By Richard Kramer

Having worked with babies for many years I am interested to learn more about how a breech birth can affect a baby’s development.  Born with their buttocks, feet, or knees emerging first, breech babies are relatively rare, comprising one in 200 births in the UK.¹

Although breech presentation is common in early pregnancy, most babies will have turned into the head first position by 36 to 37 weeks of pregnancy.  However, there are several factors that may make it more difficult for a baby to turn.  These include: a first pregnancy; a low-lying placenta (placenta praevia); too much or too little amniotic fluid; a multiple pregnancy.²  Of those babies still presenting as breech most are delivered via an elective or emergency caesarean section due to the risks involved with a vaginal birth.¹

I estimate that over a twenty-five-year period, I have seen no more than half a dozen babies born in breech position.  Nevertheless, from my professional experience, I feel that there could be a trend for those born breech to develop more slowly post-partum.  By this, I mean they show little desire to engage with their surroundings and seem to be in an emotionally ‘stuck place’.  Their confidence is stilted, they’re generally unhappy and need to feel safe in their parent’s arms for most of their time.

Of course, these characteristics are common to all babies who have experienced and are suffering from severe birth trauma but my experience, albeit very limited, suggests that birth trauma is generally worse with breech presentation.  This is illustrated by a baby I saw recently, who, at eight weeks, was still showing overt signs of colic, reflux, sleeplessness and a strong need to be held.  Although these symptoms are associated with general birth trauma, I wouldn’t expect these aspects to be so prevalent at eight weeks.

I suspect that the cause of the increased trauma originates in the slower speed of the birth and the powerful uterine contractions, which will be more direct and stronger on the cranium.

With caesarean births, my experience is that the fast process creates extra trauma, due to the sudden exit from the uterus. Inevitably the baby emerges in a shocked state, screaming and angry. In addition, caesarean craniums typically present with palpable compactness together with a flattened occiput, both of which may further compromise the baby.

A survey of online literature reveals further complications that could contribute to a breech baby’s trauma.

It appears that a breech baby is more likely to have their umbilical cord wrapped around their neck.³  Arguably, this possibly could give rise to some degree of oxygen deprivation as well as applying pressure to the sympathetic nervous system along the cervical ganglia and activating a fight or flight response.

Also, babies who are breech in the last three months of pregnancy are more likely to have developmental hip dysplasia, a condition where the ball and socket joint of the hip does not properly form.  While it can self-correct, in cases where symptoms persist, different interventions may be offered to correct the condition.  While practical, they impose restrictive tension on the baby’s pelvis and legs, which are likely to leave an imprint.⁴

Additionally, breech presentation can result in brachial plexus palsies, most commonly Erb’s Palsy, which presents as weakness, restricted movement or paralysis in one arm and loss of feeling or numbness.  Intracranial haemorrhage is also possible and risk factors include excessive moulding of the head in prolonged labour, breech delivery and use of forceps.⁵

I initially asked fellow CST practitioners about their experiences of treating breech babies but, given the rarity of seeing a breech baby, I have now extended my enquiry to include a wider audience.  If you have experienced a breech pregnancy or birth or have any thoughts or comments I would be delighted to hear from you.  Please reply to: editor@craniosacral.co.uk.

Richard Kramer is author of ‘Listening to Babies: An Empathetic Guide for Craniosacral Practitioners’.

References:
1. www.kcl.ac.uk/news/new-algorithm-to-increase-breech-birth-safety
2. Breech baby at the end of pregnancy patient information leaflet | RCOG
3. breechbirth.org.uk/2021/06/02/nuchal-cord-and-the-breech/
4. www.stepsworldwide.org/conditions/hip-dysplasia-ddh/
5. Ojumah N, Ramdhan RC, Wilson C, Loukas M, Oskouian RJ, Tubbs RS. Neurological Neonatal Birth Injuries: A Literature Review. Cureus. 2017 Dec 12;9(12):e1938. doi: 10.7759/cureus.1938. PMID: 29464145; PMCID: PMC5811307. www.ncbi.nlm.nih.gov/pmc/articles/PMC5811307/

The opinions expressed in this article are those of the author and do not necessarily reflect the viewpoints of the CSTA.