Turn baby, turn….
Most women hope for a natural birth, but what happens when a persistent breech baby puts a spanner in the works?
As your pregnancy progresses, your baby naturally turns into the head-first position. However, a small number of babies will not turn and remain in a persistent breech position, or bottom first, in the final weeks of pregnancy. There are a variety of reasons for this ranging from placental location, fibroids or uncommon-shaped uterus, laxed uterine muscle tone from multiple pregnancies or lots of fluid around baby in utero.
This can be a source of great stress and anguish for a woman in those last weeks of pregnancy as discussions around turning baby (External Cephalic Version) and alternative delivery plans may arise.
Amy* was 35 weeks pregnant with her third baby when she came to see me with a persistent breech baby on board. She had been discussing her choices and delivery plan with her Obstetrician and was wanting to wait and see if her baby would turn head first within the following weeks. A normal birth was what she really wanted and an External Cephalic Version did not appeal to her.
Her Obstetrician agreed to give Amy three weeks to see if her baby would turn. This is when she came to see me. Her Obstetrician was informed that Amy was seeking my assistance and was not resistant to her trying massage or acupuncture.
Baby’s head needed room
I approached the consultation as I always do with a thorough medical history and background of Amy’s condition. I had discovered that Amy had suffered from pubic symphysitis with each of her three pregnancies. This prompted me to thoroughly assess Amy’s hips and pelvis position and function as these may lead to a narrowing of the pelvic outlet thus reducing the baby’s ability to turn headfirst. They can also be the source of severe pain.
I commenced my assessment by comparing both hips for symmetry, movement and position and observed that Amy’s right hip was sitting slightly higher and turned toward the front when compared to the left hip. When I observed Amy walking, there was a tendency for her to raise her right hip higher than her left when taking a step forward. This confirmed my suspicions that the hips had been drawn out of alignment during pregnancy while under the affect of pregnancy hormones.
This was placing strain on Amy’s pelvis and making her gluteal muscle groups work hard to support her when she was walking.
I began the treatment by massaging her lower back and hips, focusing on the gluteal muscles to improve blood circulation and movement of smooth muscle tissue. This was aimed at reducing discomfort and allowing the hips to move more freely as well as targeting hip alignment.
Very motivated to help the baby to turn
After discussion with Amy and understanding her commitment to turning her baby to the head first position, I decided to introduce acupuncture and moxibustion into the treatment to amplify the focus on turning baby and realigning the right hip.
Acupuncture was applied also to reduce the pubic symphysitis pain. I have found this to be very effective over my years in practice. Acupuncture is complementary medical practice that involves stimulating certain points on the body, most often with a needle penetrating the skin to alleviate pain or to help to treat various health conditions.
The final layer to the initial treatment was moxabustion and this was applied while Amy was comfortable lying on her side and the acupuncture needles were in place. Moxabustion is used in Traditional Chinese Medicine to stimulate specific therapeutic effects and is the practice of burning a herb called Artemesia vulgarisacross certain acupuncture points. The application of moxabustion increases blood flow creating an environment of movement and activity in the growing baby promoting optimal positioning in utero. The key point to stimulate to assist with turning the baby is BL67 located on the outer corner of the fifth toe.
The recommended application of moxabustion is 20 mins daily for 10 days in succession. I performed the initial application so that Amy was confident to continue using it at home independently and tolerated the treatment. As with burning any substance it was important that Amy knew exactly where to place it and how much heat the moxabustion should generate on the skin.
After this initial treatment Amy felt confident to continue using the moxabustion treatment and tolerated this therapy well. Her baby did move around a lot during the treatment and I was hopeful that baby would settle head first over the next 9 days. At the conclusion of the appointment I also gave Amy instructions on postural techniques that she could adopt at home to encourage baby to turn into the head first position. I included some instructional videos for her to follow.
Another postural technique that I recommended to Amy was the cat stretches which help with pelvic pain and strain by again tilting baby off the lower back and pelvis to relieve pain. Once again I gave her some resources to support her doing the technique correctly. I explained that she should attempt these techniques daily for at 10 mins at a time to achieve optimal results.
Amy returned to see me after the 10 days of moxabustion application and postural techniques. She was very happy to report that the baby had turned head first. This was a testimony to her commitment and compliance with the treatment. Her Obstetrician was pleased.
Amy proceeded to a natural birth of her baby – head first!
* Name has been changed
By Kyla Mayer – Pregnancy and Remedial Massage, Lactation Consultant, Acupuncture and Traditional Chinese Medicine – Red Tent inside Wholistic Medical Centre