Post-Mortem: How to Flip A Breech Baby

Episode 2 of “This Alien I Grew,” featuring every technique I tried (including external cephalic version)

Hi friends,

30 weeks into my pregnancy, I learned that my little one was butt-down — and that if nothing changed, I would need major abdominal surgery (and might not be able to leave my apartment for weeks). 

So, I read EVERYTHING I could find about how to flip a baby. Then, I read basically everything online about external cephalic version (ECV) — where a doctor physically flips the baby.

I put this together as a resource for others in my shoes. Also, it’s a dramatic ordeal. And it’s a testament to the way medicine shepherds pregnant people into unnecessary surgery for the worst reasons.

Note: if you are squeamish about chiropractors, acupuncture, needles, or medical procedures in general, please skip this one! And if you never want to hear about this podcast or anything pregnancy/parenting related again, you can unsubscribe from only the “This Alien I Grew” content via the unsubscribe menu. 

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Now, for a time capsule, written at 38 weeks pregnant — before we knew the sex, hence they/them pronouns:

Timeline

• Week 20 - baby happily head down. I felt morally superior. They put one more ultrasound on the books for 32 weeks, just to check the positioning, on March 27th. 

• The night before my ultrasound on March 27th… well, I had my SAT op-ed coming out.. I tossed and turned in bed. I was really stressed and worried about the feedback. I felt really intense movements. 

• March 27: my story dropped. I went in for my scan. “Your baby is transverse” they told me - they were lying sideways, no longer head down. I swore they had moved THAT NIGHT.

  • Here’s the scary part: if the baby is still sideways or breech, it is an automatic scheduled c-section. I did not want that. My mom had a horrific c-section experience with my brother; and I had done so much reading and research into trying to have an unmedicated vaginal birth.

  • At week 37, there’s a procedure they could offer me called an External Cephalic Version (ECV or simply “version”) where a doctor grabs the baby’s head and butt and physically flips them. 

  • Everyone said “oh there’s plenty of time to flip.” But omg. When? As a baby gets bigger, it gets harder and harder. I immediately booked the most recommended chiropractor, for the low low price of $450. 

• April 3rd: 

  • Got adjusted - felt like my pelvis had been pried open 

  • After: put a cold pack under my ribs. Put another cold pack on the upper right, where we thought the head was. Then we put a warm pack at my pubes. We left this for a while and while doing next steps

  • Spinning babies exercises (jiggle, leg release, tilt, inversion, etc) 

• April 4th:

  • I woke up and looked in the mirror. My bump seemed much more… vertical. I felt around and swore that the little one had moved - to HEAD UP. 

    

    

    I started having intense kicks that made me feel like my bladder would fall out of my body.

Month of April

• My days were filled with chiropractic appointments, then acupuncture. I did spinning baby exercises but then kept thinking the baby had flipped, deluding myself that the bowling ball under my ribs was a butt. 

• Byron built a DIY inversion table where I lay upside down every night. He would then shut his eyes and commune spiritually with our child while feeling for the butt in my pelvis and lifting it up. (Literally no one will recommend you do this. Don’t do this at home. But it didn’t hurt and it confirmed that the baby wasn’t fully wedged in there.) 

• I had felt pretty good since the first trimester. Now, I lay in bed crying — or honestly, wishing I could cry — telling Byron, “I’m so scared. I’m not ready.” I really did not feel ready at all.

Early May

Still no flip. I felt like they WANTED to flip. But they wouldn’t. 

I read about sabado de matriz. I spent $450 to pay Prince’s naturopath for a “mayan abdominal massage.” It did not flip the baby. 

As I lay with needles in me underneath a sign defining “Shangri-La”, I was overcome with a realization: I cannot make this child flip. Or do anything. Yes, I want to experience vaginal birth — but there will be dozens of things I want as a parent that I will not get. 

Still, I started reading everything I could about vaginal breech. 50 years ago, the vast majority of breech babies were delivered vaginally. But American doctors, essentially, stopped training in how to do it. Only a few remain - they have gray hair and tend to specialize in it. 

I called the OB in NYC who does it — she’d stopped delivering babies. I called one in New Jersey — they couldn’t get me on their schedule.

Finally, finally, I got to week 36 and was able to get on the calendar for an ECV. Statistically, there’s about a 50% chance it would work. Then, most of the time, you can go on to attempt a vaginal delivery.

If it didn’t work: I had a whole decision tree planned out. George Washington University has a breech vaginal birth program for people who’d had failed ECVs; we could decamp to D.C. for a few weeks to give birth. (FWIW, Mt. Auburn in Cambridge, Mass, also has an OB who does breech deliveries.) 

If it came to the C-Section, we would have to decide whether to schedule at 39 weeks, as suggested, or whether to wait it out to try and give the baby more time to flip. 

This is where my mode of decision making really became exhausting.

Most people would’ve made peace with a c-section much earlier. Today, it’s not really a big deal. Yes, my mom had a horrible experience — but that was more than 40 years ago. A bestie recently got a C and she’s feeling 100%.

In the days before my ECV, I was really down on myself: Why am I so stubborn? Why am I making this hard on myself? Why don’t I just accept these circumstances? I could’ve just skipped the acupuncture, the chiropractic, the stress. I felt like there was something defective in me for wanting a certain kind of birth.

May 6:

The night before the procedure, I went for a long walk with Byron (another trick to flip), talking this through. He was not as rattled as I was, since his attitude was: “We will take it one step at a time.” Good for him.

Although I'd been optimistic that the baby wanted to flip, that night I felt like there was about a 10 percent chance it would work. (Also, we saw someone overdose on the sidewalk and had to call 911 — thank God they woke up.) It was excruciating to inhabit a state where things could go such different ways: in one state of the world, I’d be on the express track to major abdominal surgery. In the other state, I’d be headed toward the path I wanted.

It took me straight back to when I was applying to college — I had no idea if I’d be close to home, going into debt, or if I’d get into a school that would totally transform my life. 

 It’s such a specific agony. And there’s no way around it. You just have to wait and see.

But I did realize: for me, it’s not over until it’s over. While we waited, I kept thinking about rowing races. You can win in literally the last 10 strokes. [Video.] The baby could flip the morning of the C-Section! Or when you go into labor. You don’t know. I can pitch a story 20 places — maybe the 21st place takes it. 

Is this a stressful way to live? Yes. Is it worth it to think this way? Who knows. Could I choose to be a different way? I’m not sure. At a certain point, this is who I am. I’m not going to magically become a different person when it comes to childbirth or parenting.

The morning of the ECV

We get in an Uber at 6 a.m. to get to the hospital before shift change. By 7:10 I’m hooked up to the fetal monitors and have an IV lock in my hand. My procedure is scheduled for 9. One of my stories came out at 5 am, so I try to promote it one-handed, since the IV thing hurts. Around 8, our midwife comes to join us.

My midwife suggested that we could ask if they could just give it a shot in triage, sans epidural, and see if it might work. And, if not, we could get the epidural and proceed. They agreed. 

Just after 9 am, two maternal fetal medicine doctors and a nurse came into my triage room. From there, it happened quickly, before I could get scaredscarred: the doctors checked that the head was still, in fact, up. A nurse came in with a little vial and warned me it would make me feel like I’d downed four shots of espresso; she shot it in my leg. The doctors told me they’d try rolling the baby forward three times and if that didn’t work, try backwards three times. They tilted back the bed so that I was at a slight decline. One asked to dim the lights, squeezed ultrasound gel on my stomach, and told me “just breathebreath normally” (I couldn’t — I was breathing deeply). The doctor grabbed the head and the butt, then rotated his hands like he was giving me a massage for about 15 seconds. I felt pressure, but no pain or discomfort. 

I knew the baby moved; I assumed by about 10 degrees. 

“The head is down,” the doctors announced. 

It was over.  

“Holy shit,” I said again and again, and started crying. It worked. I was not on the route to surgery, to being stuck in my walk-up apartment, unable to go up and down the stairs while I recovered. I would be able to go into labor, God willing; I’d get to take the horrible Uber ride to the hospital. I might get to reach the edge of human experience, absolutely knowing I could not take it anymore and then doing it anyway. 

I kept crying. “What a great way to start a Tuesday!” one doctor said. They looked so happy. Our midwives were happy. Every time I thought about it working, I teared up. 

Not only was I fortunate with the outcome of my ECV, I was lucky to be offered the procedure at all, and offered it enthusiastically by skilled providers.

Even though versions work half the time, and thus helps avoid a lot of unnecessary surgeries, they’re rare in the U.S. In 2019, there were 151,000 breech babies in the US — but only 11,000 ECVs. Despite the most pregnant people being good candidates, that’s only about 7% of the time! The reasons why reflect all the failures of American health care. I really want to write a story about this but I will spare you the TED talk.

The Bad

• I understand why pregnant people say they always need to pee. The baby’s head sometimes feels like it’s punching me in the vag.

• I am really exhausted from all the breech-flipping attempts. I can’t even think about doing things now to get labor started.

The Good

• All the acupuncture, chiropractic, and bodywork had the side effect of helping me feel really good! I had way fewer aches and pains than before or after. (And maybe it helped the ECV work smoothly!)

• The experience got me way more used to the hospital. You can no longer visit or tour it, but I got the inside scoop. I know what to expect. I was also really afraid of the hospital and the nurses, but I’m not anymore. 

• I learned what it’s like to be hooked up to the monitors — not fun! Even three hours wearing them in bed made my body feel awful. If I end up getting an epidural, I will need many more wires attached to me and be confined to the bed for the whole time. Now I know what to expect.

• I realized how important it is to me to attempt vaginal birth — not necessarily to avoid a C-section, but as its own experience. I realize for many people, that’s bonkers. There are many experiences others love that I do not want to have: running a marathon, bungee jumping, Ayahuasca. But I really do want this.

Luckily Byron and I had taken the whole day off work. We found a lunch special that was available at 10 a.m. (I couldn’t eat or drink since the night before.) We had a KBBQ feast, followed by shaved icees. We walked many miles from the hospital home. I got a massage. We wrote thank-you notes sitting in our garden. 

It was a beautiful day. 

And, immediately, I felt more ready than I ever have. I think my mind was not ready because my body wasn’t ready. I also now believe I was so resistant to scheduled surgery because I knew, that my baby wanted to flip - but just needed some help with direction.

Am I ready for the little one to come? No. But ask me again in a few weeks — then it will not matter.

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Was I ready after all? Stay tuned next week for my birth-story post-mortem. 

I’m thinking about pitching an articles about breech babies and ECV - please help me by commenting with what surprised you or you found interesting/helpful! 

Xx

Emi