Psychosocial View of Breech Presentation

Breech presentation may be best understood via an Eastern psychosocial paradigm, based on a study that earned the Best Poster Award at the Association of Women’s Health, Obstetric and Neonatal Nurses 2010 meeting.

Caroline Peterson, DC, PhD, MPH, of Oregon Health and Science University, Portland, told the OB/GYN Nurse-NP/PA that her experience with many mothers confirms her findings.

This case-control study included 114 new mothers who completed a sociodemographic survey; 75 of them (52 cephalic and 23 breech) also had a 2-hour in-depth interview.

Dr Peterson found that although mothers of breech infants loved their infants no less and had no more stress than did mothers with cephalic presentations, coping styles were different. Mothers with breech pregnancies tended to be very analytical, busy, and fearful of pregnancy outcomes or parenting. They had higher salaries, were better educated, and had higher social prestige. They also tended to lack the coping mechanisms of “flexibility and pragmatism,” she said.

“These mothers…were performanceoriented and already overextended. Having a baby seemed like something they would take care of later. They were also more fearful about birth and parenting.” Mothers of cephalic infants had better coping skills and a greater sense of connection with their infants.

Western versus Eastern Models
The incidence of breech presentation is similar cross-culturally (2%-4%), but Western and Eastern cultures have different explanatory models for it. The West attributes breech presentation to me chanical faults of the baby/mother, whereasChinese and ayurvedic medicine view turning to cephalic presentation as a fetal developmental stage that requires the participation of the mother and baby. In the Eastern model, the breech baby is not ready to become autonomous, perhaps because the mothers are “stressed out” and “fearful,” she said.

“We should consider the possibility that turning to cephalic presentation is an important developmental stage initiated by the baby,” Dr Peterson suggested. “Another interesting possibility is that breech presentation is behavioral evidence of intrauterine ambivalent attachment, since these mothers share personality traits and parenting techniques with mothers of ambivalently attached babies.”

In the West, breech presentation is managed by external cephalic version or cesarean section. In the East, the goal is to remove barriers to turning. Chinese medicine uses the herb moxibustion, which is as likely to turn the baby as external cephalic version. The herb is heated and applied to the bladder meridian to induce smooth flow of blood and “chi” (ie, life energy).

Obstetric nurses can also influence presentation. “Don’t assume this is a mechanical problem you can do nothing about,” she said. “Tell the mother to talk to her baby, include her baby in her life right now. Tell the mother she can help change the breech presentation by creating an engaging relationship with her infant from this point forward. I have worked with many such mothers and I can tell you, this works.”