What you should know about breech birth
Your due date is nearing but your baby has not yet decided to turn round to the head-down position? This could be because there isn’t enough room for him to turn, so you may be in for a breech birth. But don’t panic, your doctor or midwife will advise you to ensure the most comfortable and safe birth for you and your baby…
© Thinkstock
A breech birth requires extra attention from your obstetrician or midwife and a certain set of conditions should be met to allow a vaginal birth. In general, a caesarean is recommended and commonly practiced in the UK for breech births, but in some cases, vaginal birth may be possible if you want one.
Dr Stéphane Boutan, gynaecologist and obstetrician at the Paris Port Royal Maternity Hospital explains…
What is the breech position and can a breech birth be avoided?
You are in the 8th month of pregnancy and your baby has perhaps still not turned around. This means that instead of having his head engaged down into his mother’s pelvis, it is the lower part of his body that is in position, known as the breech position. There are four documented categories for breech births:
- Frank breech – the most common, baby’s bottom comes first with his legs stretched up along his body, feet near his ears;
- Flexed breech – baby is sitting cross-legged, so the bottom, feet and legs come together first;
- Footling breech – more common in preemies, one or both of baby’s feet come first;
- Kneeling breech – very rare, baby is in a kneeling position;
"Once the breech has been confirmed, we often propose a procedure known as external cephalic version (ECV), which consists of turning the baby around (while monitoring the baby’s heartbeat and supported by ultrasound), through manual manipulation of the baby through the mother’s stomach wall,” Dr Boutan. Success rates range average around 50%.
For more information, see the Turning a breech baby in the womb information sheet
Breech birth – vaginal or Caesarean?
If this procedure doesn’t work, your medical team will consult with you on which delivery – caesarean or vaginal – is the safest for you and your baby. That being said, in the UK, a caesarean is the preferred method of birth for breech babies. In many UK hospitals, the policy for breech births is to proceed with an elective caesarean at 38 weeks of pregnancy.
To get the green light for a natural vaginal breech birth, your doctor or midwife would carry out a radiopelvimetry, with the aim of measuring the size of your pelvis to see if it is larger than the size of your baby’s head, which until now had been approximately measured through ultrasound. Other criteria will be taken into consideration, such as:
- The availability of an obstetrician or midwife experienced with breech births
- Facilities for an emergency caesarean delivery on-hand
- Your baby’s size
- Whether you’ve had a previous caesarean…
For further information, see the A breech baby at the end of pregnancy information sheet.
A vaginal breech birth is always more difficult as the baby’s head will be coming last and the mother’s pushing may not be sufficient, so the obstetrician may have to intervene with certain manoeuvres to help the baby’s head out. "The Løvset manoeuvre involves taking hold of the baby’s bottom and turning him in a screwing type of motion to release the arms. The head will then come out on its own. The Mauriceau manoeuvre may also be used to help with baby’s head. This entails putting one arm underneath the baby with a couple of fingers in his mouth, flexing down his head and providing traction to help bring his head out," explains Dr Boutan.
A number of these manoeuvres exist since hundreds of years, well before the caesarean existed, but vaginal breech birth does carry a number of risks for the baby, hence the need for an experienced obstetrician or midwife if a vaginal birth is to be considered.
At any moment during the birth, should there be a significant slowdown in the process of dilation, irregularity in baby’s heartbeat, respiratory distress or baby being in a difficult position, the obstetrician can choose to proceed with a caesarean. This is why an epidural would usually be given before the delivery began.
After a breech birth: what about the baby?
It’s not uncommon for a baby born in frank breech (feet level with his face) to stay in this position for a few hours after the birth (whether caesarean or vaginal). Due to having stayed for a certain time in a breech position in his mother’s womb, the baby may stay folded in the same way for a while.
A pediatrician may suggest an ultrasound of the baby’s hips around the age of one month just to make sure that all is well. You should also make sure that your baby isn’t suffering from a torticollis.
In any case, a visit to the osteopath is often recommended for breech babies or multiple births, when the babies may have been squashed into odd positions in the mother’s womb or during birth.
Source: Interview with Dr Stéphane Boutan, gynaecologist and obstetrician at the Paris Port Royal Maternity Hospital, March 2011
Copyright © 2011 Doctissimo
Posted 30.03.2011
Get more on this subject…
