8 Things to Know About Breech Births

“Your baby is in a breech position.” This doctor’s statement would be enough to send any mother into a panic in her final weeks before delivery. A breech birth refers to when a baby’s buttocks and/or feet are positioned to be delivered first. When labour begins, 95 percent of babies are laying with their head down in the uterus, but a few (roughly 3 to 4 percent) are in a breech position.

Not surprising, considering all the gymnastics your baby is doing in the final trimester. But just because your baby is bottom-up leading up to your due date does not mean you will not have a vaginal birth.

If you are confronted with the reality of a breech birth, it’s important to understand what is happening and what your options are. We’ve compiled 8 tips to guide you through the process.

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8 Types of Breech Positions

There are three common types of breech positions.

Frank breech: This is the most common position, in which the baby’s bottom is down with legs pointing upward and feet near his head.

Complete breech: the baby’s head is up, his buttocks are down and he’s sitting criss-cross applesauce-style. Ouch.

Footling breech: the baby is head-up, with one or both feet hanging down. If he was delivered vaginally, he’ll come out feet first.

You most likely won’t be able to “feel” what baby’s position is – breech or normal. During an appointment in the third tri-semester, the doctor might give you the news that your baby’s head is upward. However, it is possible for you to feel baby’s legs downward, which can alert you to make an appointment to confirm your suspicions of your bundle being in a breech position.

Keep in mind, your little one may move back and forth, in and out of position, right up until delivery time. 

7 Find a Doctor with Breech Presentation Experience

One of your concerns may be whether you can still deliver vaginally, despite your baby’s awkward position in the uterus. Who wouldn’t prefer a vaginal birth, as opposed to a major surgery with six weeks or more of recovery involved? A vaginal delivery can certainly be a reality depending on your individual situation, but the key to this is finding the right doctor to assist in the matter.

Yes, breech births are common, but ultimately, you want to find someone with experience in delivering in these types of cases. Sometimes, the best outcome occurs when you have two doctors with a lot of knowledge in both types of births. This way, the pendulum won’t swing in one direction too much and you feel you are getting the proper knowledge you need to make an educated decision. 

6  Diagnosing a Breech Presentation

Your doctor (or midwife) will be able to determine your baby’s position by feeling the outside of your abdomen and uterus with his/her hands. If a baby is breech, his round and firm head will be at the top of the uterus, and his feet and softer bottom will be lower than your uterus.

An ultrasound should always be done to confirm the baby’s position if a breech presentation is suspected.

5  Causes of a Breech Birth

Oftentimes, the general causes of a breech presentation are unknown, but some possible reasons could include:

Uterine Abnormalities: A woman’s uterus tends to be pear-shaped. When it is misshapen, or you have scar tissue left over from fibroids or previous surgery (such as a Caesarean section), your baby may not have enough room to flip over.

Amniotic Fluid: If you do not have enough amniotic fluid, your baby may not have enough room to “swim.” Too much amniotic fluid may also pose a problem as the baby may have too much space to flip and flop as she pleases into a breech position.

Fetal Abnormalities: A short umbilical cord can restrict a baby’s movement inside the uterus.

Pregnant with Multiples: Multiple births could make it crowded in there. Changing positions may not be easy if there is less space to move around.

Low-Lying Placenta: If your placenta covers your cervix, your baby may not be able to get into a proper downward position.

4  Medical Interventions

If the baby is still not in the proper position by 36 to 37 weeks along, your doctor may suggest using an external cephalic version (ECV) to make it possible for you to attempt a vaginal birth. Before this procedure is done, the baby must be monitored by fetal ultrasound, and electronic fetal heart monitoring may also be used.

What Happens During an ECV?

You will likely be offered an injection of tocolytic medicine, such as terbutaline, to relax the uterus. Once the uterus is nice and relaxed, the doctor can attempt to turn the fetus. With both hands on the abdomen, the doctor pushes and tries to roll the fetus to a head-down position.

I’m not going to lie – this is not comfortable. It will not feel the least bit pleasant. If the doctor is pushing hard or your abdomen is sensitive, it will be even more uncomfortable. If your baby appears to be distressed, the procedure will be stopped. Although complications are rare, this version procedure is always done in a hospital setting in case other medical interventions are needed.

If the first ECV attempt does not work, your doctor may suggest attempting it again with epidural anesthesia to help you relax and work through the pain you may be experiencing. Regardless, you can resume normal activities after the procedure is over.

It’s not difficult to see why this is not a popular first option for encouraging your baby to change positions. Sometimes alternative methods are preferred.

3  Natural Techniques

If you are wary of the ECV route, there are natural methods of encouraging your baby to flip positions. They are not guaranteed to work but are certainly worth a try and are harmless to both you and your little one.

Moxibustion (Moxa): This is a natural Chinese method of turning a baby. A trained acupuncturist will burn the mugwort herb near your smallest toe to stimulate an acupuncture point. This is done to encourage your baby to move. You may need to do this for a minimum of 10 days. It is considered completely safe.

Relaxing Music: Throw on some soothing, inspiring music and have your partner speak near the bottom of your tummy. With any luck, your baby will follow your tune.

Adopt a Knee-to-Chest Position: Kneel on a mat on the floor, with your bottom in the air and your head, shoulders, and upper chest flat to the floor. Don’t let your thighs press against your baby bump. Maintain this position for 15 minutes a day. The goal is to tip your baby back up and out of your pelvis.

Relaxation Therapy: Guided meditation and hypnosis may relax you enough to encourage that little one to flip back into the proper position.

Cold at the Top of the Uterus: Place a bag of frozen vegetables or a cold pack at the top of your uterus. This may encourage your little one (who prefers warm, of course) to move away from it. Make sure you put a thin layer of fabric between you and the cold object to prevent frostbite.

2  Will I Need a Caesarean-Section?

You’re almost at your due date and your baby is not budging. The ECV has failed and no amount of music or soft cooing is working. You are beginning to think a C-section may be the only route left to take. Not necessarily. True, more breech babies are born via C-section that vaginally, but certain factors may increase your risk of going down that road to begin with:

  • You have had a prior C-section.
  • You have a narrow pelvis.
  • Your baby is in a footling breech position (see above) or the neck is quite tilted.
  • The baby is very small (less than 4 lbs., 6 oz.)
  • The baby is large (more than 8 lbs., 6 oz.)
  • You have a medical condition that puts the baby or yourself at risk.
  • You have begun natural labour and it isn’t progressing. Speeding up a breech presentation is not recommended.

1 How Are Breech Babies Born Vaginally?

Vaginal births do come with their own set of risks, including possible injuries to the baby’s skull, umbilical cord prolapse, and increased tearing. But with careful monitoring and assistance, a vaginal birth can certainly go smoothly. There are two ways you can give birth vaginally when your baby is in a breech position.

Assisted Breech Delivery: This is the most common method and is much like a “regular” delivery. This can occur whether you’ve been induced or your labour has started naturally. You will be continuously monitored.

When you get to the pushing stage, your medical professional could take a “hands-off” approach until the baby’s bottom and body is out. This means only ensuring all is well and not intervening until necessary. This approach is common because the theory is that if the medical professional touches the baby too much during an internal examination, the baby could move and make the labour more difficult. Once the baby’s bottom and body is out, then he/she may assist with forceps.

Active Vaginal Breech Birth: This is a less common method and is safer when the labour is progressing on its own, with no induction. An epidural and other safe pain relievers are not recommended simply because you need to be completely aware of what your body is doing.

You push when you feel the urge to do so, and after you’ve pushed your baby’s bottom and body out, there may be a pause while you wait for the head to emerge. The “hands-off” approach will also be in force here. No one should be pulling at your baby to come out.

Being told you have a baby in the breech presentation can be a scary thing for any mom. The key is to remain calm, understand your options, and be educated going into delivery. 

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