Breech Birth

image001 A breech birth is the type of birth in which some part other than the baby’s head comes out first including their knees, legs, or bottom. At 29 to 32 weeks gestation, experts estimate that around 15 percent of babies will present with their bottoms first. During the second trimester, it is normal for a baby to be oriented in the breech position. As the pregnancy advances, the risk of a breech birth increases, because the risk is closely linked to how far along the pregnancy is.

When labor begins, most babies will be lying down on their sides and the head will face their mother’s right or left side. In the case of a breech birth, however, the child’s head will be right below the mom’s rib cage and diaphragm. Because of this, a key to diagnosing if the baby is having a breech presentation is feeling a bony and hard head in this area instead of the soft bottom that is expected.

What Is a Breech Position?

Most babies will have their head near the bottom of the uterus at around 8 months to maximize space, but the breech position means that your baby is in a position where he’ll come out feet or buttocks first.

As long as labor doesn’t occur early, around 97% of babies will be positioned with their head first with most of the rest being breech. Your baby can be in various breech positions. Frank breech is with the bottom first and feet by the head. Complete breech is bottom first and footling breech is when one or both feet will come out first.

Sometimes your doctor can tell the baby’s position at the start of the third trimester by feeling externally. Around 25% of babies are breech at this time but will usually turn over by themselves. A few weeks before the due date, your doctor will use her hands to touch your abdomen and determine your baby’s position. By 36 weeks, if your doctor isn’t sure about your baby’s position, she may use ultrasound, do an internal exam, or use special x-rays to help figure out the position and if it is safe to do a vaginal delivery.

What Causes Breech Positions During Pregnancy?

In many cases, experts aren’t sure why a baby is in a breech position, but in other cases it may be due to one of the following reasons:

  • If the labor is before your 37th week of pregnancy, the baby may not have had a chance to turn yet
  • Multiple births can limit the space to move around in
  • If there isn’t the right amount of amniotic fluid within the uterus
  • Any uterine problems including uterine fibroids or being oddly shaped
  • Weakened or stretched uterine muscles because of previous pregnancies
  • Possible health problems with the baby

How to Coax My Baby to Turn

You should try to turn your breech baby at some point from your 32nd to 37th week of pregnancy using one of the following methods.

1. Medical Techniques

  • External Version: This non-surgical technique involves giving medication that relaxes the uterus. Then the doctor will determine the baby’s position and gently push to turn the baby. During the procedure, the baby’s heartbeat is closely monitored. Although this procedure is frequently successful, it becomes harder as you are farther along in pregnancy.
  • Chiropractic Care: The Webster Breech Technique has a high success rate and is most common during the 8th month. It involves using chiropractic techniques to reduce the stress on the pelvis which in turn relaxes the uterus and nearby ligaments, making it easier for the baby to turn.

2. Natural Techniques

  • The Breech Tilt: You use pillows to raise your hips about a foot off the floor for a duration of ten to fifteen minutes and repeat this process three times a day. Try not to tense your body during the process and do it with an empty stomach especially when your baby is awake and active.
  • Using Music: Some women encourage their babies to move their heads to the correct position by playing music or other sounds such as their voice to the lower abdomen.

Which Factors Increase the Likelihood of Having a Breech Birth?

The most common reason for a breech birth is prematurity, as 25% of babies are in the breech position at 32 weeks in the pregnancy. If a baby isn’t in the position in a few weeks, it becomes harder as the space gets more cramped. As the baby’s head is heavy, it usually finds its way to the lower abdomen.

Other factors that increase the likelihood include:

  • Multiple births
  • Unusual amounts of amniotic fluid
  • Abnormalities with the baby
  • Having had more than four births previously
  • Uterine abnormalities
  • A low placed placenta
  • A small pelvis
  • A previous Caesarian section delivery

What Are the Risks of Having a Breech Birth?

Having a vaginal birth when the baby is in breech position may take longer to start, making it more exhausting for the mother. It is also more common for umbilical cord prolapse to occur, which constricts the cord and stops the blood flow. The umbilical cord may also become compressed. In some cases of breech birth, the baby’s head may also become entrapped.

The risks to the baby are usually small as long as the labor is well-managed. In some cases, however, the baby may get a bruised hip, swollen genitals, or more rounded heads. In the case of a frank breech position, the baby may extend their legs in a similar position a few days after birth. There is also an increased risk of congenital hip dislocation and trauma to the baby’s head.

Do I Need a C-Section or Vaginal Birth?

Most doctors recommend Caesarean sections in the following cases:

  • A footling or kneeling breech
  • The first of multiple children is breech
  • Pre-eclampsia
  • Your baby might weigh less than 2 kg or more than 3.8 kg
  • Specific positions of your baby
  • Previous Caesarean birth
  • A low-lying placenta
  • A narrow pelvis

Although most babies who are breech are born via C-section, some will be born vaginally. There was a large international study showing that planned C-sections were safer for breech babies, but later research suggests that certain women may be fine with vaginal birth including those with larger pelvises. However, if you do deliver vaginally, be sure there is a trained medical professional with experience delivering breech births. Planned C-sections shouldn’t be scheduled for sooner than 39 weeks.

Some factors can help your chances of giving birth vaginally including:

  • Having given birth before
  • If a doctor or midwife is trained in breech birth
  • There are nearby Caesarean facilities
  • There aren’t any other risk factors

Want to see a vaginal breech birth for a model baby? Check out the video below: