Everything you should know about breech babies

As healthcare professionals working within maternity, we encounter women who have a breech baby at term on a fairly regular basis and so are used to answering the questions that you may have. To put your mind at ease, we thought it might be helpful to answer the common questions, which often arise about breech babies.

Why Might a Baby Lay Breech?

Approximately 3-4% of babies lie bottom down towards the end of pregnancy, known as a breech position, rather than the usual cephalic or head down position.

It may just be a matter of chance that your baby has not turned and remains in a breech position, however, there are some factors which may make breech positioning more likely. These include:

• If this is your first pregnancy
• You have a uterine abnormality
• You go in to labour prematurely
• If the edge of your placenta is close to or covering your cervix (also known as a placenta praevia)
• When there is too little, or too much, amniotic fluid, making turning difficult
• If you are having more than one baby (twins, triplets etc.)

Babies who are breech in the last trimester are more likely to have developmental hip dysplasia (DDH), also known as congenital hip dislocation, due to the position they lie in. You’ll be offered an ultrasound scan of their hips a few weeks after birth to check for this, and it will be treated if necessary.

What are my options for birth if my baby is breech?

If your baby hasn’t shown any sign of moving into a head-down birth position on their own, your medical team will usually discuss a procedure called an external cephalic version (ECV) with you. This can be done any time from 36 weeks right up until the early stages of labour, but is more successful when there’s more space for your baby to move, around 36-37 weeks. We’ll cover this in more detail a little later.

If you do not opt for an ECV or it’s unsuccessful, your options will include:

• Planned caesarean section
• Planned vaginal breech birth

Both methods of birth carry their own risks and benefits, which should be discussed in more detail with your healthcare professional. Giving birth to a breech baby vaginally is not usually any more painful than a head-down position, as you’ll have the same pain relief options available to you, although it does carry a higher risk of perinatal morbidity (2:1000 compared to 1:1000 with a cephalic baby). This is mainly due to the risk of something called head entrapment. In a cephalic baby, the hard skull of the head, paves the way for the rest of the body, but the risk in a breech birth is that the body delivers and then the head gets stuck. The key to a successful vaginal breech birth, is having it in a unit that have healthcare professionals who are experienced in managing this kind of birth.

Between 20% and 30% of these 3-4% of births will not be diagnosed until the late stages of labour and as a result, many babies in the breech position are delivered via emergency caesarean section. While this may not fit in with your original birth plan, your medical team will make recommendations based around what is safest for you and your baby.

Turning a breech baby with ECV

External cephalic version, also known as ECV, is the process of turning a breech baby in the womb. This involves applying firm but gentle pressure on your abdomen in order to encourage your baby to do a somersault in the uterus to lie head-first.

You will normally be offered a medication which can help to relax the muscle of your uterus before the ECV, which can help to improve the chances of turning your baby. Before the EVC, you will have an ultrasound scan to confirm that your baby is in breech. You will also have your blood pressure and pulse checked and your baby’s heart beat will be monitored throughout the duration of the procedure to make sure you’re both okay. You will then have a second ultrasound scan after the procedure to see if the baby has turned.

An ECV can be uncomfortable and sometimes painful, however, the procedure will be stopped if you are experiencing any pain. The procedure itself only lasts for a few minutes and the experience for women is hugely varied with 5% to 1/3 reporting significant pain. The most important thing to remember is that you are in charge and can ask for it to stop at any point. If you experience any bleeding, abdominal pain, contractions or reduced fetal movements after the ECV then you should contact your doctor, midwife or hospital immediately.

It is important to note that an EVC would not be carried out in any of the following circumstances:

• You need a caesarean section for any other reason
• You have recently experienced vaginal bleeding
• Your baby’s heart rate tracing is abnormal
• Your waters have broken
• You are pregnant with more than one baby

An EVC is successful for approximately 50% of women, and it is typically more successful if you have previously had a natural, vaginal birth. Risks are low, with studies suggesting a small increased chance at 0.5% of emergency caesarean in the 24 hours following a successful ECV, and no difference in Apgar scores in babies.

What other options do I have to help turn my baby?

There are a number of other options to consider aside from an ECV, including:

• Moxibustion – the traditional Chinese practice of burning dried mugwort, which is thought to increase fetal activity.
• Acupuncture – TCM practitioners advocate the benefits of acupuncture to turn your baby, although there are no studies which support this.
• Yoga – there’s not enough evidence to determine if postural modifications increase the chance of your baby turning. However, putting yourself into a forwards and open position may give your baby more space to turn.

Our Complete Birth Preparation Course can offer more insight into complicated labour and birth, including assisted vaginal delivery, complications of labour and caesarean section. To find out more about breech babies, don’t hesitate to get in touch with a member of our team via our Bloss profile.