As your excitement builds and your due date approaches, your OBGYN or midwife will usually perform a series of routine tests to ensure that your soon-to-be-born baby is facing the right direction. Normally, your baby will prepare itself for delivery by “flipping,” ensuring that their head is pointed down towards the birth canal. When this doesn’t occur, when the baby’s body remains oriented with the head up, special steps have to be taken to ensure a healthy delivery. This is called a breech pregnancy and delivery.
A baby in the breech position at the time of delivery occurs in roughly 3-4% of all pregnancies. So while a breech pregnancy is uncommon, it’s not rare–and your team will be well equipped to handle the situation, keeping you and your baby safe through your breech pregnancy and delivery.
What is a Breech Pregnancy?
Technically, a breech position will not be declared until after week 35 or 36 of your pregnancy. It’s at this point that the baby would have normally flipped and adopted a position in which the head is facing towards the birth canal. When the head continues to instead face away from the birth canal, a breech presentation is diagnosed.
There are several different ways in which a breech pregnancy may occur:
- Footing breech: A footing breech presents when one or both of the baby’s feet are pointing down, towards the birth canal.
- Frank breech: A frank breech occurs when the baby’s feet are curled up near the head and the buttocks are directed towards the birth canal.
- Complete breech: In the case of a complete breech, the buttocks are still pointed towards the birth canal, but the legs are folded up beneath the child. The feet are near the buttocks.
Your OBGYN will determine whether your baby is in breech position by feeling the outside of your belly in order to locate the position of the baby’s head within your uterus. A breech presentation is then confirmed with a diagnostic ultrasound. Once the ultrasound is complete, you’ll have a much better idea of the position of your baby.
Risk Factors for Breech Pregnancy
No one is entirely sure what causes some women to experience breech pregnancy while others do not. However, researchers have identified some factors that may increase your risk of a breech pregnancy and delivery. Those factors include:
- A pregnancy with multiple babies (such as twins or triplets).
- Multiple pregnancies, especially in quick succession with little time between them.
- A history of preterm labor or birth.
- Uterine fibroids or other abnormalities in the shape of the uterus.
- A lack or excess of amniotic fluid in the uterus (this can impact the baby’s ability to move around).
- The occurrence of placenta previa in the mother.
These risk factors are not necessarily evidence of a cause and effect relationship, nor should they ever be a reason to place blame in the event of a breech pregnancy. Instead, risk factors for breech pregnancy and delivery indicate a statistical relationship–so your OBGYN or midwife may suggest a change in behavior to help you manage risks.
How is Breech Pregnancy Treated?
Breech pregnancy and delivery can be potentially hazardous both to the mother and to the child.
There are some steps your OBGYN can take to encourage your baby to “flip” to a safer birthing position. If a breech delivery is unavoidable, your doctor will be able to guide you through the safest choices–both for you and for your baby.
Once a breech presentation is detected, you’ll have several treatment options–especially if you are not in labor yet. Some OBGYNs will begin first with non-invasive and at-home therapies, such as the following:
- Music: Some evidence suggests music and voices can help encourage your baby to move while in the womb–so some women will put a speaker near the bottom of their belly to encourage the desired flip.
- Relaxation: Tension in the uterus can prevent the baby from moving, so expectant moms are often advised to seek out activities that are deliberately relaxing. Yoga and meditation sometimes fit the bill, but often the activity is up to the individual.
- “The Breech Tilt:” This technique relies on strategically stacked pillows to help women sit and lay at prescribed angles–the hope being that this angle encourages the baby to move its head towards the birth canal.
- Alternative Therapies: Acupuncture and chiropractic visits may be able to assist in encouraging a breech or malpositioned baby to flip to a head down position. Acupuncturists can perform a procedure called Moxibustion and chiropractors use a treatment called the Webster Maneuver–all designed to encourage the baby to flip to a head down position. We often suggest the website Spinning Babies to patients who want to learn more about possible alternative therapies.
The primary medical treatment for a breech presentation is a procedure called external cephalic version (or ECV). This procedure is scheduled at a hospital as an outpatient procedure. During an ECV procedure, the mother will likely be given medications that help relax the uterus. Once those medications take effect, your OBGYN will attempt to encourage the baby to change positions by applying pressure on the outside of your belly.
An ultrasound scan is sometimes used to help guide the procedure. Additionally, the baby’s heart rate will be monitored at all times during the procedure. Because firm pressure is often used, some women may find the experience mildly uncomfortable, so pain management medications can be made available.
An ECV procedure may not be right for everyone (for example, if you’ve had a significantly elevated amount of vaginal bleeding, or react adversely to medications), so it’s important to talk over all your options on an individual basis with your OBGYN.
ECV has a high success rate–but there are some instances in which it doesn’t work. Even in some cases where a baby successfully flips to the correct birthing position during ECV, the baby may sometimes flip back to a breech position. You and your OBGYN will monitor the baby’s position carefully as your due date approaches.
Delivery During a Breech Birth
If your OBGYN is not able to successfully move the baby, the most likely outcome is delivery via Cesarean section. That’s because breech birth has the potential to cause complications for both the mother and the baby. This is a decision that mothers will make in consultation with their OBGYN as delivery approaches.
In some cases, vaginal delivery with a breech birth can be done with relative safety, but only during very specific conditions. Those conditions include:
- Anesthesia is close at hand and surgery for Cesarean delivery can begin at a moment’s notice.
- The labor process has gone smoothly and with no trouble.
- The baby is not showing any signs of distress (and continues to show no signs of danger during delivery).
- The baby is in the frank breech position.
- The baby is full term.
- Your OBGYN decides it is safe to proceed.
In most cases however, it’s going to be safer for both the baby and the mother to deliver the child via a c-section. You’ll want to discuss all of your delivery options with your OBGYN so you’re prepared to weigh the pros and cons of any decision.
The Right Breech Solution For You
Anxiety and fear are normal responses when confronted with the possibility of a breech pregnancy and delivery. After all, you want what’s best for your baby, and a breech presentation could mean possible complications. At the very least, you might have to change your birthing plans.
Having a trusted OBGYN and midwife team can be essential–and can make the process so much easier. When you have the right medical information, you can make the best decision for you, your baby, and your family.