Hello, my name is Brenda Minica. I am a San Antonio doula certified with Childbirth International.

Having had eight children of my own I have "been there" and I know how helpful a little encouragement and the right information can be. Even if you don't need a doula in San Antonio, TX right now I would love to help you in whatever way I can!

So please e-Mail me, or connect with me on Facebook if I can be of service.

With love, Brenda


Apr
25
2009
0

Turning a Breech Baby

1.    First of all, make sure you are drinking PLENTY of fluids to maximize the amount of amniotic fluid in the uterus. This helps the baby have more room to turn.
2.    Visualize your baby turning into the correct position. Talk to your baby. Prayer, communication with your baby and positive thinking can do wonders!
3.    Postural inversion, lie on a slanted board or with pillows under your hips for about 20 minutes, three times a day. You want your hips to be elevated 12-18 inches higher than your head.
4.    If you have access to a warm pool, do a headstand in the pool with someone there to help you. Do this several times and on several occasions if possible.
5.    Shine a bright flashlight onto your belly directly above the pubic bone. Put the flashlight directly on your skin!
6.    Put a frozen bag of peas (or another ice pack) at the top of your uterus, directly on the baby’s head if possible. You can do this at the same time as when you’re using the flashlight. Babies tend to move away from cold things and toward light.
7.    Another idea is to have Daddy talk to the baby with his mouth down in the same place where the flashlight is. Or put a small radio with music right in that spot. Any combination of these things can be done at the same time to maximize the effect.
8.    If the above tricks don’t work with Mom lying comfortably, try doing them with Mom on her hands and knees. Do the “pelvic rock” while in this position as well. This brings the baby up and out of the pelvis, giving it more room to turn.
9.    Find a chiropractor experienced in “The Webster Technique” for turning breech babies. I can recommend a good chiropractor if you’re interested.
10.    Ask your doctor about doing an external version if the baby is still breech at 36 weeks. Ask what his/her success rate is with this procedure.
11.    If you are successful in turning your baby to the correct position, keep it that way by sitting tailor style on the floor as much as possible from then on. Avoid sitting in lazyboy type chairs – you always want to keep your knees below your hips. This sitting position is a good idea to encourage baby to turn also.

*This is my midwife’s advice: Chiropractor first, then if that doesn’t work, use the slant board, swimming, and pulsatilla (homeopathic remedy.)

*This information is for informational purposes only. Contact your medical caregiver for diagnosis and treatment.

Author: Brenda Minica, CD (CBI)  – All rights reserved.

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Mar
03
2009
0

Breech Presentation Fact Sheet

Breech Presentation Fact Sheet

What is Breech Presentation?

 

  • Breech presentation is the most common human malpresentation and occurs in 3-4% of all term pregnancies.1
  • Three types of breech presentation occur: Frank (baby’s hips are flexed and knees extended bilaterally) , Complete (baby’s hips and knees are flexed bilaterally), and Incomplete (baby may present with one or two feet – ‘footling’- or one knee extended and the other flexed with hips flexed).2,3
  • Early in pregnancy about half of all babies are breech presentation.4 Babies continue to turn to cephalic presentation throughout all weeks of pregnancy.1

 

 

What Causes Breech Presentation?

 

  • Only about 15% of breech presentations have an identifiable etiology.5
  • Established risks for breech presentation are: Previous breech presentation pregnancy,5,6,7,8 Late or lack of antenatal care,8,9 Prematurity (<37 weeks gestation),6,7,8 Comparatively lower birth weight,8,9 and Congenital anomalies.8,9,10

 

 

Recent Rates of Vaginal Delivery for Breech Presentation By Country

 

  • Japan 56%.11 Findings: Poor outcome 1.2% vaginal delivery : 0.0% cesarean
  • Sweden 52%.12 Findings: No statistically significant difference between vaginal birth and cesarean section babies for perinatal/neonatal outcomes.
  • Norway 40%.13
  • Finland 39%.14 Findings: Less birth trauma for vaginal breech deliveries than vaginal vertex deliveries. More trauma for breech vaginal delivery than breech CS, but lower long-term morbidity for breech vaginal than breech cesarean deliveries. Breech vaginal death 0.07%, vertex vaginal delivery death 0.02%.
  • Sweden 37%.15 Findings: Infant mortality, birth injury and convulsions higher for breech vaginal birth than breech CS
  • Ireland 23%.16 Findings: No nonanomalous perinatal deaths, significant trauma, or neurological dysfunctions for vaginally or CS delivered breech babies.
  • Denmark 15.3%.17 Findings: Higher rates of puerperal fever and pelvic infections for CS breech delivery.
  • California 4.9%.18 Findings: Neonatal mortality, asphyxia, brachial plexus injury, and birth trauma higher for vaginally delivered breech than CS. If woman had a previous vaginal delivery no difference in neonatal mortality by delivery mode.
  • Canada <5%.19

 

 

Other Research on Breech Presentation Outcomes by Delivery Method

 

  • Meta analysis 1: 24 studies published between 1966-199220
    Findings: Higher perinatal mortality, traumatic morbidity, short-term morbidity, and long-term morbidity in vaginal delivery than in CS for breech presentation. Lower maternal morbidity and mortality for vaginal delivery of breech.
  • Meta analysis 2: nine randomized trials or cohort studies published between January 1981 to June 199321
    Findings: No statistically significant difference between infant mortality and morbidity between vaginal and CS delivery of breech presentation.
  • Term Breech Trial: randomized controlled clinical trial in 121 centers in 26 countries and included 2088 women with term singleton breech pregnancies who were randomly assigned to give birth vaginally or by cesarean section22
    Findings: Perinatal mortality, neonatal mortality, and serious neonatal morbidity higher for vaginal breech delivery than for CS in countries with low levels of infant mortality. No difference in infant outcomes by delivery method in countries with high infant mortality. No difference in maternal morbidity and mortality by delivery mode.

 

 

Turning Options

 

  • External Cephalic Version (ECV) after 37 weeks has a success rate of 35% – 86% while spontaneous version occurs in 22%.23,24 Women who have successful ECV are at higher risk of having cesarean deliveries than are women with vertex presentation babies who did not have ECV.25
  • Moxibustion or ginger paste applied close to the acupuncture point Bl 67. Small studies show a success rate of 66.6%-92%.26-32
  • Other less studied options: Homeopathic formulas pulsatilla and natrum muriaticum,33-36 Gentle chiropractic treatments: Webster’s technique or Bagnell system,37,38 Hypnosis,39 Playing music over the maternal abdomen.40,41

 

 

Overview

 

  • Morbidity and mortality for breech infants and mothers is most related to inclusion and exclusion criteria adhered to by the hospital for determining mode of delivery, the competence of the attending physician, and the expectation of the mother rather than the mode of delivery.
  • In general countries that perform more vaginal breech births have birth outcomes that are as good as or better than cesarean section outcomes. Countries that perform few vaginal breech births have birth outcomes that are worse than those for cesarean section births.
  • In many countries breech vaginal birth has higher morbidity and mortality risks for babies, but the risk is still relatively low.
  • Some of what has been typed as risk (e.g. low Apgar scores) is clearly not a long-term risk.
  • Much of what has been typed as risk can be ameliorated by proper screening for vaginal birth.
  • If you want to have a successful vaginal birth look for an old-time doctor or someone with a lot of experience with breech presentation.
  • If you have a macrosomic baby or a footling breech cesarean may be better for you.
  • To have a successful vaginal birth avoid induced or augmented labor and epidurals.
  • If you are going to have a cesarean, consider having a scheduled cesarean without trial of labor.

 

 

References Cited

 

1. Hickok, D. E., Gordon, D. C., Milber, J. A., Williams, M. A., & Daling, J. R. (1992). The Frequency of Breech Presentation by Gestational Age at Birth: A large Population-Based Study. American Journal of Obstetrics and Gynecology, 166, 851-852.
2. Bennett, V. R., & Brown, L. K. (1999). Myles Textbook for Midwives.
3. Cruikshank, D. P. (1999). Malpresentation and Umbilical Cord Complications. In J. R. Scott, P. J. Di Saia, C. B. Hammond & W. N. Spellacy (Eds.), Danforth’s Obstetrics and Gynecology. (8th ed., pp. 419-436). Philadelphia: Lippincott, Williams & Wilkins.
4. Zhang, J., Park, M., & Reddy, U. (2004). Natural history of Fetal Position During Pregnancy and Risk of Breech Delivery. American Journal of Obstetrics & Gynecology, 191(6, Supplement 1), S169.
5. Luterkort, M., Persson, P.-H., & Weldner, B.-M. (1984). Maternal and Fetal Factors in Breech Presentation. Obstetrics & Gynecology, 64(1), 55-59.
6. Albrechtsen, S., Rasmussen, S., Dalaker, K., & Irgens, L. M. (1998a). The Occurrence of Breech Presentation in Norway 1967-1994. Acta Obstetricia et Gynecologica Scandinavica, 77, 410-415.
7. Albrechtsen, S., Rasmussen, S., Dalaker, K., & Irgens, L. M. (1998b). Reproductive Career After Breech Presentation: Subsequent Pregnancy Rates, Interpregnancy Interval, and Recurrence. Obstet Gynecol, 92, 345-350.
8. Amoa, A. B., Sapuri, M., & Klufio, C. A. (2001). Perinatal Outcome and Asoociated Factors of Persistent Breech Presentation at the Port Moresby General Hospital, Papua New Guinea. Papua and New Guinea Medical Journal, 44(1-2), 48-56.
9. Roberts, C. L., Algert, C. S., Peat, B., & Henderson-Smart, D. (1999). Small Fetal Size: A Risk Factor for Breech Birth at Term. International Journal of Gynecology & Obstetrics, 67, 1-8.
10. Rayl, J., Gibson, J., & Kickok, D. E. (1996). A population-Based Case-Control Study of Risk Factors for Breech Presentation. American Journal of Obstetrics and Gynecology, 174, 28-32.
11. Koike, T., Minakami, H., Sasaki, M., Tamada, T., & Sato, I. (1995). The Problem of Relating Fetal Outcome with Breech Presentation to Mode of Delivery. Archives of Gynecology and Obstetrics, 258, 119-123.
12. Hellsten, C., Lindqvist, P. G., & Olofsson, P. (2003). Vaginal Breech Delivery: Is It Still and Option? Obstetrics and Gynecology, 111, 122-128.
13. Haheim, L. L., Albrechtsen, S., Berge, L. N., Bordahl, P. E., Egeland, T., Henriksen, T., et al. (2004). Breech Birth at Term: Vaginal Delivery or Elective Cesarean Section? A Systematic Review of the Literature by a Norwegian Review Team. Acta Obstetricia et Gynecologica Scandinavica, 83, 126-130.
14. Ulander, V.-M., Gissler, M., Nuutila, M., & Ylikorkala, O. (2004). Are Health Expectations of Term Breech Infants Unrealistically High? Acta Obstetricia et Gynecologica Scandinavica, 83, 180-186.
15. Roman, J., Bakos, O., & Cnattingius, S. (1998). Pregnancy Outcomes by Mode of Delivery Among Term Breech Births: Swedish Experience 1987-1993. Obstetrics and Gynecology, 92, 945-950.
16. Alarab, M., Regan, C., O’Connell, M. P., Keane, D. P., O’Herlihy, C., & Foley, M. E. (2004). Singleton Vaginal Breech Delivery at Term: Still a Safe Option. Obstetrics and Gynecology, 103(3), 407-412.
17. Krebs, L., & Langhoff-Roos, J. (2003). Elective Cesarean Delivery for Term Breech. Obstetrics and Gynecology, 101(4), 690-696.
18. Gilbert, W. M., Hicks, S. M., Boe, N. M., & Danielson, B. (2003). Vaginal Versus Cesarean Delivery for Breech Presentation in California: A Population-Based Study. Obstetrics and Gynecology, 102, 911-917.
19. Nevo, O., Berger, H., Walsh, S., & Farine, D. (2004). Effect of Large Trials on Clinical Practice – The Term Breech Trial. American Journal of Obstetrics and Gynecology, 191(6, Supplement 1), S80.
20. Cheng, M., & Hannah, M. E. (1993). Breech Delivery at Term: A Critical Review of the Literature. Obstetrics & Gynecology, 82, 605-618.
21. Gifford, D. S., Morton, S. C., & Kahn, K. L. (1995). A Meta-Analysis of Infant Outcomes After Breech Delivery. Obstetrics & Gynecology, 85, 1047-1054.
22. Hannah, M. E., Hannah, W. J., Hewson, S. A., Hodnett, E. D., Saigal, S., & Willan, A. R. (2000). Planned Caesarean Section Versus Planned Vaginal Birth for Breech Presentation at Term: A Randomised Multicentre Trial. The Lancet, 356, 1375-1383.
23. Hofmeyr, G. J., & Kulier, R. (2002). External Cephalic Version for Breech Presentation at Term (Cochran Review).Unpublished manuscript, Oxford.
24. Lau, T. K., Lo, K. W. K., Wan, D., & Rogers, M. S. (1997). Predictors of Successful External Cephalic Version at Term: A Prospective Study. British Journal of Obstetrics and Gynaecology, 104, 798-802.
25. Vezina, Y., Bujold, E., Varin, J., Marquette, G. P., & Boucher, M. (2004). Cesarean Delivery After Successful External Cephalic Version of Breech Presentation at Term: A Comparative Study. American Journal of Obstetrics and Gynecology, 190, 763-768.
26. Cardini, F., Basevi, V., Valentini, a., & Martellato, A. (1991). Moxibustion and Breech Presenation: Preliminary Results. American Journal of Chinese Medicine, XIX(2), 105.
27. Cardini, F., & Hauang, W. (1998). Moxibustion for Correction of Breech Presentation: A Randomised Controlled Trial. Journal of the American Medical Association, 280(18), 1580-1584.
28. Cardini, F., & Weixin, H. (1998). Moxibustion for Correction of Breech Presentation. Journal of the American Medical Association, 11, 1580-1584.
29. Cooperative Research Group of Moxibustion Version of Jangxi Province. (1980). Studies of Version by Moxibustion on Zhiyin Points. In Z. Xiangtong (Ed.), Research on Acupuncture, Moxibustion and Acupuncture Anesthesia (pp. 810-819). Beijing, China: Science Press.
30. Cooperative Research Group of Moxibustion Version of Jangxi Province. (1984). Further Studies on the Clinical Effect and the Mechanism of Version by Moxibustion.Unpublished manuscript, Beijing, China.
31. Cai, R., Zhou, A., & Gao, H. (1990). Study on Correction of Abnormal Fetal Position by Applying Ginger Paste at Zhihying Acupoint. A Report of 133 Cases. Zhen Ci Yan Jiu, 15(2), 89-91.
32. Qin, G. F., & Tang, H. J. (1989). 413 Cases of Abnormal Fetal Position Corrected by Auricular Plaster Therapy. Journal of Traditional Chinese Medicine, 9(4), 235-237.
33. Baylies, B. L. (1890). Pulsatilla in Malposition of the Fetus. In IHA Transactions (pp. 133-146).
34. Farrington, E. A. (1988). Clinical Materia Medica. New Delhi: B. Jain Publishers.
35. Simkin, P. (1983). Turning a Breech Baby to Vertex. Minneapolis (MN): ICEA/Pennypress Publications.
36. Weed, S. (1986). Wise Woman Herbal for the Childbearing Year. Woodstock, NY: Ash Tree Publishing.
37. Bagnell, K. (2004). The Bagnell System for Breech Presentation. Today’s Chiropractic, 36-44.
38. Pistolese, R. A. (2002). The Webster Technique: A Chiropractic Technique with Obstetric Implications. Journal of Manipulative and Physiological Therapeutics, 25(6), E1-9.
39. Mehl, L. E. (1994). Hypnosis and Conversion of the Breech to the Vertex Presentation. Archives of Family Medicine, 3(10), 881-887.
40. Johnson, R. L., & Elliott, J. P. (1995). Fetal Acoustic Stimulation, an Adjunct to External Cephalic Version: A Blinded Randomised, Cross-Over Trial. American Journal of Obstetrics and Gynecology, 173(50), 1369-1372.
41. Johnson, R. L., Strong, T. H. J., Radin, T. G., & Elliott, J. P. (1995). Fetal Acoustic Stimulation as an Adjunct to External Cephalic Version. Journal of Reproductive Medicine, 40(10), 696-698.

 

 

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