Breech Babies

 

I've been told my baby is breech what does this mean?

This means that, instead of lying in the uterus in a head-first position [cephalic], your baby is sitting upright, with its bottom [extended breech], or bottom and feet [flexed breech], over the cervix. Your midwife or doctor may suspect that the baby is in this position by abdominal palpation, or during a vaginal examination, but it can be confirmed by ultrasound scan.

Why does this happen?

  • Gestation: Up to about 32 35 weeks of pregnancy, babies are often in a breech position, and this is not a problem at all. After 35 weeks the vast majority of babies have turned so that they are head down, but some will turn spontaneously after this. If you go into pre-term labour and your baby is breech, the options for delivery will be discussed with you as they would if you were at full-term.
  • Parity: If this is not your first baby, and particularly if you have had several babies before, the baby may still turn after 35 -37 weeks and may not engage until labour begins. If you are expecting twins, it is very common for the second twin to be in a breech position.
  • Liquor volume: The amount of liquor [amniotic fluid] around the baby, can affect its position. Polyhydramnios an excessive amount of fluid - can make it more difficult for the baby to engage in the pelvis and remain in one position. It may be breech one minute and head-down the next this is known as an unstable lie.
  • Oligohydramnios: A reduced amount of amniotic fluid around the baby may make it more difficult for the baby to change position, and particularly to turn itself right over into a head-down position.
  • Location of the placenta: If you have placenta praevia [see below], your baby will need to be born by caesarean section, so it is not a problem if the baby is breech. If you have an anterior placenta [on the front wall of the uterus] it may be more difficult to carry out an external cephalic version [see below].
  • Pelvic anomalies: Sometimes the shape and / or tilt of your pelvis make it more difficult for the baby to adopt a head down [cephalic] presentation and it will remain breech. There may be congenital reasons why a pelvis is this shape, or it may be the result of previous trauma to the pelvis, hips or lower back.
  • Uterine anomalies: Some women have a bicornuate uterus, [literally two horns]. This shape, where a complete or partial septum divides the uterus vertically, often means that the baby does not have room for its bottom and legs in the upper part of the uterus and is likely to be breech. If you have this condition, your consultant will monitor your pregnancy very carefully and advise you if you need to have a caesarean section.

Confused Baby: Sometimes none of the above factors apply, and there is no obvious reason why the baby is breech. It is thought that some babies are simply confused about which way up they should be at term.

What can I do about it?


This depends on the stage of pregnancy and other factors as mentioned above, and also on whether or not you are already in labour when the breech position is diagnosed.

If your baby is found to be breech before the start of labour, you have three choices:

1. Elective caesarean section

This may be the preferred mode of delivery if there are other factors involved which would make a vaginal delivery difficult or impossible [see above]. You may be advised to have a caesarean section if it is your first baby, as there is no way of knowing if the babys head will be able to pass through the birth canal.

Likewise, if you are expecting twins, and the first twin is breech, you will usually be advised to have a caesarean. If attempts to turn the baby [see below] have not been successful, you will usually be given a date to come in for an elective caesarean. If your waters break or you go into labour before this date, you need to phone the hospital and will be asked come in.

Whether you come in in labour, or on the day of your planned caesarean, you will have a scan to see if the baby is still breech. If the baby has turned into a head-down position you can have a normal delivery.

2. Having the baby turned

The best outcome for you and your baby is if the baby can be persuaded to turn to a head down position before you go into labour. If this happens, you could go on to have a normal vaginal birth. There are different ways of helping the baby to turn.

  • External cephalic version (ECV)

    This is only carried out in hospital, and by a doctor who is trained in this procedure. It is usually attempted at about 37-39 weeks.

    What is this?

    You will normally be given an injection which makes the uterine muscles relax, and you will be asked to lie as flat as possible with your hips elevated, to tip the baby's bottom out of your pelvis. By pushing on your abdomen in a certain way, the doctor will then try to guide your baby to do a forward roll into a cephalic position. Your baby will be monitored and scanned before and after the procedure.

    Will it work?

    This is more successful if the baby's feet and legs are down by its bottom, as it can help by kicking itself round. If the legs are extended, and / or if the breech is already engaged it is much less likely to succeed. This procedure can usually be attempted more than once if it is unsuccessful, or if the baby does turn, but then subsequently turns itself back to breech.

    Is it safe?

    ECV is contraindicated in certain cases, and it can be uncomfortable. It does also have some associated risks, such as fetal distress, placental abruption, and even cord prolapse if your waters break mid-procedure. These risks will be explained to you before you agree to try the procedure. If you are Rhesus negative you will also need to have an anti-D injection.

  • Maternal positions

    If ECV is unsuccessful, contraindicated, or if you don't want to undergo the procedure, you can use different positions to try and prevent the breech engaging deeply in the pelvis and encourage the baby to turn on its own.

    Lying on your back, with your hips elevated on pillows and your knees bent, roll from side to side for about 10 minutes, 3 times a day. Alternatively, adopt a knee-chest position [kneel in an all fours position, then rest your head, arms and upper body down on a pillow or cushions] for 10 minutes as many times a day as you can.

    If it is easier, the same position can be achieved by kneeling in all fours, but with your knees on a pile of firm cushions or low footstool. This is more strenuous on the arms, but may cause less indigestion.

  • Moxibustion

    A technique used in traditional Chinese medicine which works in a similar way to acupuncture, but using moxa sticks [a heat source] rather than needles. When used over the correct acupuncture points on your feet, it has proved very successful in getting breech babies to turn themselves to a cephalic presentation. A practitioner trained in the safe use of moxibustion in pregnancy will show you the correct technique for using the moxa sticks safely at home. Moxibustion can be used from 35 weeks, and as an alternative to, or in addition to, ECV and/ or the maternal positions described above.

3. Vaginal breech delivery

Once you have thoroughly considered all the options, this may be your choice, particularly if you have had uncomplicated vaginal births before and wish to avoid a caesarean section.

The doctors will want to make sure that this baby is not much bigger your previous babies, so might advise regular ultrasound scans to monitor growth. Your labour would be carefully monitored to ensure that the baby is coping well throughout, and usually there would be an obstetrician and paediatrician present for delivery as well as the midwife.

If you are expecting twins, where the first twin is cephalic, and the second is breech, you can usually have a vaginal birth for both twins.

If you are already in labour when it is discovered that the baby is breech, you only have two choices, as it is not usually possible to turn the baby:

Vaginal breech delivery
or emergency caesarean section.

The doctor will explain to you the risks/benefits of each type of delivery, depending on your individual circumstances and the stage of labour you are at when you come in to hospital. If you are having your baby at home and a breech presentation is diagnosed [or suspected], you will need to be transferred into hospital by ambulance unless it is unsafe to do so because the baby is already delivering.