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Breech Presentation and a Balanced Pelvis

It seems to be a trend in my life and practice right now to come in to contact with pregnant women whose babies are presenting breech. Most of what I do as a prenatal chiropractor is to simply help women have healthier and more comfortable pregnancies and deliveries, but every once in a while, I get a chance to put my skills to the test and really show these mamas the "magic" of chiropractic.

Although I guess I should start by saying.... it isn't magic.

What I do in helping women get their breech babies to turn is exactly the same thing that I do for all my other mamas whose babies never turn head up. But I thought I'd write today about the Webster Technique, what it is, and why it works, to possibly help a mama wondering if chiropractic care is right for her to make an informed decision.

Webster technique was created by Dr. Larry Webster in the 1980s, in response to watching his daughter's long and arduous labor with her daughter. He wanted to find a way to use chiropractic care to balance a woman's pelvis and in turn help them have shorter and less complicated labors. Once he began using his newly discovered technique, he quickly realized that it also did something else - when women presented with babies not in optimal position, the babies would turn head down (vertex) after the mother began receiving care using this new technique.

The Webster Technique is simple - it makes sure that the bones, muscles, and ligaments of the pelvis are balanced. This balance allows the baby to have as much room as possible, allowing it to move into position for birth. Balance of the pelvis has the added bonus of decreasing pain and discomfort that the mother might be feeling during pregnancy as well. Here's how it works - chiropractors assess the pelvis to see whether or not the sacroiliac joints are moving correctly. Often, one of them is "stuck" and not moving as it should, which usually means that the other one is moving too much, to compensate. We then assess the sacrum to make sure that it is correctly positioned as well.

There are two uterine ligaments, the uterosacral ligaments, that attach from the uterus to the front of the sacrum. We obviously can't reach these ligaments to loosen them, but in correcting any malpositioned sacrum, we can effectively balance the uterosacral ligaments too. There are lots of muscles in the pelvic region, but the 2 we focus on most often are the piriformis and the iliopsoas (or psoas). (Find more information on those two muscles in my previous blog posts - piriformis and psoas.) Once the muscles are balanced, the next step is the release of the round ligaments. Unlike the uterosacral ligaments, the round ligaments are easily found and released on the front of the pregnant belly. Most practitioners will also check to make sure that the pubic bones are correctly positioned as well. That is a full Webster adjustment.

Babies WANT to be head down. If a baby is transverse (sideways) or breech (head up), there is always a reason. Most of the time the reason has to do with the mother's body and not the baby itself. This means that when the round ligaments, sacrum, pubic bone, and their surrounding muscles are balanced, the baby naturally turns into position for delivery. Sometimes, however, no matter what we try, a baby doesn't turn. In these cases, most of the time after delivery it is discovered that there was a reason for this inability to turn.

Today, I'm not going to get into my feelings on the dying art of vaginal breech birth, but I wanted to take a minute to discuss options when your OB or midwife determines that your baby is breech. I feel like more and more OBs are beginning to recognize the benefits of chiropractic care during pregnancy and to recommend it to their patients,

breech presentation or not. But many times the only option given to a pregnant mom whose baby is breech is an external cephalic version (ECV for short), and if that doesn't work, a scheduled c-section. Many women are devastated by this pronouncement, especially if they had their hearts set on a vaginal birth. The success rate for ECVs is 58%, but this number includes those baby that are successfully turned head down during the procedure but then return to breech presentation before delivery. The greatest risk associated with an ECV is a temporary change in the baby's heart rate, which happens about 5% of the time. Other risks (that happen way less often, but are more severe) include rupture of amniotic sac, vaginal bleeding, and umbilical cord prolapse, all of which will lead to an emergency c-section. Webster Technique, by contrast has an 82% success rate, and the only risk I could find that is associated with Webster technique adjustments is some possible soreness post-adjustment.

I have given you lots of information on how to help your breech baby to turn, but wouldn't it be nice if you didn't ever have to deal with a breech presentation at all? Here are some tips for getting baby into optimal position early, and helping him stay there.

1. Start with chiropractic care - obviously this is my first suggestion. But seriously, not only will it help you stay active and pain-free throughout your pregnancy, it will also allow baby to get into position from the start.

2. Exercise - sitting (especially on super soft surfaces like the couch!) is your worst enemy when it comes to optimal baby position during pregnancy. You need to exercise regularly, even if that is just walking for 30 minutes per day. Prenatal yoga is great, as is swimming. Be careful not to over-exercise though! Too much high intensity exercise can cause your pelvic floor muscles to become too tight, making it harder for baby to get out (which means a longer labor for you, and no one wants that!).

3. Spinning Babies - I can not say enough good things about and the exercises found there. They have so many good suggestions. If you're pregnant, you should definitely go spend some time on their site.

4. Sit correctly - as I said earlier, couches are no longer your friend. Any position that puts your spine into a "C" curve, curling your sacrum under, is bad. And if you have an office job and sit in a chair all day, you have some work to do. My advice would be to get a yoga ball to sit on at work, and one to sit on at home. Sitting on a ball helps your pelvis stay

balanced and open, allowing baby freedom to get into position and keeping the path open to the exit! And if you're going to be sitting for any length of time, you need to take a break and get up and walk around for at least 5 minutes every hour.

That's it for today! I'd love it if you'd share this post with the pregnant (or soon-to-be-pregnant) mamas in your life. And if you're dealing with a stubborn babe who won't turn head down, give me a call! I'd love to help you have the easiest birth possible.

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