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A breech presentation refers to the position of the baby in the uterus. It is normal, up to the seventh month of pregnancy, for the baby to be in a head-up, or breech, position. After the seventh month, any position other than vertex (head-down) may not only challenge the possibility of a vaginal birth, but put abnormal stressors on the developing baby.
The risk is small; research shows that approximately 4 percent of full-term (38-42 week) pregnancies are breech presentations. There are several causes of a breech presentation. A structurally altered pelvis is a likely possibility; this can be caused by rickets (severe vitamin D deficiency), poor bone and joint development, or structural or functional pelvic compromise. Additional causes of a breech presentation are uterine abnormalities, placenta previa, multiple births, excessive amniotic fluid, or fetal anomalies such as hydrocephaly and anencephaly.
There are three main types of breech presentations: frank, complete and footling. With a frank presentation, the baby’s legs are extended upward with feet near the head. This is the most common breech presentation, occurring 65 to 70 percent of the time. Complete presentation means the baby is “sitting” upright in the uterus, with legs crossed and feet near the buttocks. A footling presentation is when one or both of the baby’s feet are extended downward toward the cervix.
Throughout the 1990's, some breech babies were still delivered normally. However, beginning in 2003, nearly all hospitals declared a halt on delivering breech babies vaginally. C-section section became the protocol, and is now performed nearly 100 percent of the time for breech-positioned babies due to a recommendation by the American College of Obstetricians and Gynecologists (ACOG). Options on breech vaginal delivery have quickly become a thing of the past. Not only that, but in the medical field, the need to train an obstetrician on vaginal breech births no longer exists! Some midwives, however, are still trained in breech presentations, and may be willing to assist in vaginal breech births.
The virtual elimination of vaginal breech births has now raised a generation of obstetricians who are inexperienced and unprepared to handle a breech case. But what about the woman who knows she is carrying a breech baby and doesn’t want a cesarean section? Few doctors remain who offer alternative techniques or choices for breech delivery. Most obstetricians simply suggest the woman go in for an external cephalic version (ECV; see below) at around 37 weeks, and if that fails, will encourage the woman to schedule a c-section.
Women need to be educated and empowered to know that many options exist, ranging from prevention to treatment, both invasive and non-invasive. There are a variety of alternative techniques that may encourage optimal fetal positioning.
The Webster technique, as defined by the International Chiropractic Pediatric Association (ICPA), is “a specific chiropractic analysis and adjustment that reduces interference to the nerve system and restores balance to maternal pelvic bones, muscles and ligaments. By aligning the pelvis, stress in the attached ligaments and muscles is reduced. This in turn may reduce undue tension in the uterus. A pelvis in state of balance offers the optimal environment for the developing baby. With this optimized space, the baby has a greater chance of getting into the best possible position for birth. Optimal fetal positioning leads to a safer, easier birth.
There have been a few studies indicating success in regards to optimal fetal positioning and the Webster technique. The Journal of Manipulative and Physiological Therapeutics ( JMPT ) reported an 82 percent success rate of babies turning head-down when doctors of chiropractic utilized the Webster technique. The conclusion of this retrospective study declared that chiropractic care may be a valuable adjunct to prenatal care. Truly, the Webster technique needs further investigation in its role in the overall care of pregnant patients and safer birth outcomes.
The ICPA is conducting a major practice-based research project to determine the effectiveness of the Webster technique. The authors discussed their preliminary results: “There is a long tradition in chiropractic on the care of the pregnant patient. The results of our study demonstrate some measure of effectiveness and safety of the Webster technique in relieving the consequences of intrauterine constraint (i.e., malposition/malpresentation) in pregnancy. Higher-level research designs are needed to make cause and effect inferences.” The ICPA is currently proceeding with their conclusions: “This presentation contributes to the knowledge base that pregnant patients may derive benefits from the Webster technique. We advocate for continued research in this field.”
Currently, the ICPA recommends that women receive chiropractic care throughout pregnancy to create pelvic neuro-biomechanical function. Even when the baby’s position is appropriately head-down, chiropractic care with the Webster technique optimizes neuro-biomechanical function of the pelvis. Found to be safe, the implications of the Webster technique throughout pregnancy may have a huge impact in supporting natural childbirth.
The ideal time to be evaluated and begin chiropractic care is before pregnancy, or in its early stages. A restriction in the pelvis may not be enough to adversely affect the baby’s position, but may affect the mother’s comfort, the progress and duration of labor, and the proper development of the child. One study indicates that first-time mothers receiving chiropractic care deliver 22 percent faster than those without adjustments, and deliver 37 percent faster on subsequent births. Again, further research is necessary, and the ICPA is proactive in accomplishing this.