How to Handle… a Breech Baby

Some babies take their own sweet time turning head-down to prepare for delivery. Although most do eventually get the memo, a small number remain head-up for longer than we'd prefer. Read on for very different advice from three very different experts—and choose an approach that feels right to you.

George Mussalli, MD, maternal fetal medicine specialist, and Jaqueline Worth, MD, obstetrician, at Village Obstetrics & Gynecology in New York City

"If your baby is in a breech position, our first comment is: Don't panic. 97 percent of breech babies turn to head-down by 37 weeks.

"There are a variety of methods that some women have tried to turn their babies around. Some moms swim and do underwater somersaults, while others practice the exercises described at spinningbabies.com. In our experience, the most successful method is called external cephalic version. This is most safely done in a hospital, where a doctor uses her hands on the mother's abdomen to guide and turn the baby to head down. In experienced hands, an 80 percent success rate can be expected."

Ina May Gaskin, renowned American midwife and the author of Birth Matters: A Midwife's Manifesta

"The key necessities for optimal care for vaginal breech birth are a tranquil atmosphere, a kneeling posture for the mother, and the patience required to allow the birth process to proceed without interference. Manual intervention should be reserved only for those comparatively rare cases in which the position of the baby's arms or chin must be adjusted to allow further descent once most of the baby's body has emerged from the mother's body.

"Some physicians recommend cesarean section for all breech babies without waiting for labor to begin, but very little research supports such a recommendation. Cesarean surgery does not guarantee good outcomes for breech babies. Especially when the baby is premature and low birth weight, the vertical incision to the uterus that the majority of obstetricians perform in these cases substantially raises the risks to the mother in future pregnancies, so most breech experts believe that the risks to the mother need to be considered.

"Unfortunately, most experts in breech delivery are now over 60, or received their medical education in some country other than the United States. The greatest risk presented by breech presentation today is the serious erosion of obstetrical skills due to the pressure exerted by the insurance industry on the ability of medical schools to teach the skills related to breech delivery."

Jill Blakeway M.S. L. Ac., licensed and board certified acupuncturist and clinical herbalist, author of Making Babies and Sex Again, and founder of The YinOva Center

"Acupuncture has been used for hundreds of years in China to support breech babies as they turn. We use a well-known acupuncture and moxibustion protocol which involves warming a point on the small toe. I must admit that when I first learned about this in graduate school, I was skeptical. It seemed improbable that burning an herb above someone's toe could have any effect on a baby's position. Over the years, however, I've seen it work over and over again. In fact, it's one of the most tested points in Chinese medicine and has a success rate of anywhere between 69 and 85 percent in successive clinical trials.

"I like this treatment because it's gentle. If the baby does not turn, there may well be a significant reason for that, so we prefer that our patients don't do the kind of manipulations that force the baby to turn. The beauty of the moxa treatment is that it only gives the baby more room and does not try and manually move the baby."