Origins of the Breech Tilt

When I was pregnant in 2005, I used a bunk bed ladder for the breech tilt instead of an ironing board.  However, getting onto the upside down ladder was probably dangerous and I pulled a ligament (or two) which was the antithesis of what I was trying to do at the time which was assist my baby into a head down position.  As I laid upside down on the bunk bed ladder (with pillows shoved in between its steps) I felt a bit ill and wondered if it was that important for my baby to turn.  

Recently Midwife Rachel Shapiro had asked me about the origins of the Breech Tilt.  Of course, I just said it was common knowledge for home birth midwives in the 1990s.  Whether a bunk bed ladder, ironing board, pillows or a gentle hill where one could lie at an incline, such positioning allows the baby to come out of the pelvis and possibly rotate. Due to using positioning and gravity, I expect it goes back to indigenous midwifery in one or various places over the world where credit would also be due if known.

But as I looked in older midwifery books, I saw pictures or discussions with little background information.  Finally, it was in A Good Birth, A Safe Birth by Diana Korte and Roberta M. Scaer where I found the research reference:


“The breech tilt position was originated by Juliet De Sa Souza at Grant Medical College in Bombay, India.  If, by the beginning of the eighth month of pregnancy, the baby is still in a breech position, the mother lies in the tilt position for ten minutes twice a day.  With an empty stomach, lying on her back on the floor, knees bent so that her feet are flat on the floor, the mother puts three good size pillows under her bottom.  De Sa Souza reports in 1977 that 89 percent of 744 babies in breech presentations turned to a headfirst position with this exercise, most within two to three weeks.  Once the baby has turned from breech to head-down position, discontinue the tilt exercise.”    

– Page 152, A Good Birth, A Safe Birth 

Dr. Juliet De Sa Souza  published her research in OB/GYN News Vol 12, No.1 in its
Jan, 1, 1977 issue.  However, unlike the obstetricians of the time, De Sa Souza didn’t name the position after her, she named it so that name described the position itself.  As I haven’t found this original paper yet, I do wonder how many of these breech presentations were subsequent full term pregnancies?

Over generations, someone found that they could use gravity better on a board (no bunk bed ladders were suggested).  I’m not sure where that addition happened or with whom.  As a midwife working with breech pregnancies, I suggest using the breech tilt (on an ironing board) for 10 minutes 3 times a day when trying to turn a baby.  34 to 35 weeks is a good time to start doing this work especially for a first time parent and maybe earlier if one has had a previous breech baby at term.  

As a midwife, I find the breech tilt is useful for releasing a bum that is deep in the pelvis, but it can also provide access to the round ligaments for release just above the pubic bone.  I usually add an abdominal release as well as a bit of rocking.  The hope for the breech tilt is that the baby slides up to the top of the funds and is able to tuck its head and come back down into the space that is provided.  Shifting that space can sometimes make all the difference in the opportunities that babies can find!  

(As an aside, I’ve always wondered when I could use this candid shot of me pondering the universe standing next to the slant board.) 

Banks, Maggie.  Breech Birth Woman-Wise.  Hamilton, New Zealand:  Birthspirit Ltd.  1998. 40.

Korte, Diana and Roberta M. Scaer.  A Good Birth, A Safe Birth Third Edition.  Boston:  Harvard Common Press. 1992. 151.