Using PT to Reduce Breeched Position

By Melanie Llanes

Pelvic Health Physiotherapist

breech positionIn the US, approximately 7% of babies are in the breeched position in the third trimester with almost 94% of those babies delivered via cesarean section. This is due to the increased risk of mortality for the baby if vaginally delivered in a mal position. This is such an important fact and I always try and help moms mentally process unplanned cesareans because many times, a cesarean birth is definitely needed. However, I always wonder how many could have been avoided if they had pelvic physical therapy prior to delivery?

A breeched position is when the baby’s buttocks and/or feet are in place to come out first during birth, according to the American Congress of Obstericians and Gynecologists (ACOG). I tell moms that sometimes babies just know what position they like. A big part is, babies don’t like to be squished and will move into a position of comfort. Every single patient I have who always notices the baby kicks only on one side, always has tightness on the other side. As soon as she stretches it out and gets some body work, she starts to feel the kicks all over. Before 34 weeks, the kicks really should be all over because that tells me they have room to wriggle.

ACOG supports that sentiment by stating that multiples, an abnormal uterus shape or having fibroids that alter the uterus shape are some causes for a breeched position. Essentially, any time the baby does not have room indicates they could end up in a breeched position.
Being a pelvic PT and specializing in birth prep, I learned the components of an efficient pregnancy and delivery: Relaxed pelvic floor muscles, good hip and spine mobility, proper breathing mechanics and healthy coping strategies to deal with the stress of labor. When I meet moms whose babies have presented in a breeched position, there is always something off, if not multiple factors, that are not working efficiently.

Our bodies were designed for labor and yes, there are times where the baby really just does not want to turn, but there are no absolute predictive factors that say that we shouldn’t try! I strongly believe that environmental factors have contributed to breeched positioning- prolonged sitting, high stress jobs, and less activity. 

Pelvic PT breech positioningI had one client whose OB says there was no use in trying. Luckily, she took it upon herself to seek me out. We discussed how I couldn’t guarantee her baby would flip from frank position, but the work we could do would not be harmful to her or her baby. It would only help her feel more comfortable during her pregnancy. She was on board. 

Upon examination, she had such tight back muscles and her baby was sitting more forward. I performed tons of posterior hip and back body work as well as internal pelvic floor soft tissue mobilization to relax the muscles and encourage baby to descend into her pelvis. I provided her with exercises to maintain that movement. She also performed the spinning babies forward leaning inversion immediately after all the body work. The result after three sessions: a happy text from a mom whose baby was flipped.

Another patient’s baby was traverse and she had both side body and abdominal tightness. Body work enabled the release of her quadratics lumborum muscles.  We worked on strengthening her hip stabilizers to prevent her pelvic floor muscles from compensating and her lower back muscles from tightening back up again. It was a lot of pelvic rocking in multiple planes. Again, after 3 sessions, the baby moved. I will also say that this mom had multiple rounds of chiropractic care as well so it very well could have been a combination of both! But the point is–both moms had OBs who were warning them of possible c-section and neither recommended pelvic PT or any body work.

Why does our medical system jump to high risk medical procedures without attempting low risk techniques? At the end of the day, shouldn’t you have the chance to do what your body is naturally meant to do?

Dr. Melanie Llanes is a Doctor of Physical Therapy, a long time yoga teacher, and the owner of Best Self Wellness, providing concierge wellness services, specializing in elite orthopaedic and pelvic health PT, and prenatal and restorative yoga – all in the comfort of your own home.