Monday, November 19, 2012

Alternative Modalities For Turning the Breech Baby: Heads Up! Breech Conference

Day 3 

Alternative Modalities for turning the breech baby

Marie Julia Guittier: Hypnosis for pain control during ECV
Marie Julia, a midwife & PhD candidate from Switzerland, led a study looking at hypnosis for controlling pain associated with ECV. From an earlier study, they found most women would recommend ECV, but many found the pain to be severe (27%) or excruciating (4%). She and her research partners wanted to know if hypnosis can reduce pain during ECV. They compared 122 standard care women with 63 having hypnosis during the ECV. They didn’t observe any statistically significant differences in women’s perceptions of pain. Success rates did not improve with the hypnosis group. Physicians had mixed evaluations of hypnosis; most (72%) thought hypnosis facilitated the ECV, although some did not.

Lindsey Vick: Hypnosis to turn breech babies
Lindsey Vick is a hypnotherapist and Reiki practitioner from Virginia. She referred to a study by L.E. Mehl examining using hypnosis to turn breech babies. There were 100 women in the hypnosis group and 100 women in the control group, matched for obstetrical & sociodemographic characteristics. Women in the study were between 37-40 weeks gestation. 81% of breech babies in the hypnosis group turned, vs 48% of comparison group. She started collecting data on women whose breech babies she was encouraging to turn using hypnosis. For more information, see Mehl LE. Hypnosis and conversion of the breech to the vertex presentation. Arch Fam Med. 3.10 (Oct 1994): 881-7.

JoseLo Gutierrez: Moxibustion
JoseLo is an acupuncturist in the DC area. He spoke about moxibustion for turning a breech baby. It can be used on all toes, but the little toe is the most effective. It can also be combined with massage, essential oils, and hypnosis.

Nancy Salgueiro: Chiropractic to prevent & turn breech presentations
Nancy is a prenatal and pediatric chiropractor in Ontario and is Webster’s certified. She briefly explained the main approach & goals of chiropractic care: to ensure that the brain is communicating effectively with the body via the nervous system. She then discussed the bio-mechanical connections (ligaments) between the uterus and the pelvis. If there are misalignments in the pelvis, the ligaments will pull on the uterus and not give the baby as much space to grow, develop, and maneuver. Webster’s Technique is a chiropractic technique that can be used for anyone. For pregnant women, it’s often used for helping a breech baby turn by adjusting the sacrum and by relaxing the round ligaments in the front of the uterus. It involves no direct manipulation on the baby.

She referred to a retrospective study in the Journal of Manipulative and Physiological Therapeutics that found Webster's technique effective in helping breech presentations turn. (I think that this study has a lot of methodological flaws; I'd like to see a better designed prospective study with matched control groups. On the other hand, chiropractic care is unlikely to cause harm, so the only real downfalls of trying Webster's during pregnancy is the cost.)

Nancy recommends starting Webster’s as early as 34 weeks to have time to get the pelvis balanced. Don’t put it off till the last minute. You can also do this before an ECV to keep the baby from flipping back to breech after it’s turned.

Adrienne Caldwell, Massage Therapy
Adrienne is a bodyworker and massage therapist certified to work with pregnant and postpartum women. After her first baby was breech, she started focusing on helping women with malpositioned babies. She agrees with Nancy to start early and ensure you have a balanced, dynamic body.

My thoughts on this session: 
Women with breech babies are highly motivated--often desperate--to encourage their babies to turn. I've heard numerous stories of women who tried everything to turn their breech baby: inversions, handstands or flips in a pool, ice packs on the abdomen, music played near the pubic bone, knee-chest positioning, chiropractic, hypnosis, moxibustion, ECV, and more. The evidence for some of these modalities is weak. On the other hand, these techniques are unlikely to cause harm. I'd love to see vaginal breech birth a real option for all women, but in the meantime I'd also like to see more quality research on what really works to turn breech babies. With vaginal breech birth being out of reach of most North American women, turning the breech baby is often the last chance to have a vaginal birth.


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