A breech baby or breech pregnancy is when the baby’s legs or hips are positioned so that they come out of the vagina first. In most pregnancies, the baby is in a position where the head is in the cervix, and the legs are towards the navel. But the position of the fetus changes during pregnancy and sometimes turns upside down. In 95% of pregnancies, between the 32nd and 38th weeks of pregnancy, the fetal head is placed towards the cervix.
But in some cases, the baby remains breech or upside down in the 36th week of pregnancy, and the head is not close to the cervix. Giving birth in this situation is associated with risks and difficulties.
How common is a breech baby?
There is a small chance that the baby will not move into a head-first position before 37 weeks of pregnancy. Breech babies account for about 3-4% of all full-term pregnancies.
Types of breech position
There are different positions for the fetus. Ideally, the baby will be head-down, facing back, with their chin tucked into his chest. Breech babies can be in several different positions:
- Frank breech: The baby’s buttocks are placed in the cervix, and the legs are placed up and near the ears. This is the most common breech condition when the baby’s buttocks come out of the uterus first during childbirth.
- Complete breech: The head of the baby is facing up (the side of the mother’s navel), and his buttock is facing the cervix. In this position, the legs are folded into the abdomen.
- Footling breech: The soles of the feet are towards the cervix and during childbirth, one or both of them come out first.
- Transverse lie: This is a type of breech where the baby is positioned horizontally across the uterus instead of vertically. This causes their shoulder to enter the vagina first.
What causes a baby to be breech?
Although doctors sometimes cannot determine why a baby is in the breech position, there are some possible conditions that contribute to this outcome. However, keep in mind that having a breech baby is possible without any of these risk factors.
Uterine abnormalities
Usually, the uterus looks like a hollow, upside-down pear, but in some women, it has a different shape, which is often detected by a pelvic exam or ultrasound before or during pregnancy. The mother may have had an abnormality since birth or developed later due to scar tissue from surgery, fibroids, or severe uterine infection. As a result, the baby may not have enough room to turn and exit head down.
Location of the placenta
If the placenta is low-lying (placenta previa), it covers the cervix or lies near the top of the uterine wall but blocks the space near the baby’s head, so the baby may not be able to wiggle its way into a downward position.
The volume of amniotic fluid
Too little or too much amniotic fluid can also cause a breech position. Not enough fluid makes it difficult for the baby to “swim, “while too much means the baby has plenty of room to move between breech and head down.
Multiple gestation
If there are multiple pregnancies, one or more babies may not be able to be in the head-down position because there is less space to move.
Previous breech
If a mother had a previous breech baby, it is more likely that subsequent babies will also be breech.
Premature birth
The earlier the baby is born, the more likely it is to be breech. About 25 percent of babies are breech at 28 weeks, but only 3 percent or so are breech at term.
Being breech one of the parents
According to some research, the baby is also more likely to be breech.
Fetal abnormalities
Rarely, a problem with the baby’s muscular or central nervous system can cause breech. Having an abnormally short umbilical cord may also restrict the baby’s movements.
Smoking
Smoking during pregnancy may increase the risk of breech birth.
Complications
In general, a breech pregnancy is not dangerous until the baby is born. With a breech delivery, there is a greater risk of the baby getting stuck in the birth canal and cutting off the baby’s oxygen through the umbilical cord.
The biggest question in this situation is, what is the safest way for a woman to deliver a breech baby? Before cesarean births became common, doctors, and usually midwives, were taught how to perform breech births with minimal risk. However, breech delivery has a higher risk of complications than vaginal delivery.
A planned cesarean section is generally safer for babies than a natural birth during a breech pregnancy. Infant death and complication rates are significantly lower with planned cesarean delivery for breech babies. But the rate of complications for mothers in both cesarean and vaginal delivery groups was almost the same.
How is a breech baby diagnosed?
The healthcare provider may be able to tell which way the baby is turning by placing the hands in certain places on the abdomen. By feeling where the baby’s head, back, and hips are located, it is usually possible to find out which part of the baby is placed in the opening of the vagina first before it comes out of the vagina. Ultrasound may be used to confirm the position of the baby.
What are the options for treating a breech baby?
If the baby is breech at 37 weeks of pregnancy, the doctor may:
- Try turning the baby in the uterus into the head-first position
- Plan a C-section birth
- Plan a vaginal breech birth
Can a doctor flip a breech baby?
If the midwife or doctor thinks that the baby is still breech at 36 weeks, the doctor should do a scan to confirm this. If the scan shows that the baby is breech, the midwife or doctor will talk to the mother about options for safe delivery. They will likely offer the mother an external cephalic version (ECV). If this does not work, or if the mother is unwilling to do this, they will discuss options for breech delivery.
Is it possible to turn a breech baby?
The doctor can try turning the baby into a head-first position using an “external cephalic version” (ECV). During this time, the ob-gyn puts pressure on certain parts of the mother’s bump to encourage the baby to move in the uterus.
What is an external cephalic version (ECV)?
ECV can be performed from 36 weeks to early labor as long as the water has not yet broken. It is successful for about 50% of women. If successful, the mother is less likely to need a C-section or other medical assistance during labor.
Is ECV right for everyone?
ECV is recommended for most women, however, there are reasons why it may not be recommended for some people. This includes:
- If a cesarean section is needed for another reason, such as a low-lying placenta
- Vaginal bleeding in the last seven days
- There is concern about the child’s health
- Different shaped uterus
- If the water is broken
- Pregnancy is more than one baby
Before ECV
Before starting, the doctor will scan the mother to make sure the baby is still breech. They also check the mother’s blood pressure and heart rate. The mother will be given medicine to relax the uterus (tocolytic), which will make it easier to turn the baby. This medicine is safe for mothers and babies but may increase heart rate. The baby’s heart rate is also checked before ECV.
During an ECV
This procedure will take a few minutes. The pressure may feel uncomfortable, but it should not hurt. If it causes pain, the mother should inform the doctor.
After an ECV
The mother will have another ultrasound scan to check if the baby has successfully turned its head. Blood pressure and heart rate are also checked again, along with the baby’s heart rate. If there is bleeding, abdominal pain, contractions, or reduced movements after ECV, the mother should go to the hospital.
Other ways to turn a breech baby
There are a few tips that may help baby turn, including:
- Stretches and positions: In this method, the mother kneels on a mat for about 15 to 20 minutes every day, lowers her head to the ground, and raises her bottom. The goal is to move the baby out of the pelvis to give him or her more room to turn. No research supports this method, but some mothers say it has worked for them. If, in this case, the mother feels pain or dizziness, stop it immediately.
- Do pelvic tilts: For five minutes, several times a day.
- Maintain good posture: In this position, the mother sits upright on an exercise ball, which can help open the pelvis and make it easier for the baby to move.
- Music: In this case, the mother puts headphones or speakers at the end of her uterus to encourage the baby to turn.
- Temperature: Putting something cold on the upper abdomen and something warm on the lower abdomen.
Deliver vaginally with a baby breech
Vaginal delivery is possible for breech babies. It can be more dangerous for the baby, and the risk of injury is much higher. If the umbilical cord is compressed during birth, the baby may be deprived of oxygen, which can damage the brain and nerves. The umbilical cord can also slip around the baby’s neck or arms and cause injury. Healthcare providers have varying levels of comfort with the vaginal delivery of breech babies. Most healthcare providers recommend cesarean delivery for all babies who are in the breech position, especially babies who are premature.
The bottom line
About 3 to 4 percent of all pregnancies result in the baby being breech. A breech pregnancy occurs when the baby is placed upside down in the woman’s uterus so the legs are facing the birth canal.
In a normal pregnancy, the baby automatically turns into a head-down position in the womb to prepare for birth, so a breech pregnancy presents a variety of challenges for both mother and baby. Having a breech baby can be unexpected and change the mother’s vision of childbirth.
If you are in this situation, talk to your obstetrician about your concerns about the breech delivery of your baby, including the risks and benefits of choosing a cesarean section, expectations from the surgery, and how to prepare. Dr. Arjang Naim MD provides the necessary guidance to pregnant mothers in these cases.
Additional questions
- Does walking help get the baby’s head down?
Walking for up to an hour a day may encourage the baby’s head to move downward.
- Why is amniotic fluid volume important?
This liquid provides the necessary space and growth factors for the normal growth and development of fetal organs, such as the musculoskeletal, digestive, and pulmonary systems. Doctors can use amniotic fluid as a tool to monitor pregnancy progress and predict fetal outcomes.
- How much amniotic fluid is required for normal delivery?
The amount of amniotic fluid around the 34th week of pregnancy is, on average, 800 ml, which is the highest amount. About 600 ml of amniotic fluid surrounds the baby at full term (40 weeks of pregnancy).
- Can everyone have a natural birth?
If the pregnancy is healthy and without complications, natural childbirth is unimpeded. Cesarean delivery may be the right option if you have heart disease, preeclampsia, twin pregnancy, or a breech baby.
- Where is the placenta located on an ultrasound?
It is usually located along the anterior or posterior walls of the uterus and extends to the lateral walls. The middle part of the placenta is usually between 2 and 4 cm.
References
https://www.pampers.com/en-us/pregnancy/giving-birth/article/breech-baby
https://www.healthline.com/health/pregnancy/breech-baby#talk-to-your-doctor
