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Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

Turning a Breech

Babies do still turn after 36 weeks. In fact, the optimal time for manually turning the baby is 37-38 weeks, when there is typically the greatest volume of amniotic fluid. It would probably be a good idea for you to do as much as possible for you to increase the amniotic fluid. Make sure you're drinking as much fluid as possible (up to a gallon a day if you're in a hot, dry climate). Also, studies show that each time you immerse yourself in water, the water pressure will force fluids out of your tissues and into your bloodstream, which will subsequently increase the amount of amniotic fluid. How do you feel about nice, relaxing baths in the evening?

And it does appear that the key to helping the baby turn is relaxing, both in your normal daily routine and when you're actively trying to turn the baby. This is one of the reasons why hypnotherapy is so successful in turning breeches, something like 80-90% compared with 50-60% normal success. All those muscles have to relax in order to allow the baby to turn. Floating in a nice warm tub might help a lot with this also.

The reason that breech birth is a concern is that the head is usually the biggest part of the baby, so it's possible that the rest of the body could be born before the cervix is fully dilated. This is only a problem because once the umbilical cord contacts room conditions, it tends to congeal, and stops bringing oxygen to the baby. If this happens before the baby's head is born, the baby isn't getting oxygen through the cord and can't breathe because the mouth isn't out yet.

Two *very* important things to know. If you have a waterbirth, the baby's body will be born into conditions that simulate the uterus, and the cord is no more likely to congeal than if it were still inside. There are concerns that the cord could be pinched between the baby and the pelvis, so you don't want this condition to last very long, but a waterbirth buys you a *lot* of safety margin.

If it does appear that the baby's oxygen supply is compromised, for whatever reason, they can still establish an airway even before the head is born. Obviously, they need to drain the water quickly and/or get you out of the tub, but then they can hold the vaginal tissues away from the baby's face to establish an airway while waiting for the cervix to finish dilating and the baby's head to mold appropriately.

Ideally, you get the whole baby out in a relatively quick process, but the above can help protect against the most common problems of breech delivery.

A frank breech is the most favorable breech position because those feet are safely tucked out of the way and won't try to come out and bring the cord with them. Also, that nicely rounded hindquarters is still a very good aid in dilating the cervix, so it's much more likely that the cervix will dilate *fully* before the baby begins to be born.

In any breech delivery, you need someone who is experienced in all aspects of breech delivery, believes that it is safe, and whom you trust implicitly. The classic solution to avoiding having the head get stuck is what's called the "hour of patience". After it's believed that your cervix is fully dilated, you all sit around and wait an hour to make absolutely sure. You need to have a caregiver who is *very* skilled at assessing dilation, who will be alert to the time when you're fully complete *before* the baby's butt starts to descend and then will assist you in getting in a good position to weather the next hour, which can be trying because you may be starting to experience an urge to push. A skilled caregiver will do as much as possible to minimize the urge to push through position changes and working with you through each contraction.

The good news with a breech birth is that you're guaranteed that the head will not be posterior because they can turn the head as the body is being born. [Very Big Grin]