Breech presentation at term is sometimes associated with maternal or fetal abnormalities, but most often is simply an error in orientation, or as I say a baby who did not pay attention in childbirth education classes!

There are three types of breech presentations, frank, complete, and incomplete. With a frank breech the legs are flexed at the hips and extended at the knees so the feet are up by the head. With a complete breech presentation one or both of the legs are extended (imagine the baby standing with one or both feet on top of the cervix). If the baby is in the incomplete breech position one or both hips are not flexed and the feet and knees are often below the buttocks. The frank breech presentation is the most common of the three and the safest position for a baby to be in if a vaginal delivery is to be attempted.

Since there are risks to both the mother and baby with breech delivery attempts are often made to convert the babies position prior to labor. Breech exercises include the breech tilt, the ironing board exercise and use of the knee-chest position. Please check with your health care provider prior or starting these.

I usually recommend the breech tilt. Between 32 and 35 weeks you raise your hips 12 to 30 cm off the ground using pillows (couch or very firm pillows are best). Try to do this 2-3 times a day with an empty stomach and when the baby is active, if possible. With the ironing board exercise prop one end 12 to 18 inches high on a couch. Make sure it is stable and do as often as recommended with the pelvic tilt. Instructions for the knee chest exercise are to kneel with hips flexed on the floor or bed and head, shoulders and upper chest flat on the mattress.

It is often recommended to combine these exercises with visualization (picturing the baby turning), relaxed breathing and soothing music. The exercises attempt to use gravity to encourage the baby to rotate. There are few studies to support the effectiveness of the exercises, but since the baby may rotate on her own anyway, there's little to risk by trying them.

Alternative medicine practitioners also recommend moxa (burning an herb called mugwort) and acupuncture to assist in turning the baby from breech to vertex. You may want to explore this with a practitioner in your area.

Prior-to-term babies often change from breech to vertex and back again. After 36 weeks of pregnancy, the likelihood of spontaneous version (breech baby turning vertex) is 25%. If the baby remains in the breech presentation after 37 weeks your health care provider may recommend an external cephalic version. This involves going to the hospital and with ultrasound and fetal monitor use attempting to turn the baby by pushing on the abdomen. Success rates vary from 40% to 70%. It is often uncomfortable (for a brief period) and there is a very small risk of fetal heart rate abnormalities after the procedure which could lead to an emergency cesarean section.

Delivery of a breech baby is a complex matter which requires the evaluation of many factors. Please discuss this with your health care provider at length.

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