Breech Babies
Varieties of “Breech”
Babies turn and change position in the womb throughout the first 36 weeks or so of pregnancy. But a baby may be called “breech” if, in the last weeks of pregnancy or during labor itself, she is not head-down in the birth canal. As full term approaches, most babies will naturally turn themselves into this position, called “vertex.” In contrast, a breech presentation means the baby is buttocks down, its feet up by the head in a tuck position (frank breech), or buttocks down with legs crossed (full breech), or having one or both feet down first (footling breech).
Breech babies account for around 4 percent of full-term births. Although the causes of breech presentation are not fully known, the American Congress of Obstetricians and Gynecologists suggest they are more likely in some situations: if the baby is preterm, if the birth is multiples (twins or more), if the uterus has any abnormalities, or the placenta is previa (covering part or all of the uterus opening).
A baby’s position in the womb can usually be determined by external exam, where the physician places his or her hands on the mother’s abdomen to feel the baby’s shape. An ultrasound will also show whether a baby is in a breech position or not.
What does it mean for you if baby is breech? Although some babies can be delivered breech, there are greater risks of injury to the baby during delivery and other possible complications, such as a trapped umbilical cord, or head entrapment. Doctors will often recommend caesarian section of a baby who is breech at term, as they did for Sue, Olathe, whose first baby’s position was discovered only when she was fully dilated during labor. Delivered by C-section, her healthy baby still came out bottom first, with scraped knees to show for it!
Angie Shaw, OB/GYN with Via Christi Center for Women’s Health, says she has experienced such surprises in both directions: a breech presentation in labor when an ultrasound just the week prior showed the baby vertex, and a scheduled C-section breech when the baby suddenly presented vertex!
Turn Around, Baby!
Various techniques may be used to help a breech baby turn head down in the weeks before labor. The American Pregnancy Association suggests natural techniques that can be safely tried at home to encourage the baby to turn on his own, such as playing music or a recorded voice on the lower abdomen to encourage the baby to turn toward the sound, or performing a breech tilt (sometimes called an ironing board tilt) by supporting the hips in a rise off the floor several times a day. Sometimes a breech baby may turn back into breech position again after having turned vertex, so efforts may need to be repeated!
Shaw says that she usually schedules external cephalic version as close to labor as possible, and then follows with an induction so that the baby cannot turn breech again before delivery. External cephalic version is a common technique with a success rate of more than 60 percent. Although non-surgical, this procedure is performed by a physician, with fetal monitoring, and usually near a birthing room. Essentially, the physician attempts to turn the baby around (version) through external manipulation: with hands on the mother’s abdomen. Although non-surgical, medicine is often given to relax the uterus, IV pain medication can be given and fetal distress may necessitate halting the procedure, or even proceeding to immediate caesarean-section delivery of the baby. In some cases, external version cannot be attempted at all.
Because baby might turn again, and because of the possible risk of preterm labor resulting in premature delivery, external version is generally performed after 36 weeks. Marilyn, a mom from Fairway, explained that despite undergoing a painful, external version of a footling breech, baby waited a whole five minutes before turning breech again. After a second version, her delivery was induced, and her “breech baby” is now a straight-A freshman! As always, check with your doctor for what is best for you and your breech baby.
Casie Hermansson is a mom, writer and professor at Pittsburg State University.