Breech birth

What Is Breech?

In breech position, the baby's bottom is down. There are a few types of breech:

• Complete breech -- the baby is bottom-first, with knees bent.
• Frank breech -- the baby’s legs are stretched up, with feet near the head.
• Footling breech -- one leg is lowered over the mother’s cervix.

You are more likely to have a breech baby if you:

• Go into early labor
• Have an abnormally shaped uterus, fibroids, or too much amniotic fluid
• Have more than one baby in the womb
• Have placenta previa (when the placenta is on the lower part of the uterine wall, blocking the cervix)

Turning Your Baby (External Version)

If your baby is not in a head down position after your 36th week, your doctor can explain your choices and their risks to help you decide what steps to take next.

Your doctor may try to guide the baby into the right position. This is called external version and involves pushing on your belly while watching the baby on an ultrasound. The pushing may cause some discomfort.

You may be given a medication that relaxes the muscles of the uterus.

• An ultrasound shows the doctor where the placenta and baby are located.
• Your doctor will push on the abdomen to try and turn the baby’s position.
• Your baby’s heart beat is also monitored.

Success is higher if your doctor tries this procedure at about 37 weeks. At this time, the baby is a little smaller, and there is usually more fluid around the baby. The baby is also old enough in the small chance that there is a problem during the procedure that makes it necessary to deliver the baby promptly. External version can not be done once you are in active labor.

Risks are low for this procedure when a skilled doctor does it. Rarely, it may lead to an emergency C-section if:

• Part of the placenta tears away from the lining of your womb
• Your baby’s heart beat drops too low, which can happen if the umbilical cord is tightly wrapped around the baby

If My Baby Doesn't Turn, Will I Have a C-section?

It depends, but most babies who remain breech after an attempt at turning them will be delivered by C-section. Your doctor will explain the risk of delivering a breech baby vaginally.

The danger of breech birth is mostly due to the fact that the largest part of a baby is its head. So when the breech baby’s pelvis or hips deliver first, the mom’s pelvis may not be large enough for the head to be delivered also.

Other problems may be:

• The umbilical cord may be damaged or blocked. This can lessen the baby's oxygen supply.
• The mother also has an increased risk of cervical or vaginal tears with abnormal positions.

To try to deliver the baby normally:

• The woman’s pelvis will need to seem large enough.
• Labor started on its own and is progressing well on its own.
• The baby is full-term and appears to be of average weight.
• The breech is frank or complete.

Even then, fewer and fewer doctors who deliver babies have much or any experience delivering a breech birth. It is the standard in America to deliver most breeches by C-section, given the decreased risks for the baby.

If a C-section is planned, which is likely for most women carrying a breech baby, it will usually be scheduled for no earlier than 39 weeks. You'll have an ultrasound at the hospital to confirm the position of the baby just before the surgery.

There's also a chance that you'll go into labor or your water will break before your planned C-section. If that happens, call your health care provider right away and head for the hospital. It is important to go in right away if you have a breech baby and your bag of water breaks, because there is a higher chance that the cord will come out even before you are in labor. This can be very dangerous for the baby.

Birth Positions When Labor Has Started

• Your baby must pass through your pelvic bones to reach the vaginal opening. Certain positions result in a smaller area and shape the baby to pass through this tight passage.
• The best position for the baby to pass through the pelvis is with the head down and body facing towards the mother’s back.

Sometimes the baby will move itself into head-down position. If not, the doctor will try to help move the baby. If the baby cannot be moved, you may need to have surgery to deliver the baby safely.

These positions are abnormal (not normal) and may cause problems:

• Occiput posterior: The baby is head-down but is facing the wrong way. The baby faces the mother’s front instead of the mother’s back. It is easier to deliver the baby if it is facing the back. These babies may rotate from front to back during labor.
• Transverse: A baby in the transverse position is sideways. Often, the shoulders or back are over the mother’s cervix. This is also called the shoulder or oblique position. The risk for having a baby in the transverse position increases if you go into labor early, have given birth five or more times, or have placenta previa.

There are other positions that are abnormal, but less common. The rarer positions are:

• Face-first
• Brow-first
• Compound -- the baby’s hand or foot comes out of the birth canal with the head or bottom

In some cases, a vaginal birth may be possible.

• Occiput posterior: In this position, vaginal delivery is possible but is harder for you and the baby. Labor often takes much longer. Sometimes the doctor uses forceps to help get the baby out.
• Transverse position: Unless the baby can be turned into head-first position, a vaginal birth would be too risky for you and the baby. Your doctor will deliver the baby by C-section.

Update Date: 9/19/2012

Updated by: Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.