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Breech Presentation

MALPOSITIONS

This consists of any position where the foetus is not sitting with the head positioned downwards towards the hips (cephalic). 
This includes:

1. Breech Presentation

• Frank
• Complete
• Footling

2. Transverse Presentation

3. Shoulder Presentation 

BREECH PRESENTATIONS

1. Frank Bottom down legs extended and up near the headline Most common type of breech Most Favourable outcome in vaginal delivery
2. Complete Babies hips and knees are flexed so that the baby is sitting crosslegged, with feet beside the bottom
3. Footling One or both feet down in the hips Bottom sits higher than the hips Least Common type of breech

OTHER MALPOSITIONS

1.Transverse Baby lies sideways If not turned will need a Cesarean Section
2. Shoulder Can be arm or shoulder at hips If not turned will need Cesarean Section

REASONS FOR MALPOSITIONS

AFTER THIRTY (30) WEEKS

• Baby is under of over weight
• Previous C-Section
• Oligohydramnios (Inadequate volume of amniotic fluid) or Polyhydramnios (too much amniotic fluid)
• Bicornuate (heart shaped uterus, with a deep indentation at the top) or separate uterus with hard septum
• Mother has a thyroid dysfunction
• Mother is stressed
• Having twins
• Unknown

WHY MIGHT IT NOT TURN

• Weak condition of the baby
• Short umbilical cord
• Footling breech with both legs
• Frank breech with both legs extended
• Baby is uncomfortable with its head down

WHY DOES IT MATTER

• Potential difficultly during birth
• Prolapsed umbilical cord (In a prolapse, the umbilical cord drops through the open cervix into the vagina ahead of the baby.  The cord can then become trapped against the baby's body during delivery. Umbilical cord prolapse occurs in approximately one in every 300 births)
• Fewer breech presentations at term = Fewer Caesarean Sections at term = Fewer Complications or mother and foetus at delivery = Fewer complications for mother in next pregnancy.

CONTRAINDICATIONS FOR TURNING

• Multiple pregnancy
• Previous Caesarean Section (within two (2) years)
• High Blood Pressure / Pre-Eclampsia
• Placenta Previa
• History of ante-partum haemorrhage
• History of premature labour (this pregnancy)
• Known abnormality of the uterus or pelvis
• Oligohydramnios
• Known hydrocephalic foetus

IDEAL CANDIDATE FOR TURNING

• 30 - 36 weeks and having your first baby
• 30 - 40 weeks for subsequent baby (If had via a vaginal birth)
• No Bleeding during pregnancy, especially the last months of pregnancy
• No previous Caesarean section
• Considered a "low risk" pregnancy
• No Placenta Previa

TREATMENT OPTIONS

Acupuncture and Moxibustion have been shown to successfully turn breech babies with the use of Bl 67 (Zhi yin) in combination with other acupuncture points.  Bladder 67 has been used for 2000 years and is scientifically proven to successfully convert breech presentations. 

Acupuncture and moxibustion are non-invasive and effective in helping a women to progress to go to an efficient labour as it assists in turning the foetus from a posterior position to an anterior one.

Research:

1. Ineke van den Berg, Lidia R. Arends, Johannes J. Duvekot. Correction of nonvertex presentation with moxibustion. Letter to the editor: Am J Obstet Gynecol. 2010 Apr 30. [Epub ahead of print]

2. Ineke van den Berg MSc, Guido C. Kaandorp, MSc, Johanna L. Bosch, PhD, Johannes J. Duvekot, MD, PhD, Lidia R.
Arends, PhD, M.G. Myriam Hunink MD, PhD. Cost-effectiveness of Breech Version by Acumoxa for women with a breech foetus at 33 weeks gestation: a modelling approach. Complement Ther Med. 2010 Apr;18(2):67-77. Epub 2010 Feb 7.