How Leisure in our Culture Affects Breech Presentation

It is pretty well known America has one of the highest cesarean rates out of all other countries. I have spent a lot of time in Doula literature, exploring why other countries seem to have more success with Vaginal births. It would be ignorant not to acknowledge that Cesareans in America are expertly executed in times when it is most necessary. For that, I am grateful for the lives saved in emergency situations. However, I can’t help but wonder if American providers are a bit “incision happy.” I’ve heard countless stories from women about their providers quickness to take them into the OR when it was not medically necessary. While there is an abundance of reasons a provider might be “incision happy,” I have thought a lot about how leisure in our day-to-day life prepares us to jump right in when a provider offers a cesarean.

In one of my recent blog posts, I mentioned Breeched babies after 36 weeks being a reason a 39 week cesarean is often scheduled. A breeched baby is a baby that is not head down and is misaligned with the cervix in the womb. Some babies are chilling in a hammock position, others are head up, and some are just still doing all sorts of tricks while they have the space. The typical concern is that if the baby is Breeched at 36 weeks, as they run out of room they will remain stuck in that position and will not be able to engage into the pelvis for a normal vaginal birth. This is why the OB will often quickly schedule a 39 week cesarean.

When navigating a situation like this, it is important to first consider why a baby may be in a breech position. While there is limited scientific evidence to fully support this idea, I believe lifestyle factors play a significant role in the United States.

Much of our daily routine involves prolonged periods of sitting in highly comfortable, supportive positions. For example, many people spend hours in cushioned office chairs, followed by time in slightly reclined car seats during commutes. At home, this often continues with lounging in soft recliners while watching television or using mobile devices. Even during sleep, memory foam mattresses allow for a wide range of wonky, but comfortable, positions.

While these conveniences promote comfort, they may not support optimal fetal positioning. Many of the chairs and resting surfaces we use encourage a posterior-tilted pelvis or slouched posture, which could potentially influence how a baby settles in the womb. In contrast, more active lifestyles or upright postures may better support ideal positioning (think of European countries where they bike or walk everywhere, spend less time in an office and commuting, and often have a variety of social gatherings to attend to in their free time rather than losing themselves in their devices.

I think it is important to start these practices early, but an active lifestyle, spending more time on the floor or standing (rather than in chairs), and making a strong effort to have good posture can make a huge difference in how baby settles in the womb. Things like prenatal yoga (promoting a lot of all-four/inverted positions) helps create space in the womb and is excellent for keeping your pelvis flexible to allow baby space to move down. Walking also encourages baby into a head down position due to the gentle rocking of the pelvis (and helps baby go to sleep in the womb!) Finally, how we sit REALLY matters.

Pregnant women should make conscious efforts to avoid recliner chairs by promoting upright/forward leaning positions as often as possible. For example, you can adjust your seat in the car to push you forward and have your knees be slightly lower than your hips. If you want to lounge on the couch, you can do a left side-lying position and stack a couple pillows between your thighs, or you can sit on a birth ball or yoga bolster on the floor. Sitting on the floor or on a birth ball also helps support core muscles to hold a strong posture as baby gets bigger. Avoiding crossing your legs or sitting in wonky positions (ask your husband or family members/friends/coworkers to help call you out if you’re sitting strange.) I also recommend changing positions as often as possible (sitting to standing if your lifestyle allows.)

Something important to note is that it is still relatively common for babies to be breeched at 36 weeks (even if you’ve had an active lifestyle) affecting 3-5% of American women between 36-39 weeks. If you have a good provider, they should tell you ways you can work with your body to help the baby flip head down. Some babies don’t flip down until shortly before their due date! So, a good provider should tell you there is still plenty of time for baby to flip and they should let you know a variety of options to help them flip. An ECV is a medical procedure used to flip a breech or transverse baby to a head-down position, usually performed around 36–38 weeks. Doctors apply manual pressure to the outside of the abdomen to turn the fetus. This approach typically has a 50% success rate.

There are a LOT of natural ways to help baby flip that are recommended and can be found on Spinning Babies Website. We will discuss those techniques in depth in a later post.