Breech birth describes a baby's position shortly before and/or during the birth. Sometimes called a "breech baby," the word breech suggests that the baby's bottom or feet are nearest to the birth canal, as opposed to its head (the preferred position). While most babies are breech at some point during gestation, they usually turn "head down" during the latter part of the third trimester in preparation for birth.
There are three types of breech positions:
Frank Breech: Bottom down with legs and feet pointed up near the baby's head. This is the most common breech position.
Complete Breech: Head up, bottom down, with baby sitting on his/her legs and feet, or in a cross-legged position.
Footling Breech: Baby is head up with one or more feet pointing downward.
Breech position is usually fairly easy for your provider to diagnose by feeling your belly and uterus, and usually confirming with an ultrasound. Although some babies will show breech presentation in the weeks leading up to birth, many still change their position at the last minute.
Causes and risk factors for a breech baby vary, but most of it has to do with how your baby moves and positions itself in your uterus. The location of the placenta, amount of amniotic fluid, and uterine abnormalities can all contribute. Premature birth (before 34 weeks) often results in breech positioning, since the baby hasn't yet had time to move into a head-down position.
The Problem With Breech BabiesBreech babies have been born vaginally for centuries, but most providers prefer to avoid a breech vaginal birth for various reasons:
- Increased risk of perineal tears and episiotomy
- Umbilical cord prolapse
- Increased occurrence of injuries to baby's skull and limbs
- Long, hard labor resulting in surgical birth is more common
Childbirth is never easy, so when a factor like breech positioning is present, it increases the difficulty and potential problems in a labor. If your baby is still breech after 37 weeks, your doctor may likely discuss scheduling a C-section, or attempting a vaginal birth, depending on the circumstances. Be flexible with your birth plan and do what you can beforehand to change baby's position. In the end, a healthy baby and mom is the goal.
Vaginal Delivery of a Breech BabyAlthough nearly 90% of breech babies are delivered via C-section, some breech babies can be delivered vaginally. Factors that make this possible include:
- Frank breech positioning
- Small to mid-sized baby at full-term
- Mother has a roomy pelvic opening; perhaps has birthed vaginally before
- No current complications of pregnancy such as gestational diabetes or preeclampsia
- Multiples in womb and first baby has already emerged allowing space for flipping of next baby
- Baby shows no signs of distress
In order to attempt (and the word attempt is key, here) a vaginal breech birth, you and your provider must both feel comfortable, along with your provider having the necessary training and experience. The above circumstances often don't line up, so naturally most breech babies are born safely via C-section.
What to do if Your Baby is Breech
If you discover that your baby is breech after 32 weeks, it's good to do all you can to move baby into a better position. Between 32-37 weeks, your provider can attempt an ECV, or external cephalic version. This technique uses hands on the mother's stomach to push the baby into a head-down position. When doing an ECV, your provider will give you a medication to relax your uterus, although the procedure will likely cause some discomfort. Over 50% of ECV attempts are successful, but babies can still flip back into breech position.
Other options include acupuncture, relaxation and hypnosis with trained professionals. Some women also find positioning exercises, such as pelvic tilts, helpful in spinning the baby to a head-down position.