“Too often in life, we take things for granted. The simple essentials of our days: warmth, light, food, choice, money. We neither know our own worth nor question its source or reliability. We assume it is all there –forever – and there is no need to cherish or earn it.

Episode 3 has several storylines to highlight, but I want to focus on one that really caught my attention—a breech birth! I was excited that this topic was being covered. Breech births occur in approximately 3% to 4% of full-term fetuses. It is when the presenting part of the baby is either the buttocks and/or the feet. This mainly occurs with fetuses that have normal anatomy; however, there can be a congenital malformation like we had in our storyline with Mrs. Gillian Baxter.

I loved seeing the student midwife, Rosalind Clifford, do the Leopold maneuver to feel the baby’s position and then ask Sister Julienne to double-check her assumption of the baby being breech. Then, Dr. Patrick Turner came in as another set of hands and ears as he listened to which quadrant of the abdomen he heard the fetal heart rate the best or strongest. They offered a cephalic external version at the clinic which is when you try to manipulate the baby into the correct position.

As a modern-day midwife, I have witnessed changing practices with breech presentations and births. There are many providers that just go to the Caesarian section with this presentation. Assisting with a breech birth is becoming somewhat of a lost art.

Breech presentation is more common earlier in the pregnancy because there is a larger amount of amniotic fluid. The fetus can also move much more easily in the uterus. The prevalence of occurrence when the fetus is less than 28 weeks is approximately 20% to 25% percent of the time; at 32 weeks, the prevalence is approximately 7% to 16%; and, then at term, it is 3% to 4%. Even when the fetus is term, they can change their position.

In a study by Hannah et al. (2000) researchers randomized the term breech participants into Caesarian section (CS) or vaginal birth groups. They reported that at the time of their births, the group that had been randomized into the planned CS had 2% of the babies that had spontaneously changed into the head down/cephalic presentation. The planned vaginal birth group had 4% that had altered their presentation to the head-down presentation. In another study by Westgren and his associates (1985), the researchers performed serial ultrasounds on the women who had term breech presentations to follow and see how many spontaneously changed from breech to cephalic; this occurred 25% of the time.

Whether a woman chooses a CS or a vaginal birth is dependent on many factors; however, it is guided by patient values and preferences along with provider experience, values, preferences, and the individual situation of the client which would impact the risks and benefits of the various approaches.

If an individual wants to attempt encouraging their fetus to change positions, many Modern Day Midwives have some suggestions for them to try! If they are a candidate for an ECV, they may also attempt other alternatives while they wait for the ECV. Some mothers also just opt to try the alternatives. The varied techniques that people may attempt can include just waiting to see if the baby turns spontaneously on its own or postural maneuvers. Additionally, there are techniques that I have often utilized, including moxibustion and acupuncture.

Postural maneuvers involve having the woman elevate their pelvis in a knee-chest position. You can have the woman attempt this with or without a full bladder. Another technique is having a woman lie down and they have their hips elevated or supported by a cushion or several pillows. Sometimes providers have encouraged women to go swimming and the buoyancy of the water and altering positions of the mother may assist or encourage the baby to turn. Women sometimes play music in their pubic area and use visualization of the baby turning as well while they do these postural techniques. All of these maneuvers may help and will not be harmful. There are also varied providers and professionals that we can offer for them to have a consult visit for varied maneuvers (at the end I share a website for suggestions).

One of my favorite techniques to offer is moxibustion. Moxibustion is a type of Chinese medicine that can help turn a breech baby. It involves burning an herb called moxa (Artemisia spp.), which is a dried herbal preparation made of the aged, powdered mugwort herb, at prescribed points on the body. For attempting to turn a breech presentation, the acupuncture point is called Zhiyin or Urinary Bladder 67. This Chinese herb is burnt close to the outer nail of the fifth toe. It can be used alone by burning the herb or you can use it beside or on the actual acupuncture needle. You can perform this for 20-60 minutes and do this once or twice a day. This can be done for one to two weeks. I would do this for my clients in the office and then teach them and whomever they wanted to assist them (family member or friend) on how to administer the moxibustion safely at home. The presumed mechanism of action was that this would create a warming sensation and stimulate activity in the uterus. This increase in activity would encourage more movement of the fetus.

In a systematic review of seven randomized and quasi-randomized trials, with 1152 women with a singleton breech fetus, moxibustion compared with no moxibustion resulted in lower rates of breech presentation at birth (Cochrane Systematic Review, 2023). Also, starting moxibustion treatment before 37 weeks of pregnancy probably reduces the chance of the baby being head-up or breech at birth. So I always did a 

Leopold maneuver starting at 32 weeks gestation and offered postural alterations to encourage changes; then, if this did not resolve things, I offered moxibustion and acupuncture treatments. So if your baby is breech or you have a friend who has a breech baby—they may want to check out this fabulous site called Spinning Babies (see the link in the references and resources below). They review many things and have varied activities to try along with varied professionals that can assist you from acupuncturists to physical therapists, chiropractors, and others. Thank you Call the Midwife for bringing this topic up in the series. It is good to know of options that are available to you if this occurs.

“In the spring of 1969 no one at Nonnatus House knew what the future held. They only knew that the future had begun. Seeds had been sown and sap was rising. There would be growth there would be opportunity. There was so much hope. They knew spring would turn to summer and to autumn. That leaves would brighten and fade to brown and then snow would fall and everything would change. But at Easter—everyone was flying. The sky shone with promise and they could see forever.”

REFERENCES

Coyle ME, Smith C, Peat B. Cephalic version by moxibustion for breech presentation. Cochrane Database Syst Rev 2023; 5:CD003928.

Hannah ME, Hannah WJ, Hewson SA, et al. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Term Breech Trial Collaborative Group. Lancet 2000; 356:1375.

Westgren M, Edvall H, Nordström L, et al. Spontaneous cephalic version of breech presentation in the last trimester. Br J Obstet Gynaecol 1985; 92:19.

RESOURCES

Website: Spinning Babies