If Your Baby Is Breech
Most babies move into the normal, head-down position in the mother’s uterus a few weeks before birth. But if this doesn’t happen, the baby’s buttocks, or buttocks and feet, will be in place to come out first during birth. This is called breech presentation. It occurs in about 3 out of every 100 full-term births.
Although most breech babies are born healthy, they do have a slightly higher risk for certain problems than babies in the normal position do. Most of these problems are detected by 20 week ultrasounds. So if nothing has been identified to this point then most likely the baby is normal. Your doctor may advise cesarean birth or try to turn the baby into the proper position with a procedure called external version.
By 3-4 weeks before a mother’s due date, most babies move into the head-down, or vertex, presentation. Most of the babies who don’t turn by then will be in a breech presentation when it’s time for delivery. The baby will appear to be sitting in the uterus, with its head up and its buttocks, feet, or both down-at the entrance of the birth canal, ready to emerge first.
One way for the doctor to tell what position the baby is in is to carefully feel the baby through the mother’s abdomen and uterus. Placing his or her hands at certain points on your lower abdomen, the doctor can try to make out the general position of the baby’s head, back, and buttocks. If the doctor thinks that the baby may be in a breech presentation, ultrasound may be used to confirm the diagnosis. Because your baby may keep moving around up until the end of pregnancy, we may not be able to tell for sure whether your baby has settled into a breech presentation until labor has begun.
The causes of breech presentation are not completely clear. It is known, though, that breech presentation is more common when other factors are present:
- The mother has had more than one pregnancy
- There is more than one fetus (twins or more) in the uterus
- The uterus holds too much or too little amniotic fluid (the liquid that surrounds the baby inside the uterus)
- The uterus is not normal in shape or has abnormal growths, such as fibroids
- The placenta (the tissue inside the uterus that is connected to the baby) partly or fully covers the opening of the uterus–a condition known as placenta previa
- The baby is unable to turn itself for some reason
Premature babies (those born 3 or more weeks early and weighing less than 5 1/2 pounds) are also more likely to be breech. Early in pregnancy, the shape of the uterus and the shape of the baby’s head and body are such that breech presentation is more common. Birth defects are also more common in breech babies and may account for why these babies have not turned into the proper position before delivery. The chances of that are very small because most of those defects would have been seen at previous ultrasounds.
Can a Breech Presentation Be Changed?
In some cases, the baby’s position can be changed by a method called external version. This technique consists of manually moving or turning the baby into the head-down position. It does not involve surgery. The doctor places his or her hands at certain key points on your lower abdomen and then gently tries to push the baby into the head-down position, much as if the baby were doing a slow-motion somersault inside the uterus.
Often a drug is given to the mother first to relax her uterus. This drug can make you feel jittery and make your heart race but this is usually mild. Also, several safeguards are used in case problems arise. An ultrasound exam done in advance allows the doctor to better examine the condition and position of the baby, the location of the placenta, and the amount of amniotic fluid in the uterus. If the baby’s knees are extended, the success rate for version is very low.
Before, during, and after version, your baby’s heartbeat will be checked closely.If any problems arise, efforts to turn the baby will be stopped right away. About one half of attempts at version succeed. If not successful, there is virtually no chance that the baby will turn around on its own. Some babies will shift back into a breech presentation after successful version. If that happens, your doctor may try again, but version tends to be harder to perform as the time for delivery grows closer.
Risks of version
The risk of version is very low. The main risk is pain. Pressure on the abdomen can be uncomfortable. If it is too uncomfortable the procedure will be stopped. A risk for the baby is distress. This is avoided by watching the baby’ heart rate during the procedure. Another risk is rupture of membranes. This is unlikely but is one of the reasons this is done in the hospital. Rarely patients will have bleeding. Any problems that arise can be dealt with because the patient can be observed on the monitor or undergo Cesarean section.
Vaginal Delivery: Risks and Complications
At the time of birth, the baby’s head is the largest part of its body, as well as the firmest. There is a chance that the body could deliver but the head would get stuck. This is unlikely, but if it happens it can be a major problem for baby and/or mother. For this reason most couples do not want to take any chance and C-section is the delivery route of choice if version is not attempted or unsuccessful. Breech babies who are premature are nearly always delivered by cesarean birth.
Another problem is called cord prolapse. This means that the umbilical cord slips to the bottom of the uterus, towards the birth canal. As the baby’s buttocks and legs move down into the birth canal, the cord can get squeezed, slowing the baby’s supply of oxygen and blood. This is a risk for patients with a baby in the breech position and a dilated cervix, who go into labor or break their membranes. So if your baby is breech and any of those things occur, you should call your doctor as soon as possible.
Most breech babies are born healthy and normal. However, a breech presentation poses a several hard choices for both the mother and the doctor. Some of the problems of breech babies remain, despite the method of delivery used. When you know about the problems and the possible solutions, you will be in the best position to work with your doctor to ensure that delivery goes as smoothly as possible.
- Breech Presentation: A situation in which a fetus is positioned buttocks or feet down, at the top of the birth canal, ready to be born first.
- Cesarean Birth: Delivery of a baby through an incision made in the mother’s abdomen and uterus.
- Electronic Fetal Monitoring: A method in which electronic instruments are used to record the heartbeat of the fetus and contractions of the mother’s uterus.
- External Version: A technique performed late in pregnancy in which the doctor manually attempts to move a breech baby into the normal, head-down position.
- Placenta Previa: A condition in which the placenta lies very low in the uterus, so that the opening of the uterus is partially or completely covered.
- Premature: Born before 37 weeks.
- Vertex Presentation: A position normally assumed by a fetus before labor and delivery, in which the head is positioned down, at the entrance to the birth canal, ready to be born first.