Tuesday, June 21, 2005

How a month can fly

I can't believe it has been a whole month since I last posted anything on my blog, but then it seems par for the course that I will have a period of activity followed by silence, why break the habit of a lifetime!! I am nearly 30 weeks pregnant now and definitely enterring the home stretch. I have had a few midwife appointments that gave me the all clear and also got through my 28wk blood tests which confirmed that all is healthy including my clotting factors and most importantly my glucose levels. I think I was expecting to get bad news from these tests because I felt a massive relief when I found out that all was well. The only remaining concern now is that Beanette is breech but I have had some joy managing to turn her halfway to transverse for a couple of hours so I know she still has room to turn. Talking of which, that's something to share, some tips for turning breech babies.

- Spending time on all fours whilst circling your hips.
- An odd one is to be upside down in water e.g to do a head / hand stand in a swimming pool.
- Put your self in the position you want your baby to be in! Head down!
- The breech tilt is well known. Get a broad plank of wood, like an ironing board. Prop it at an angle against the couch or a chair. A few pillows stuffed around the base will help prevent tipping. Another pillow goes under your neck. The funny thing is next. Lie on the board with your head down and feet resting on either side of the board on the couch. Take a couple tries to get it right. Then remain on the board for up to 20 minutes, 3 times a day

- MobilityWalking is an excellent way to help baby turn and stay vertex. Walking creates movement in the pelvis which helps baby to turn as the mother’s upright stance provides more room making it easier to turn effectively. Regardless of which technique is used to turn baby, Mom needs to get upright, and stay in upright, active positions for at least 30 minutes a day to encourage baby to stay head down.
- Relaxation and Visualization. Relaxation is a very important component in allowing baby to turn. When you are upset or tensed up, so is your baby. Your baby can sense when something is wrong and will even turn to a breech position until you are ready, at which time the baby will often also turn to a vertex position. As mentioned above, it may be Mom’s fear of birth or an aspect of giving birth. Positive visualization combined with a relaxed mind and body can often be the first and only step needed. Some visualizations that have worked are:
- Imagine a helium balloon attached to the baby's foot, imagine the baby turning somersaults.
- Combined with deep-water immersion and handstands in the water, Mom can visualize the baby doing a forward somersault.
- Visualize baby not only un-engaging, but turning to the vertex, and re-engaging in a favorable position (be specific in your visualizations). The key to this is RELAXATION.
- Visualize the baby turning while practicing deep relaxation. Imagine the baby doing a front dive heading for the mom's backbone and then "splashing down" into the pelvis.
- Have dad tell the baby where to be and visualize this as he explains "talks" baby through the turn. It may be helpful to have a picture or pictures to help with knowing how and in what position is best.
- Sound/Light Therapy. An extension of visualizations is talking to your baby and sound therapy. In Childbirth Without Fear by Grantly Dick-Read, he "encourages the mother to talk to her baby, encouraging it to turn around...the baby may not understand the words, but the soothing tone of voice will ease any anxiety about shifting out of a disadvantageous position." An alternative is to "place earphones just above your pubic bone and play music for the baby. The theory is that babies can hear well and may move toward the music in order to hear better." Excerpt from Pregnancy, Childbirth and the Newborn by Simkin, Whalley & Keppler. You can also put a radio or cassette/CD player in your pants, near your pubic bone or you can also try between your knees when you are on the ironing board (see slant board techniques below). Nice sounds such as soothing music, your recorded voice or whale sounds are the best. Talk to the baby about turning. Partner can even speak close to mom, low down on her belly, to encourage baby to move towards the sound. In contrast, place headphones on Mom’s abdomen in the fundal area and played "headbanger" music. The baby went vertex very soon after. Presumably the baby didn't appreciate the music and turned to get away from it. A variation is to use a flashlight so the baby may move toward the light. You can start by shining the light at the top of your belly and then slowly moving it down to where you want the baby's head to be.
- Hypnosis. "Hypnotherapy may help pregnant women turn their breech baby around to the normal head-first, or vertex, position. A researcher at the University of Vermont, Burlington, used hypnosis with one hundred pregnant women whose fetuses were in the breech (feet-first) position between the thirty-seventh and fortieth week of gestation. The intervention group received hypnosis with suggestions for general relaxation and release of fear and anxiety. While under hypnosis, the women were also asked why their baby was in the breech position. The study, which appeared in the Archives of Family Medicine, reported that 81 percent of the fetuses in the hypnosis group moved to the vertex position, compared with 48 percent of the control group. Not surprisingly, hypnosis was most effective for the women motivated to use the technique." Natural Health magazine, November-December 1995
- Hot and Cold Therapy. In colder climates it’s believed that heat around the pregnant belly can encourage baby to turn. This can be done with a hot water bottle or warm compress, or a tub full of warm water. This helps to relax the stomach muscles, allowing baby the extra room to move. An excellent start to other breech turning techniques as this relaxes the stomach muscles, which makes other techniques more effective (See also deep water immersion, below). Cold therapy is also beneficial. Using the "Frozen peas" trick, have mom place a bag of frozen peas on her fundus, which is where the back of the baby’s head is, and the baby will move away from the cold. This can be done in conjunction with a warm bath, positioning, light therapy and other techniques.
- Aromatherapy. When in the (breech tilt) position, use a little sweet almond oil to massage your belly over the area of your baby's back using a firm but gentle pressure. Excerpt from Aromatherapy for Pregnancy and Childbirth by Fawcett. This would help relax the stomach muscles and encourage baby with the massaging strokes of your hand. Massage in the direction you want baby to turn.
- Homeopathy. As with all diagnosis, it is preferable to consult with a professional to ensure the correct remedy and dosage for each situation. First, check for underlying concerns.
Is fear causing tightness of the lower uterine segment and keeping the baby high? Ignatia Amara 30C, one tablet every two hours has proven effective for anxiety, depression from suppressed grief, anger or shock. If Mom has excess or not enough amniotic fluid, try homeopathic Natrum Muriaticum. Excess water may cause baby to float to a breech position. Mom can also eat lots of watermelon or cucumber with the seeds to reduce fluid as they are natural diuretics. Too little fluid will also be problematic as baby will not have enough buoyancy to turn. Pulsatilla, a well known homeopathic remedy that is used for breech and other mal-presentations as well as prolonged labour. Pulsatilla acts on the muscular walls of the uterus and stimulates their growth. Start as soon as you find out about the breech presentation, but no longer than four weeks prior to your due date as baby will have ample room to turn on his or her own prior to that, and likely will. Take in whatever dosage you have available and lower dosages simply repeat more often each day. Combine this with the breech tilt exercise at least twice a day for 10 minutes each time. Have Mom take one Pulsatilla tab before beginning the breech tilt. And finally, Bach Bougainvillea flower essence has been found to work really well for turning breeches. Although not technically a homeopathic remedy, I will include it in this category. This information from Guide to Homeopathic Remedies for the Birth Bag by Patty Brennan and Homeopathy for Pregnancy, Birth and Your Baby’s First Year by Miranda Castro
- Acupuncture and Acupressure. Acupressure or acupuncture (preferably with a professional) using the Bladder 67 point has been proven to turn breech babies. The Bladder 67 point is on the outside of the little toe on both feet, right next to the nail. To apply acupressure, rub and push your fingernail into this point.
- Moxibustion. Doctors in Italy and China use moxibustion, the application of heat from burning herbs to acupuncture points. Moxibustion is applied to the Bladder 67 and is an alternative to acupuncture or acupressure techniques. For a great article on how to do moxibustion for breech baby: www.birthinternational.com/articles/andrea13.html
- Webster’s Technique. The contemporary chiropractic technique used for turning breech or other adverse fetal presentation is called the "Webster In-Utero Constraint Turning Technique" or Webster’s technique after Dr. Larry Webster. Dr. Webster reports effecting successful version in 97% of breech presentations, documented successful versions by other chiropractors is 82%. The first step is to confirm presentation of baby and acquiring a maternal history of the pregnancy and other relevant factors is mandatory. When the baby is found to be in a breech presentation, the Mother is assessed clinically to determine, and correct, sacral alignment. The Mom then turns on her back and the baby’s location is determined in relation to her belly button. The trigger point for the rectus abdominus muscle is then found on the Mom’s left side and the chiropractors thumb is placed on this point. Pressure is exerted gradually and evenly straight down until the trigger point is found and pressure is maintained, but shifted slightly inward to isolate the broad ligament. As little as 3 to 6 ounces of pressure is often sufficient to induce relaxation of the trigger point. Pressure is maintained for a minimum of one to two minutes, more as necessary on evaluation of the trigger release, even up to 35 minutes. If little or no fetal movement is felt, some counter pressure with the opposite hand can be applied on the uterine wall opposite the side of the trigger point. Following the adjustment, Mom is again assessed for sacral alignment and in most cases the alignment is achieved. If not, another sacral adjustment is needed. Additional adjustments should not be performed on the same day as the Webster technique. As little as one procedure may work, but typically it can take from three to ten adjustments performed over a two to three week period. Thus it is important to initiate this technique as soon as possible and know that it is harder for the baby to move close to term.
- Pelvic Tilt and Slant-board Exercise. This is probably the most well known alternative breech turning technique. The position of your baby will dictate which position works best. If baby has his/her back to your front, the slant-board exercise is most effective. If baby has his/her back to your back, the beanbag or pelvic tilt exercise will be most effective. The baby’s back and head are the heaviest parts and these techniques use gravity to push the baby’s head into the fundus, tuck it and then do a somersault into the vertex position. Do this exercise on an empty stomach and discontinue for lightheadedness or shortness of breath. Realize that there will be some pressure exerted on the thorax (chest cavity) by the abdominal contents being pushed upward toward the mom's head. One question often asked about these techniques is, "wouldn't the heavier head keep the baby in that position?" These techniques do two very useful things. It helps to disengage the baby from the pelvis and When the baby's head comes up against the inside of the fundus, s/he is inclined to tuck his/her head and do a somersault into the vertex position.
- Slant-board Exercise: Lie on your back with your hips raised high on pillows or lie on an ironing board slanted at a 45-degree angle against a sofa. For lightheadedness you can us a small pillow under the right hip (if the "plank" is stable) to elevate some uterine pressure from the inferior vena cava (large vessel bringing blood back to the heart from the legs). This maneuver should not be tried if you have high blood pressure, heart problems or lung problems. Relax, breathe deeply, avoid tenseness. An alternative is for Mom to also use pillows on a flat surface to raise hips 12-18" above shoulders.
- Beanbag Chair or Pelvic Tilt Exercise: Made an indention for your tummy and lie down on your front, again with your head lower than your hips. An alternative to this is to adopt an all fours position and slowly lower your chest to the floor (knee chest position), again so your hips are higher than your head. (This looks like the position recommended for prolapsed cord).
If done 10 minutes twice a day for 2-3 weeks after the 30th week the pelvic tilt had an 88.7-96% success rate in 744 patients. It is recommended that the pelvis be raised 9-12 inches above the head and be done on an empty stomach. OB/GYN News Vol12, No.1. You need to do this several times a day for 10-15 minutes and you have to be persistent, as they do not usually turn on the first try. If the baby does turn, stand up slowly and talk a long walk or do some squats to try to help the baby settle into the vertex position.

In conclusion, there are many decisions to be made. The Mother and her partner can only determine which choice, or choices, are best, though it can be greatly influenced by her caregiver. I sincerely hope these decisions have been made easier though the information I have provided in this article, and I wish you and your baby a great birth experience!

Are there any safe and proven methods to turn a breech baby?
Expert: Marie McDonald, RGN, RM, ADM, MBA (Health) [See Biography]
Question: Are there any safe and proven methods to turn a breech baby?
Marie McDonald: A baby is breech when her bottom, foot or feet — instead of her head — are presenting in the lower part of the uterus (womb). Your midwife or doctor should be able to tell if your baby is breech or not by feeling your bump. Up until 32 weeks gestation about 15 per cent of babies lie this way, but by 37 weeks the number is down to about three or four per cent. Many breech babies spontaneously turn around before, or even during, labour without any assistance. Many babies who remain in the breech position can be turned by hand, using a technique called external cephalic version (ECV). This technique has been practised by doctors for thousands of years and a lot of research has been carried out to test its safety. The results have been so positive that the Royal College of Obstetricians now recommends that: 'All women with an uncomplicated breech pregnancy at term (37-42 weeks) should be offered ECV.'
ECV is generally carried out when you are close to your due date. Sometimes, it is even carried out at the beginning of labour. You will not need to have a general anaesthetic. The procedure will be carried out in hospital, where there is equipment to monitor your baby's heartbeat and ultrasound. You will be given a drug to help make the muscles of your womb relax and, if you are Rhesus negative, you will have an injection of anti-D. Because ECV is very often successful, a policy of offering it to every woman with a breech baby means that there will be far fewer caesareans for breech babies. ECV is more likely to be successful if:
• this is not your first baby
• there is plenty of water round the baby
• your baby has not yet descended into your pelvis.

Turning techniques you can do at home are collectively referred to as spontaneous cephalic version. Some trials have been conducted to determine the effectiveness of these various methods, but more study is required before we can really be sure how well they work.
In one study of 71 breech babies, 65 turned when their mother adopted the knee-chest position. To do this, kneel on your bed with your bottom in the air and your hips flexed at slightly more than 90 degrees (don't let your thighs press against your bump). Try to keep your head, shoulders, and upper chest flat on your mattress. Maintain this position for 15 minutes every two waking hours for five consecutive days. Alternatively, try lying on your back with your hips slightly elevated and your hips and knees flexed. Gently roll from side to side for 10 minutes and repeat this manoeuvre three times a day. If you have had any backache, pelvic pain or hip pain during your pregnancy, do talk to your midwife or physiotherapist before you try this. Finally, moxibustion is a form of acupuncture which is currently being researched to see if it could help turn breech babies. Some therapists claim an 80 per cent success rate, but before trying it, seek advice from a qualified acupuncturist — you'll find one via the British Acupuncture Council.

At the end of the day it might be that your baby prefers to lie in the breech position. But if this is the case it does not mean you are automatically in line for a caesarean section. Discuss the possibility if having a normal delivery with your midwife and obstetrician.

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