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Breech baby and trying to turn it

[00:00:00] Good morning theme. As I said, it's Monday. I'm tired. You can tell from my eyes I look puffy wrinkly. It's okay. I know you love me. Anyway, we're gonna talk about Bre Babies Today. Sore, you guys might know, is when the bottom is down. I drew a quick little picture. I'm not an artist. There are a couple different types of breach. 

First of all, breach babies, anywhere from three to 4% of all babies will be breached at term. And I say that because, listen, now the days that a lot of us are doing ultrasounds really frequently, Hey, let's just peek at the baby's heartbeat. We'll see BRE babies all the time, 28 weeks, 28, 9 weeks, 32 weeks. 

That doesn't. , because we're talking about once you get to full term, so by full term, or at least by like 35 ish weeks, most babies will be in the right position, meaning head down. But a portion will be breach or transverse. But we're not gonna talk about all that. We're gonna talk today about breach, which is when the butt is down. 

Now, occasionally when I have a patient who goes, you know, every time I've looked at my anatomy ultrasound, and maybe again, if I looked, [00:01:00] because I needed to have an ultrasound every couple weeks, every time I've looked, the baby's been. I can't say that. That doesn't make me think, huh? This baby might stay breach. 

Why would babies be breach? Two reasons that we know of, um, that are anatomic. One is just something about the shape of your pelvis. One could be something about the shape of your uterus. As I always joke, babies aren't just stubborn and just breech. They're usually that way because they're comfortable in that position. 

So the shape of your uterus can be a little bit off instead of kind of an upside down pair. It can be heart shaped, it can be off to the side. It can be. Mine just was strange looking, as my partner said, without any definable abnormality. Um, again, something about the shape of your pelvis and how your sacrum lies can actually make it more comfortable for the baby to be breached. 

Occasionally it can be due to things like the baby not having enough muscle tone from different congenital anomalies. or the baby having, um, things like Down Syndrome, those are less likely reasons for breach. So I don't wanna insight anxiety [00:02:00] right now. Again, are they possible? Yes. Are they probable? No. 

The majority of babies who are breached are perfectly healthy, but just choosing to be in that position because it's more comfortable for them. So it's not even really their choice. So these are my two quick little pictures. The most common breach. This is what we call frank breach. So the two terms for the butt being down that we. 

If we're gonna talk about a version, which is what we're talking about today, which is when the baby will flip, we try to flip the baby. Is Frank breach where the legs are extended or complete breach. Where the legs are bent. Why these terms? I don't know. They don't make intuitive sense to me. I mean, Frank Breech, I guess is like, frankly, the butt is down. 

That's how I look at it. Okay. Just the butt. The butt and the legs. You can also have a footling breach or a double footing breach where just the feet are down. Down. Those, we would not talk about turning. So for the purposes of today, we're gonna talk about a version, and I'm talking about it more so today because I got a bunch of. 

Interestingly this [00:03:00] last week, um, one of our patients had an attempted external cephalic version with Dr. Antonios, who's very good at them. I'm not as great at them. Um, and then interestingly, something came up with a delivery yesterday that I wanna point to cuz these are common things that happen. So first of all, yesterday's situation. 

A patient went into labor spontaneously on her own. First time mom broke her water, had a very good labor curve, meaning things went pretty quickly, um, which is not always the case, but it's great when it happens. She ended up having to push for about three and a half hours, which was longer than I had thought. 

And the shape of her pelvis seemed fine, and the head seemed to be engaged nicely and not turned. But during pushing, I started to feel like probably the head was turned a little bit and when she and her husband and I were having discussion, they reminded me that the baby had been breached until 36 weeks and then spontaneously flipped. 

I say that meaning we did not have to do a version, but the husband had bought something called mok, so. We're gonna discuss a couple different things that you [00:04:00] can try to do to turn the baby. So let's say the baby is breach. Why do we care? Well, we care because when a baby is breached, we don't like to deliver babies vaginally breach anymore. 

It used to happen back in the day. There are still some very skilled, older obstetricians who did a lot of them. Who feel more comfortable, and I would suggest to any of you out there, I'm not your doctor, but if I, if I were your doctor, what I would say is I would not deliver a vaginal breach baby because I do not have the skillset to do it. 

Very few of us have done enough of them to do it. That said, if you're with someone really skilled who feels confident, it's not what I would encourage my own sister to do because of the risks that as the baby is coming out, the arms can get entrapped over the head, or rarely the, actually the body can come out and the chin. 

Extended too much. So those aren't common things that can happen, but it's a possibility. So it's something you should discuss with your doctor. I'm not saying don't do it. I'm merely telling you the data shows that we would try to flip the baby or do a c-section, um, but in very skilled hands it is possible. 

Before we talk about aversion, what are some other [00:05:00] kind of, um, I like to use the word crunchy because I have no other word to use, so hate that word, but I'll use it. Crunchy things you can try. Well, people say get on your hands and knees and rock back and forth. Why would that work? We don't know, but people try it. 

People say, put something cold on your belly, close to the baby's head because the baby maybe doesn't like cold things. So a bag of frozen vegetables and ice pack up by the baby's head. See if the baby flips around. My view of these things is they're harmless. Why not try them? Right? Even if they're senseless, it doesn't matter. 

They don't hurt you. You might as well give it a try because if you would like to try to deliver vaginally, you should do all the things you can within reason. Two other techniques that have actually been kind of studied in the integrative world are the Webster technique, which is something that chiropractors do. 

I do not understand it. Any chiropractors are welcome to weigh in on it, but I think it is safe to do. It has to. I believe with the shape of your pelvis and sacrum and some techniques that the chiropractors can do to kind of manipulate things with the idea that the baby, again, is in that position because of constraints in the pelvis. 

So the Webster technique, um, and then [00:06:00] something called Mok mok is a plant. I'm saying plant, herb, plant, um, a Chinese plant herb, it's like mug ward or something, and they come in these chubby little sticks, they look like chubby sticks of incense and you either go to an acupuncturist or, the reason it was interesting yesterday is this particular patient. 

Didn't feel comfortable going to the acupuncturist during Covid. So her husband contacted an acupuncturist, found out where he could get moxa, and ended up doing moxa on their own at 36 weeks. So you take these little chubby sticks. Again, I don't know how to do it, but I would go to a trained professional, um, or I guess Google it cuz I don't think it's harmful. 

But you burn these sticks near the woman's toe, not on their toe. You don't burn their skin. And the idea is that due to. Things that acupuncture can affect. Please, acupuncturists weigh in on this. The baby might turn, and this couple who are a very, um, I don't know how else to describe it other than a very concrete [00:07:00] couple who were not the type who typically did anything or ascribed to things that were more integrative or eastern. 

I was probably much more kind of willing to do all these things than they are, but they did it. They felt like they felt the baby really moving and then the baby flipped and they acknowledged that. Who knows? Was it from that or was it something else? We. anyway. They didn't need a version. Dr. Antonio's tried a version on a patient of ours on Thursday and it was not successful, which is okay because what do I always say? 

Then? You have a C-section. Is that lesser than? Nope. It's just different. Different set of goods and bads. Right? But let's say you are someone who, at term meaning 37 weeks, you still have a breach baby, which again is about three to 4% of all babies at term. And let's say you are a good candidate, meaning you don't have a placenta previa, you don't have twins. 

You, um, what are some other concrete contraindications You don't have. Your water's not broken. Those are reasons we would not try a version. But let's say everything else is healthy and safe and you want us to attempt to turn the baby external cephalic version. External, you know, means outside. Cephalic means head [00:08:00] version means turn, E, c, v, so we can try to turn the baby. 

We do this at the hospital with the all the precautions ready so that if you need a C-section, emerge. . We have everything on board. Okay? Because as you can imagine, when we're trying to turn the baby externally, we're putting some pressure on the baby, on the head cuz that's how we turn it through the head. 

So sometimes as we turn the baby's head or push on it, the baby doesn't like that and the heart rate can drop. It sounds scary to you guys, but here's what I tell patients. I don't love doing versions because I just, I don't know. My view is the baby's breach. You know how I feel about C-section. So I would just assume do a C-section. 

That said, I fully understand why women would like to try. And I think it's appropriate to, in an effort to minimize the C-section rate, offer it in the right candidates. Therefore, the best way to do it is safely. And so, while it is not scary, it is something that has to be taken seriously done at the hospital, done with anesthesia ready, with the operating room ready with labor and delivery ready. 

How many times in 21 years have we had to do an emergency C-section for a bre? , [00:09:00] I'm guessing too, but it might really only be one, but I feel like there's probably one I'm forgetting, so not a lot. And the truth is, this is what happens. You'll have your doctor and sometimes an assistant, they'll have an ultrasound, they'll have made sure everything's okay with the baby. 

They'll check the baby's position. To see if the baby is frank or complete. They'll check where the placenta is. They'll check how much fluid. An anterior placenta can make it harder because then we're pushing with the placenta, obviously, like through the placenta. A posterior placenta, meaning when the placenta is in back, like if we looked at this picture, if the placenta was behind the baby, it would be easier and having enough amniotic fluid. 

And if you had already had a. Those are all reasons that would be more effective. So we'll talk about the pros and cons and what makes it easier in a second. But basically with the ultrasound, the doctor looks at the baby's heartbeat, makes sure everything's okay, and then tries to either push up on the bottom if the bottom or the butt is engaged into the pelvis or just pushes forward. 

So if it were this picture, the [00:10:00] doctor's hand would be here and. Pushing the baby a forward roll typically. Okay. Cuz that's the easiest way to get the baby to flip. So someone might be pushing up on the butt right above mom's bladder and the other doctor might be pushing with their hand. Or it might be just be one doctor doing that with two different hands. 

Is it uncomfortable? Yeah. Can you imagine? Like it's in your uterus and the doctor has to be pushing. It is uncomfortable, but when it works, it. So what can increase the chances of it working? Having enough amniotic fluid if you are a malt tip, meaning you've already had a baby, more likely, maybe because your uterus is more malleable, maybe because the baby one baby has already come out vaginally, um, having a posterior placenta and having a complete breach. 

So Frank breach is a little bit less likely to work. , how often does it work? I mean, the data is all over the place. Like anecdotally, I would say for me, like I don't know 20% of the time, but the data says 50% of the time it can work, and a significant number of those babies will stay. Head down what we call Vertex and then deliver vaginally. 

So if it's [00:11:00] something that you're really interested in, I think it's worth talking about your, with your doctor. If you're not, then you do a C-section. There's two schools of thought as to when to do it. I had trained where you do it at 39 weeks, meaning you schedule a C-section, you schedule the version on the same day. 

You try the version. If it doesn't work, you do the C-section. Little bit less likelihood that it'll work because there's a little bit less. But it's a, it's, um, easier because you have everything done on that one day and there's less chance that the baby's gonna flip back if you are successful. My partner, and many of the doctors nowadays do it at 37 weeks, so I abide. 

So 37 weeks, when you're full term, you come in, the version is attempted. If it works, great, you go home, hopefully go into labor. And if it doesn't, Then you get scheduled for your C-section at 39 weeks. Certain physicians will try different things like sometimes giving an epidural because that relaxes everything and makes it. 

Pros and cons, obviously it's an epidural and that means that you're going home with the epidural being taken out. So that's an extra procedure with small risks. Some doctors will routinely give something to call tribu toline, which is the shot [00:12:00] of medicine that makes your uterus contract. I mean, sorry, make sure UUs relax from not contracting. 

Some will give pain medication. Um, so all of these things can increase the chance of it working. Again, my view of versions is this, are they safe? Absolutely. In the right hands. Are they often success? ish, 50 50. Are they something I love? No, but that does not mean it's not right. So I really think if your baby is breached, you should have a good conversation with your doctor. 

And if in the end you try it and it works. Great. If in the end you try and it doesn't work, no big deal. Many patients, including me and including this patient I was talking about yesterday with the moxibustion, have kind of this funny shaped uterus. So as we were discussing this, her baby came out, her husband was telling me how they did this. 

Her placenta came out, and I could feel that she has what's called a septum. So within her uterus, let's say the uterus was shaped like an upside down pair. Again, there's what's called arch where it can be heart shaped on the. Hers on the outside felt normal. She was very thin so I could feel it, but the inside [00:13:00] had a septum. 

So basically a little peak of tissue on the inside made perfect sense cuz that's what made her baby bere. And that's what, um, and that. Just couldn't sometimes make it harder to deliver the baby at all. In her case, it worked. My kind of funny shaped plus uterus, made my baby harder to come out. My first one who delivered vaginally, and then my second I did a C-section and we saw my funny shaped uterus, and then my third was breach. 

So again, academics. It all makes sense. All right. I hope that all makes sense. I hope that answered your questions. I think that there's nothing else I had to talk about with breach, but it's Monday and again, I'm tired. Okay. Have a great week.