Posts Tagged ‘breech’

Can you turn a breech baby?

Friday, December 4th, 2015

DoctorPregnant_zps3ac96800You may have heard recently about a technique that can be used to “flip” a breech baby. This procedure is called external cephalic version (ECV) and is done by your prenatal care provider.

When is a baby breech?

As your due date approaches, your baby usually moves into a head down position. During a vaginal delivery, this means that the baby’s head comes out first. But in about 3-4% of full-term births, the baby doesn’t move into a head-down position. This is called a “breech presentation.” A breech baby can be positioned so that the baby’s bottom, feet, or both are facing down.

What is ECV?

Since it is best for your baby to be in a head down position for a vaginal delivery, if the baby is breech, a C-section may be medically indicated. To improve your chances of giving birth vaginally, your provider may decide to perform an external cephalic version. According to the American Congress of Obstetricians and Gynecologists (ACOG) “external cephalic version (ECV) is an attempt to turn the baby so that he or she is head down.”

Your health care provider may attempt an ECV when you are between 36-38 weeks of pregnancy. He or she will apply firm pressure on the outside of your belly to try to get the baby to roll into a head-down position. Two people may be needed to do this and ultrasound may be used to help guide the turning.

When is ECV not safe?

An ECV will not be attempted if:

  • You are pregnant with more than one baby
  • There are concerns about the health of the baby
  • You have certain uterine or cervical problems
  • The placenta is in the wrong place or has detached from the wall of the uterus (placental abruption)

Can complications occur with ECV?

ECV typically takes place in the hospital in case complications arise.  The baby’s heart rate will be monitored both before and after the procedure.  Some problems that may occur with an ECV include:

ACOG states that over 50% of all ECV attempts are successful. However sometimes the baby moves back into a breech position. While ECV can be tried again, it gets more difficult as the baby gets bigger.

If your baby is in a breech position, talk to your health care provider. You can discuss if you are a candidate for ECV as well as what delivery options may be best for you.

Have questions? Email us at AskUs@marchofdimes.org.

What is Torticollis?

Monday, January 13th, 2014

Torticollis literally means twisted neck. It is a something you have most likely had at one time or another—many of us have probably woken up with it after sleeping in an unusual position.  However it can also occur in newborns.

In newborns, it is called infant torticollis or congenital muscular torticollis and it is relatively common. Boys and girls develop it equally.  The cause is not exactly clear. It may occur if the baby’s head is in the wrong position while growing in the womb, or if the muscles or blood supply to the neck are damaged. It may also occur after a difficult birth, especially if the baby is very large or is delivered in a breech position.

In torticollis, the sternocleidomastoid muscle, the large, rope-like muscle that runs on both sides of the neck from the back of the ears to the collarbone, is stretched or pulled. If it tears, then it causes bleeding and bruising within the muscle. Scar tissue then develops and this causes the muscle to shorten and tighten, pulling the baby’s head to one side. The scar tissue forms a mass or lump that sometimes can be felt on the side of the neck.

Congenital muscular torticollis may be visible at birth or it may not become evident until several weeks later. The following are the most common symptoms:
• tilting of the baby’s head to one side
• the baby’s chin turns toward the opposite side
• a firm, small, one to two centimeter mass is present in the middle of the sternocleidomastoid muscle

Babies may experience symptoms differently. And the symptoms of torticollis may resemble other neck masses or medical problems, so it is always important to talk to your baby’s health care provider if you are concerned.
In most cases torticollis is diagnosed through a physical exam, but sometimes x-rays and ultrasound may also be utilized.

Treating torticollis involves stretching the neck muscle. Passive stretching and positioning are used in infants and small children. The best way to treat torticollis is to encourage your baby to turn his or her head in both directions. This will help to loosen tense neck muscles and tighten the loose ones. Also it is important to remember tummy time.  Tummy time  helps to build both neck and shoulder muscles and helps your baby get ready to crawl.  Tummy time is important for all babies—not just those with torticollis.

Most babies with torticollis improve with stretching and positioning exercises.  In some cases though, surgery to correct the neck muscle may be necessary. Again, if you think your baby may have torticollis, make sure to talk to your health care provider.

What is the breech position?

Friday, April 5th, 2013

Dr. Siobhan Dolan discusses the breech position in the new March of Dimes book, healthy mom, healthy baby.

“Babies typically move into a head-down position during the last month or so of pregnancy. But some don’t, meaning that when labor starts, they are positioned to be born feet-first or buttocks-first. This is called the breech position. Having a breech baby is most likely to happen when a woman goes into labor early, has had previous pregnancies, is pregnant with more than one baby, has a condition in which there is too little fluid in the amniotic sac, or has problems or abnormalities with the uterus or placenta. Sometimes it happens for no identifiable reason.

“If your baby is breech, your provider may recommend a procedure called an external cephalic version. In this procedure, a provider places his or her hands on your belly and tries to move the baby into a head-down position from the outside of your body. This can be uncomfortable, and it may not work. Sometimes a “version,” as it is often called, is attempted more than once. Delivering a breech baby vaginally is risky, especially for mothers having their first delivery, so if your baby can’t be moved out of the breech position, your provider will likely recommend a c-section.”

Learn more about healthy mom, healthy baby, read excerpts from the book, even order a copy at this link.

Breech birth

Friday, October 12th, 2012

Most babies prepare to enter this world head first. A small percentage of babies, however, don’t make that final turn and end up offering themselves feet or fanny first. This is called breech presentation.

We’re not sure why these babies don’t turn, but it does appear more common under these circumstances:
  • When there has been a previous breech presentation
  • In pregnancies of multiples (twins, triplets…)
  • When the amniotic fluid is abnormally low or high
  • If a woman has placenta previa
  • If her uterus is abnormally shaped or if she has fibroids
  • If there is a history of premature delivery

If a breech presentation is suspected, an ultrasound will confirm it. Most breech babies are born healthy, but there may be a slight increase in the risk of the baby having a birth defect and closer examination may be offered.

When a baby is in a breech position, health care providers will try to encourage it to turn into the head down position some time between 32 and 37 weeks. There are different ways to attempt this and it’s important for a woman to discuss the options with her provider to determine which is safest for her pregnancy. These are a few of the options (no guarantees that any of them will work, though):
  • External version – This may require medication to relax mom’s uterus. Essentially, this involves the provider pushing on the lower abdomen to rotate the baby. It is monitored by ultrasound and the fetal heart rate is checked regularly. This is not an option for women carrying multiples, in cases of low amniotic fluid, or when a woman has had previous c-sections.
  • Chiropractic care – The Webster technique is used to reduce stress on the woman’s pelvis, optimize its mobility, decrease the tension on the uterus and relax supporting ligaments. This regional relaxation makes it easier for the baby to turn on his own.
  • Breech tilt – Mom lies flat on her back and then raises her hips about 12 inches off the floor and supports them with pillows. She stays in this position for about ten minutes, three times per day. This can be alternated with Mom resting her head on a pillow and raising her hips up, resting on her knees. These positional shifts let gravity help move her baby. 
  • Hypnosis – A good hypnotherapist may be able to place a woman in a state of deep relaxation which might make it easier for her baby to turn.
  • Moxibustion – Used to stimulate the baby’s movement, this is an ancient Chinese technique that involves burning herbs and focusing on acupressure points, typically performed by an accupuncturist.

When babies still don’t turn, most will be delivered by cesarean section, though not before 39 weeks if all is going smoothly. While most providers will not consider it, there are occasional circumstances when a vaginal delivery might be possible in a breech position. In such cases, a woman wants to be sure that her provider is well experienced in these types of deliveries. She should be mindful that cesarean may still be a necessary final outcome.

Watching the new PBS series “Call the Midwife” last week inspired this post. Did you see it? What did you think?