A breech baby is not headfirst in the mother’s womb, and while most babies turn towards the end of pregnancy, some remain breech. Doctors may recommend exercises or a procedure to turn the baby, but if the baby is still breech towards the end of pregnancy, a cesarean section is usually preferred. Vaginal delivery of a breech baby is possible in certain circumstances, but there are potential risks to the baby, including brain injury and umbilical cord compression. In developing countries, vaginal delivery of a breech baby is more common due to the higher risk of a cesarean section.
A breech baby is a baby who is not headfirst in the mother’s womb. This means that the baby’s back and/or legs are closer to the bottom of the uterus and that the baby will be born feet first or feet first. The typical baby is born head down and this is a much safer position for the baby and the mother.
Many babies are in the breech position for some time during pregnancy. Towards the end of pregnancy, most babies turn so that their head is closer to the cervix. However, at around 32 weeks gestation, most babies are still breech.
Some things can cause breech, although why some babies are breech isn’t always known. Sometimes a twin can be in the breech position. Other times a higher than normal volume of amniotic fluid causes the baby to remain in the breech. Most babies roll over in the last eight weeks of pregnancy, but some babies may be older and just get trapped.
If your obstetrician notices that your baby is still breech in the final months of your pregnancy, she may recommend some exercises that can help encourage your baby to turn. However, as the pregnancy nears its end, doctors and mothers must make decisions about how to successfully deliver a breech baby. In most cases, doctors prefer to perform a cesarean section (C-section) if the baby is still breech.
Another option is to have a procedure in the hospital at around 36-37 weeks to manually turn the baby from the outside. This is called the external cephalic version and has a success rate of about 40-70%. In a hospital, the doctor or midwife uses their hands to try to roll the baby out of the breech position.
This operation cannot be performed in case of fetal distress or during some high-risk pregnancies. In low-risk pregnancies it may be worth trying the procedure as vaginal birth carries less risk to the mother than a cesarean. The biggest complication of the external cephalic version is the risk of premature labor, but delivery at 36-37 weeks is thought to be quite safe.
Some mothers opt for vaginal delivery of a breech baby, and doctors may advocate for this if the breech position is relatively safe and also if certain circumstances exist. If the woman has already given birth and has a larger or more spacious pelvis, some breech presentations may not pose many problems during labor. There are four breech positions and when considering vaginal labor doctors want to look for what is called a frank breech or full breech.
In a frank breech, the baby is bent over and born bottom first, feet at head level. In a full breech the baby’s legs are similar to a cross-legged position and are close to his hips. The baby’s head should not look up, as a breech baby born in this position may die or have a severely injured spine. Other potential risks to the breech baby include umbilical cord compression or umbilical cord prolapse, which can lead to brain death and brain damage. Brain injury can also occur when the baby’s head passes through the birth canal, as this is rapid rather than gradual.
Because of the potential for fetal damage, most doctors encourage mothers with a baby in breech presentation to have a C-section. Although the risks of a cesarean are greater for the mother than those associated with a vaginal birth, they are lower for the baby. It can be a tough choice, but many doctors aren’t really supportive of moms making that choice. Instead they strongly advise mothers not to risk the potential health of an unborn child. In developing countries, however, the risk of having a C-section can be much higher, and it is more common for a breech baby to be born vaginally.
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