birth risks

What to Do when Baby is Breech

Finding out your baby is breech can be an emotional experience.

I know for my friend who just gave birth, the last few months were filled with anxiety and doing everything possible to get baby to turn. As her due date approached, she slowly began to accept that baby may know best for position, even though she continued to work hard to give baby the opportunity to move into a head down position.

For most of us, even if we don’t know why, we know that the best way for baby to be born is head first.

Sticking with the physical aspects of birth, having the head birth first follows the natural curve of the spine and allows the body to follow along smoothly.

However, when baby is feet or bum first, this does not happen.

Since the dawn of cesarean birth, babies who are [known to be] breech for the most part have been scheduled to be born through a cesarean. The medical community feels the pros of a cesarean out way the risks of of a breech vaginal birth, for most moms.

So if you are a woman who really wants to have a vaginal birth, the fear of a cesarean can be very strong.

But how you handle that fear can be even stronger. Having an experienced provider who is open to assisting a breech vaginal birth would be wonderful, unfortunately, that is not always available.

So what can you do?

Fortunately, most babies turn on their own, with 3-4% remaining breech at birth (source). But there are ways to support your body and baby through this process when there are no other medical complications preventing baby from turning.

Inspired by my friends journey I put together my top 6 strategies (in no particular order) to help baby turn into a head down position.

The main focus to all these strategies is to create space in the pelvis. The pelvis is the outlet for birth. There is the upper ring and lower ring made up of two bony sides (or wings I call them), the sacrum, and soft tissue. These rings can expand and shrink depending on posture, muscle and tissue tension, and joint movement. Performing techniques that target softening and expansion of these rings is the goal!

  1. Pelvic Opening Exercises

    Doing stretches that promote widening of the pelvis and gentle mobility of the sacroiliac joints does just that. These exercises involve a lot of stretching the muscles and tissues around the low back, trunk, pelvis and hips.

    An example of one exercise sequence I teach my patients are pelvic tilts, circles & sways.

    These can be done in various positions but there are 3 that I find most effective: hands and knees, a birth ball or standing. They can be performed from small to large movements, slow or fast, and as many as feel comfortable.

    They are great to do throughout pregnancy as well as while in labor.

  2. Spinning Babies

    Spinning Babies was created by Gail Tully as strategies to help optimize babies position. They provide exercises and hands on techniques to create space for baby to “spin” in utero to be in the best position for birth.

    They offer online support and in person care through providers trained with Spinning Babies.

  3. Fascial Release Bodywork

    Sometimes muscles and joints that become tight over years of imbalance may need more than stretching and movement to create space.

    Using a form of manual therapy that targets the fascial system. This system is a network of connective tissue that surrounds and is interwoven into every fiber of the body and provides the support necessary for optimal functioning.

    When the fascial system is dehydrated and restricted it inhibits muscles and joints. Fascial release nourishes these tissues, allowing them to open up and create space. Performing releases around the spine, ribs, pelvis and hips improves babies chance of finding optimal position.

  4. Webster Technique

    This technique is used by Chiropractors to analyze the sacrum for subluxation and provide adjustments accordingly to restore neuro-biomechanical function.

    While this technique does not necessarily create more space, sacral subluxation can cause baby mal-position, due to the imbalanced of space in the pelvis. Bringing the sacral into alignment allows baby to find a better position.

  5. Osteopathic Manipulation

    Osteopathic manipulation are hands on techniques that Doctors of Osteopathy use to balance joints and surrounding tissues. Again, various techniques can be utilized to manipulate the spine, pelvis and sacral joints to target the uterine and cervix ligmants and muscles to bring alignment to the area and remove mechanical interferance to baby’s position.

  6. Acupuncture

    Acupuncture is another technique that can be used to open the pelvis and hips to create space for baby to turn into optimal birth position. Acupuncture points are targeted in the back, arms, hands, legs, and feet to remove restrictions and improve energy flow in the sacrum, surrounding muscles and uterine ligaments.

    Some acupuncturists are also trained to do Moxabustion, a Traditional Chinese Medicine technique where moxa (Chinese herb) is burned over a point in the outer toe. This has been shown to be effective in turning babies for hundreds of years in China and recently validated with randomized controlled-studies.

I invite you to an informational consult call to learn more about how I can help your baby find optimal position as a maternal pelvic health physical therapist!

What You Were Not Told About Birth: Part 1

So I can't tell you how many times I have been chatting with a client and she says

Why didn't they [meaning her OB or midwife] tell me that?

And I can never really give a good answer, because I don't know why providers don't inform expecting moms what may or will happen to her body after birth.

To me, this should be common practice, so that moms can make the best decisions while preparing for birth and recovery. If we are unaware of what to expect how can we prepare?

This creates more of a reactionary mindset, which is typically more defensive.  Rather than a proactive mindset, which is typically more offensive.

So I've decided to delve into the issues that aren't brought up. The changes, birth injuries and short and long term problems that arise from pregnancy and birth.

To begin, I want to talk about a podcast I listened to this morning on the way to work.  It was called Risky Birth-ness from The Longest Shortest Time.

It was brought to my attention by a past client, who thought I'd enjoy the topic, being about the risks of vaginal births.

In the episode the host, Hillary interviews Kiera Butler who wrote What the Expect: Why aren't we talking about the surprising number of women injured by childbirth?  for the magazine Mother Jones.

[You may subscribe to the magazine for free here]

After downloading the podcast I couldn't wait to listen to it!!

I am such an advocate for women who experience childbirth injuries so I was excited to hear what Kiera had to say.

So I was shocked to feel less than satisfied by the conversation. Which you can listen to here.

Hillary and Kiera spoke some specific birth traumas that can occur from vaginal birth and how the prevalence of birth traumas are on the rise.  How Doctors are required by law to inform women the risks of  C-section but aren't required to discuss the risks of vaginal birth.

They also discussed certain interventions that may occur during vaginal birth, such as epidural, vacuum, episiotomy, and how the risks of these interventions are not addressed. And how vaginal birth can leads to short term and long term injury. Kiera went into a little more detail around these, stating short term injury is tearing or episiotomy and long term can be prolapse and stress incontinence. [I will go into more detail to these later].

But to me, this episode sounds almost like an anti-vaginal birth discussion until the very end.  I do not believe that was the intent; however I feel there was information lacking about the comparison in risks between C-section and vaginal, not just stating there are risks with C-section as well because it is major surgery.

Here's my insight on the risks of vaginal birth - 

Vaginal birth is the most natural way to deliver; however there are circumstances that can reduce a woman's ability to birth vaginally, so in those cases C-section is necessary.

Just because vaginal birth is the most natural doesn't mean there are no risks to your body.

There needs to be more education upfront about how to birth, including positioning, respecting the bodies innate pushing reflex. This includes the providers involved doing every effort to use these practices rather than the default lying on the back and telling moms to push.

Providers need to have more training on the muscular on the pelvis or to at least have it become standard practice to have expecting moms see a physical therapist trained in pelvic floor and prenatal care.  This gives expecting moms the best opportunity to bring awareness to the proper muscles that are the most involved or injured during birth, regardless of method.

Even though the risk of stress incontinence and prolapse is twice as likely for those women who have vaginal births compared to C-section and may lead to surgery in the long run. These are still risks of C-section in addition to other complications like abdominal pain, back pain, painful sex...

Medical interventions should be the last resort based on an individual basis, because there are other risks that are involved, such as epidural migraines, lack of body awareness to feel a natural push (which can lead to tearing), trauma to infant from vacuum or forceps, etc.

Hospitals and birthing centers need to be more open about it being the woman's decision for birth method and the experience she is looking for. Meaning she should not feel pressured or shamed into either method, but treated with respect.

Care does not end after birth. There needs to be more education around recovery, what to expect, what could happen and how to be proactive. I like how Kiera brought up recovery in France includes PT! [I have to listen to the podcast about pelvic floor PT].

And never, I mean never, tell a mom "At least you have a healthy baby" when she expresses a discontent with the birth experience because it diminishes her feelings.

Each birth experience is different because each woman is different, so every women should have the opportunity to be able to make an informed decision about that experience, without feeling pressured by society, medical community, friends, family or other moms. The only way we can make informed decisions is by being educated by those who have the information.  If birth trauma is not discussed, normalized or dismissed, then woman won't know to ask. So providers need to be the first to bring it up. Especially since, pregnancy books don't talk about birth trauma.

After listening to this podcast I was worried I was over reacting, but was pleasantly reassured by other's comments that I was not the only one who felt that this episode left me wanting more.  As one woman pointed out in the comments - there was nothing said about vaginal injuries being linked to the birth environment, including medical professionals you've never met, machines, IV, other sounds, etc, which may affect the moms mindset around birth. As I mentioned in another post, when a mom feels uncomfortable with a situation during labor the body responses by slowing or stalling progression. This can lead to intervention and possible injury.  So I'm glad someone brought this up in the comments.  That yes, there can be birth trauma and injury but what percentage of this trauma was caused by or within less than desirable environments.

I know I may stir up some conversation about this topic and I'd love to hear from you.  Tell me about your birth experiences. That is the only way we can learn from each other and figure out the best way to educate other woman about the birthing process.

Look for part 2 of this series as I get more in depth with some of the issues brought up in the podcast like stress incontinence, pain, prolapse and more.