Most babies will move into delivery position a few weeks prior to birth with the head moving closer to the birth canal. When this fails to happen, the baby’s buttocks and/or feet will be positioned to be delivered first. This is referred to as "breech presentation." Breech births occur in approximately 1 out of 25 full-term births.
What are the different types of breech presentations?
- Frank breech: In this position, the baby’s buttocks are aimed at the birth canal with its legs sticking straight up in front of his or her body and the feet near the head.
- Complete breech: Here, the buttocks are pointing downward with the legs folded at the knees and feet near the buttocks.
- Footling breech: In this position, one or both of the baby’s feet point downward and will deliver before the rest of the body.
What causes a breech presentation?
The causes of breech presentations are not fully understood. However, the data show that a breech birth is more common:
- In subsequent pregnancies
- In pregnancies of multiples
- When there is history of premature delivery
- When the uterus has too much or too little amniotic fluid
- When there is an abnormal shaped uterus or a uterus with abnormal growths, such as fibroids.
- With women who have placenta previa
How is a breech presentation diagnosed?
A few weeks prior to the due date, the health care provider will place his/her hands on the mother’s lower abdomen to locate the baby’s head, back, and buttocks. If it appears that the baby might be in a breech position, they can use ultrasound to confirm the position. Special x-rays can also be used to determine the baby’s position and the size of the pelvis to determine if a vaginal delivery of a breech baby can be safely attempted.
Can a breech presentation mean something is wrong?
Even though most breech babies are born healthy there is a slightly elevated risk for certain problems. Birth defects are slightly more common in breech babies and the defect might be the reason that the baby failed to move into the right position prior to delivery.
Can a breech presentation be changed?
It is preferable to try to turn a breech baby between the 32nd and 37th weeks of pregnancy. The methods of turning a baby will vary and the success rate for each method can also vary. It is best to discuss the options with the health care provider to see which method he/she recommends.
External Version: External version is a non-surgical technique to move the baby in the uterus. In this procedure, a medication is given to help relax the uterus. There might also be the use of ultrasound to determine the position of the baby, the location of the placenta and the amount of amniotic fluid in the uterus. Gentle pushing on the lower abdomen can turn the baby into the head-down position. Throughout the external version the baby’s heartbeat will be closely monitored so that if a problem develops, the health care provider will immediately stop the procedure. External version has a high success rate. However, this procedure becomes more difficult as the due date gets closer.
Chiropractic Care: The late Larry Webster, D.C., of the International Chiropractic Pediatric Association, developed a technique that enabled chiropractors to reduce stress on the pregnant woman’s pelvis leading to the relaxation of the uterus and surrounding ligaments. A more relaxed uterus makes it easier for a breech baby to turn naturally. His technique is known as the Webster Breech Technique.
The July/August issue of the Journal of Manipulative and Physiological Therapeutics reported and 82% success rate for the Webster Technique. Further, the results of the study suggest that it is preferable to perform the Webster Technique in the 8th month of pregnancy.
The following risk-free techniques, often suggested by physical therapist, Penny Simkin, can be tried at home for free:
The Breech Tilt: Using large, firm pillows, raise the hips 12″ or 30cm off the floor for 10-15 minutes, three times a day. It is best to do this on an empty stomach when your baby is active. In this technique, try to concentrate on the baby without tensing your body, especially in the abdominal area.
Using Music: We know that babies can hear sounds outside the womb. Consequently, many women have used music or taped recordings of their voice to try to get their baby to move towards the sound! Placing headphones on the lower part of your abdomen and playing either music or sounds of your voice can encourage babies to move towards the sounds and out of a breech position.
Some homeopathic remedies have also been found to be successful in correcting breech positions. If interested, you can contact your local holistic practitioner about the possibility of using of Moxibustion or Pulsatilla to correct a breech position.
Vaginal delivery versus cesarean for breech birth?
Most health care providers do not believe in attempting a vaginal delivery for a breech position. However, some will delay making a final decision until the woman is in labor. The following conditions are considered necessary in order to attempt a vaginal birth:
- The baby is full-term and in the frank breech presentation
- The baby does not show signs of distress while its heart rate is closely monitored.
- The process of labor is smooth and steady with the cervix widening as the baby descends.
- The health care provider estimates that the baby is not too big or the mother’s pelvis too narrow for the baby to pass safely through the birth canal.
- Anesthesia is available and a cesarean delivery possible on short notice
What are the risks and complications of a vaginal delivery?
In a breech birth, the baby’s head is the last part of its body to emerge making it more difficult to ease it through the birth canal. Sometimes forceps are used to guide the baby’s head out of the birth canal. Another potential problem is cord prolapse. In this situation the umbilical cord is squeezed as the baby moves toward the birth canal, thus slowing the baby’s supply of oxygen and blood.
In a vaginal breech delivery, electronic fetal monitoring will be used to monitor the baby’s heartbeat throughout the course of labor. A cesarean delivery may be an option if signs develop that the baby may be in distress.
When is a cesarean delivery used with a breech presentation?
Most health care providers recommend a cesarean delivery for all babies in a breech position, especially babies that are premature. Since premature babies are small and more fragile, and because the head of a premature baby is relatively larger in proportion to its body, the baby is unlikely to stretch the cervix as much as a full-term baby. This means that there might be less room for the head to emerge.
Compiled using information from the following sources:
William’s Obstetrics Twenty-Second Ed. Cunningham, F. Gary, et al, Ch. 24.
Danforth’s Obstetrics and Gynecology Ninth Ed. Scott, James R., et al, Ch. 21.