Breech Babies

Breech Babies

Today I am going to talk about:

What does it mean if my baby is breech?

What if my baby is still breech at 37 weeks?

If my baby doesn’t turn will I need a caesarean section?

What alternative techniques might I try to encourage my baby to turn?

 

What does it mean if my baby is breech? 

By around 36 weeks of pregnancy, 95% of babies have adopted the normal head down position in the uterus (womb) also known as cephalic presentation. The main reason for this is that the bottom and legs are bigger than the head, so they occupy the top of the uterus where there is more space.

But if your baby is in the breech position it means that your baby is coming bottom or feet first. In rare cases, a baby will lie sideways in the uterus with his shoulder, back or arm presenting first some babies may also lie transverse that is across the uterus this is called transverse lie.

There are several types of breech presentation:

Frank breech is bottom first with feet up near the head

Complete breech is bottom first with legs crossed in front of body

And

Footling breech is bottom first and one or both feet coming first.

If your baby’s position isn’t clear during abdominal examination your midwife or doctor may arrange an ultrasound scan to confirm the position.

 

What if my baby is still breech at 37 weeks?

If your baby is still lying breech at 37 weeks your doctor may wait to see if your baby turns naturally to a head down position. If your baby does not turn, depending on your hospital policy and your obstetric history, you may be offered external cephalic version (ECV), in which your baby is gently turned by the doctor’s hands on your abdomen into a cephalic presentation under ultrasound guidance.

ECV only works about half the time and is more likely to work in women who have already had a baby.

 

If my baby doesn’t turn will I need a caesarean section?

It depends. You may have a vaginal breech delivery if you have a twin pregnancy where the first baby is in the head first position and the second baby is not or if your labour is so rapid that you arrive at the hospital just about to deliver.

However, the vast majority of babies who remain breech are delivered by caesarean section.

A large international study published in 2000 showed that planned caesarean section resulted in the safest outcomes for term singleton breech babies.

Longer-term follow up of the babies in this study led researchers to question this conclusion. Other researchers suggested that certain patients may have a safe vaginal delivery, this includes women whose pelvis seemed large enough, whose labour started and progressed well on its own and whose babies were frank or complete breech and appeared to be average weight and had no abnormalities on scan.

While considering these studies the American College of Obstetrics and Gynaecology issues an opinion in 2006 stating that it may be reasonable for some women to deliver vaginally, but they cautioned that the health professional must be experienced in preforming vaginal breech deliveries and that women must be made aware that the risks to her baby may be higher than with a planned caesarean section.

If a caesarean section is planned, which is likely for most women, it will usually be scheduled for around 39 weeks. You will have an ultrasound scan carried out before surgery to make sure the baby hasn’t changed position in the meantime.

There is a chance that you could go into labour or your waters break before your planned caesarean section. If this happens please call the hospital straight away.

 

What alternative techniques can I try to encourage my baby to turn?

There are some alternative techniques you might hear about. There is no proof that any of them work and there is no proof that they are safe therefore you must consult your midwife or doctor before trying them.

From 32 weeks position yourself on to your knees and forearms on the floor so that your bottom sticks up in the air. Stay in this position for 5 to 15 minutes. Make sure there is someone around while you do this in case you feel faint. If you find this position uncomfortable stop doing it.

One study showed that moxibustion (an ancient Chinese technique which burns herbs) in combination with acupuncture and the position described above may be of some benefit. It is important to discuss this with your midwife or doctor before you give it a try and always use a qualified acupuncturist.