turn position. The baby’s hip would be in front of the other and the baby now faces the mother’s inner thighs. The baby’s shoulders also turn similarly and the baby now faces the mother’s back.
The external rotations start thereafter and the baby’s shoulder comes out as the baby enters the maternal pelvis region. These contractions and other muscular toning within the canal make the baby’s head flexible. Chin merges into the chest and comes out with the baby’s face. The baby’s head is the last to come out.
The increased compressions and pressures during labour could cause some swelling to baby’s genitals. Sometimes, the hips could be a little bruised. However, these problems subside soon after the birth. Similarly, babies born through frank breech positions may continue to hold their legs in the same position for few days after the birth. This is completely normal.
Causes of Breech Position during Pregnancy
There are no actual causes for breech. However, a few possible links to breech births include:
Premature deliveries: If the mother develops labour before the 37th week of pregnancy, the foetus could be in breech position. The foetus normally turns into head-down position only between 37th and 39th week of pregnancy.
Abnormalities: If the mother has any abnormalities in the uterus like unusually shaped uterus or uterine fibroids, excess or insufficient amniotic fluid, heart or brain disorders, or any other problems like Down’s syndrome, breech deliveries could be an after effect.
Multiple pregnancies: If the mother has two or more foetuses within the uterus, it cannot move into head-down position due to lack of space leading to a breech delivery.
Diagnosis of Breech Birthing
Until 28 weeks of gestation, more than 30% of babies are in a breech position. However, when the mother reaches full term, around 39 weeks of gestation, the foetus should be in a head-down position, except in 3-4% of cases.
Doctors would try to locate the heartbeat of the baby with the help of a stethoscope. If the doctor is able to hear the baby’s heartbeat clearly only below the navel, the baby is in a head-down position. However, if the heartbeat is heard clearly above the navel, the baby is in a breech position. Doctors would recommend an ultrasound examination to confirm this. This is the most reliable test as it would reveal the actual position of the foetus.
Doctors would conduct a physical examination of areas around the abdomen. The head of the foetus is relatively harder than that of the buttocks. If the head is felt above the buttocks, it could be in a breech position.
Sometimes, medical practitioners could conduct a cervical examination. They would try to feel the foetus by placing gloved fingers through the vagina and reaching the cervix. In some cases, the cervix may open a little before the actual delivery. The smooth feel of the foetal head can be easily distinguished from the irregular feel of a breech presentation.
The mother can also diagnose the position of the baby. If the baby is in breech position, the mother would often feel the round and hard part of the foetus around the umbilicus or under the ribs. If the foetus is in a head-down position, the mother would feel the kicking at the top of the uterus.
Sometimes, doctors or midwives would try to feel the baby’s palpitations with the help of Leopold’s manoeuvres. Although the head and buttocks of the baby may be more or less similar, the head would be characteristically balloon-type and harder.
Treatment Options for Breech Birthing
There are few treatment options, which could help in turning the position of the foetus before delivery.
Postural tactics: Doctors or midwives would use postural tactics and techniques to change the position of the foetus internally. These measures are normally harmless. In most cases, they are able to change position of the foetus into a head-down position thereby assisting in a normal vaginal delivery. In some cases, the foetus would come back into breech position even after successful postural management tactics.
External cephalic version: Doctors conduct an ultrasound before and after the attempt to change foetal position. Doctors monitor the heart rate of the foetus and give the mother medicines to relax the uterine muscles. Thereafter, they press at specific areas of the abdomen to change position of the foetus. Doctors make repeated attempts if the initial attempts remain unsuccessful in changing the position of the foetus.
Self-treatment: The mother can try a postural management technique at home. The mother should position herself so that the hips remain above the head for many times in a day. Practice this for several weeks to notice any changes in position of the foetus.
Breech Baby Delivery
Doctors would normally suggest a caesarean section for safe delivery of babies in a breech position. This type of delivery ensures the safety of both baby and mother. In cases of vaginal deliveries of breech position foetuses, there is always a high risk of serious damage to body organs and those of the nervous system.
The Use of Moxibustion to Turn a Breech Baby
The American Medical Association journal published studies of successful changes of breech position in a majority of cases using a combination of acupuncture and moxibustion therapies1.
In particular, moxibustion is especially used as a successful therapy that can turn the breech position of the baby into a normal head-down position. Moxibustion has been proven successful in more than seventy percent of breech position pregnancies.
The moxa stick is placed as close as possible to Zhiyin (BL 67) for around twenty minutes. The heat increases the effect of gravity. Therefore, the heaviest part of the foetus, the head, changes position and enters the pelvic region. The foetus then goes into a head-down position from a breech position.
It is recommended to start treatment around 34 to 36 weeks of pregnancy. The treatment cannot deliver results within a single day and may take several days. Ideally, the mother should undergo this treatment in a lying position, preferably at bedtime. The treatment should continue for several nights for the baby to change position comfortably and perfectly.
Although this treatment can deliver necessary results, the mother can undergo external cephalic version just before labour starts. This will surely change position of the foetus and ensure a successful delivery. In some cases, the foetus may not change position even after all such therapies and treatments. This could be due to various other reasons. If the placenta is very low, it may not allow the foetus to move freely. Similarly, if the uterus is oddly shaped, foetal movements would be restricted and the baby may not be able to turn positions easily.
If the baby does not change position, it is possible to use acupuncture. You can undergo acupuncture treatment at specific points like those on the lower back, ear, scalp, and other parts of the hand. Some other points include few meridians on arms and legs that could reflect on the intestines and kidney. These treatments help change the breech position of the baby.
Limitations of the Treatment
Moxibustion and acupuncture treatment has been proven very effective for turning breech position of the foetus. The treatment also stimulates few hormones that cause uterine contractions. The induced contractions help foetus change position. However, excessive treatments could make the foetus turn into to its original breech position.
Cardini, F & Weixin, H. (1998). Moxibustion for Correction of Breech Presentation, JAMA. 280: p1580-1584.