Heads up! And that is precisely what a breech pregnancy is: when your baby is positioned head up, his buttocks, feet, or knees are poised to come out first, instead of his head, at the time of delivery.
In the early stages of pregnancy, the breech position is quite common. Babies typically spend most of their time in the head-down (vertex) position in the womb during the later stages of pregnancy. However, it’s not uncommon for babies to be in a breech position, where their buttocks or feet are closest to the birth canal, earlier in pregnancy.
But as the third trimester progresses and the due date approaches, nearly 97 per cent of babies turn naturally to the head-first position. However, about three to four per cent of full-term pregnancies remain in a breech position.
What Is Breech Pregnancy
A breech pregnancy occurs when the baby is positioned with his or her buttocks or feet first. While delivering a baby in this position can be a bit more complicated, it’s not uncommon and can be handled relatively easily.
If you’re pregnant and having a breech baby, here’s what you need to know about the condition:
- A breech baby is born when the baby’s rear end comes out first, but the head does not come out until after the body has been born.
- This type of birth will require some special techniques on the part of your doctor, but it is possible for any woman who has had one in the past to have another one without any complications.
- The biggest concern when having a breech birth is that if your child turns around during labour and faces up instead of down, they could get stuck during delivery. This would require surgical intervention and could result in serious injury to both mother and child.
Breech Position of Baby
It’s not uncommon for your baby to change positions a few times during the last weeks of pregnancy. A baby’s breech means that he may be ready for birth soon, but it doesn’t necessarily mean that he’ll be born that way.
Babies can move around a lot in the womb, often turning around or moving into another position before birth.
If you have an ultrasound and your baby is still breech, your doctor will discuss what options are available to help him turn. Most babies turn on their own by 37 weeks, but some don’t turn until later in labour.
If your baby hasn’t turned by 41 weeks, it’s unlikely that he’ll change position on his own before birth.
Pregnant woman holding her belly
Types of Breech Position of Baby
A breech baby may be lying in one of the following positions:
- Frank breech. This is the most common breech position where the baby’s bottom is near the birth canal, with the thighs against the chest, legs pointing upward, and feet up by the ears.
- Complete breech. In this position, the baby’s hips and knees are flexed. The legs are folded with feet beside the bottom.
- Footling breech. The baby is positioned with his head up while one or both feet are positioned downwards. The baby would come feet first in this position if delivered vaginally.
- Kneeling breech. Both knees are set to come first in this breech pregnancy position, and the feet are folded up behind the baby’s thighs.
A baby in breech position is poised to be born feet or buttocks first, rather than head first. | Image Source: Pinterest
Signs of Breech Baby
Here are some signs that could indicate that your little one is in a breech position:
- Your belly feels hard underneath when you press on it
- There are strong contractions but don’t see any movement on the outside of your belly
- Back pain (if it’s severe, call your doctor)
- You feel a strong kick from their bottom or feet.
- The baby moves around more in the lower abdomen than the upper.
- You feel an ache or pull in your pelvis. This could be caused by pressure on the bladder or rectum as the baby moves into the pelvis.
Causes of Breech Baby and Risk Factors
It’s not always possible to know why babies wind up in a breech pregnancy position. Sometimes it’s just a chance that he doesn’t turn it in by his due date.
Sometimes, as in the case of premature delivery, the baby simply didn’t have enough time to turn its head down.
However, certain factors may lead to a baby remaining in the breech position. These include:
This could be present either from the mother’s birth or may develop later due to any surgery, including a C-section, a severe uterine infection, or a uterus with abnormal growths such as fibroids (benign tumours of muscular and fibrous tissues that develop in the wall of the womb).
This condition may prevent the baby from having enough space to position himself correctly.
A small amount of amniotic fluid allows the baby to flip around too much; a large amount of amniotic fluid, on the other hand, makes it difficult for the baby to “swim” around.
- Down Syndrome or any other disability
In some rare cases, about one in 10 babies may have a physical disability with the muscular or central nervous system that can cause a breech pregnancy.
When there is less space to move around, one or more babies may be unable to turn into the head-down positions.
This can get wrapped around the baby, thus limiting his movement.
- History of premature delivery
This may cause a preterm birth which doesn’t give the baby enough time to come into the head-down position.
Studies have also found that some first-time mothers who have a tight abdomen or strong core are more likely to experience a breech pregnancy.
Similarly, mothers who have birthed about five or more times are likelier to have a loose womb and may have breech birth subsequently.
What Are the Risks of a Breech Delivery?
Breech deliveries can pose additional challenges and risks compared to head-first (vertex) deliveries. These risks include a higher chance of birth complications, such as head entrapment, umbilical cord compression, and birth injuries.
As a result, healthcare providers often consider options like external cephalic version (ECV) to attempt to turn the baby or recommend a cesarean section (C-section) for a safer delivery. We’ll discuss these a bit later.
How to Turn Breech Baby
Image Source: iStock
If your baby doesn’t naturally turn by week 37, you may attempt to coax him into a head-first position. Try some of these natural techniques–but seek your doctor’s approval first:
- Pelvic tilts to strengthen your abdominal muscles. On the floor, lie flat on your back with your knees bent. Raise your pelvis about 10-12 inches off the floor, and hold it up for 10-15 seconds. You can support your hips using a pillow if necessary to avoid any stress on your body.
- Yoga position, such as bending down on your knees in a dog position. Place your forearms on the floor and buttocks higher than your head in front of you. Rock back and forth.
- Playing music, taped recordings or even having your partner speak near the bottom of your belly may stimulate your baby to move towards the sound.
- Relaxation techniques, such as meditation and maintaining good posture (sitting upright on an exercise ball helps), open up the pelvic area. This makes it easier for your baby to move around.
- Cold press near the top of the stomach, as suggested by some mothers, can make the baby uncomfortable. The sensation may send the baby downwards.
- Moxibustion, an ancient Chinese technique, involves burning herbs to stimulate key acupressure points.
- Hypnosis involves inducing a state of deep relaxation during a mother’s 37 to 40 weeks of pregnancy. This relaxes the uterus and coaxes a baby to turn down.
Note that these haven’t been proven effective, but some mums swear by them.
Can Sex Turn a Breech Baby
There is a common belief that having sex can help turn a breech baby into the head-down position, but it’s important to clarify that there is no scientific evidence to support this claim. The position of a baby in the womb is primarily determined by factors related to the baby’s growth and the mother’s uterine structure, and not by sexual activity.
If a baby is in the breech position (feet or buttocks first) close to the due date, it’s recommended to consult a healthcare provider for options such as external cephalic version (ECV) or other medical interventions to encourage the baby to turn head-down.
Sleeping Positions to Turn Breech Baby
The first thing to do is try to relax. Stress can be bad for the baby and make it more difficult for him or her to turn, so give yourself a break! Do things that reduce stress in your life, like meditation, yoga, or even reading a book.
You should also try sleeping on your left side (if you’re right-handed) with your left leg crossed over your right leg. If you can’t sleep comfortably on your side at night, try leaning back against a wall or headboard when sitting in bed.
If these methods don’t work for you, ask your doctor about other options. He or she may recommend acupuncture or pelvic rocks—little exercises that help loosen up the muscles around your pelvis and uterus, so they don’t get too tight while sleeping on your back.
Image Source: iStock
Treatments and Drugs
External cephalic version (ECV)
Medically, the only proven way to get your baby into a head-down position is to attempt an ECV.
ECV is a non-surgical technique wherein the doctor tries to push the baby into the head-down position by applying firm but gentle pressure on your abdomen using his hands. The procedure is usually done at the end of pregnancy, around 37 weeks of gestation.
Studies have found ECV to have a high success of about a 58 per cent rate in turning breech babies and about a 90 per cent rate in the case of babies lying sideways (or a transverse lie). However, the baby can flip back into a breech position even after a successful ECV.
ECV is not recommended for women with certain conditions such as vaginal bleeding, low lying placenta; low levels of amniotic fluid; premature rupture of the membranes; those with a baby with an abnormal fetal heart rate, or those who have twins or multiple pregnancies.
What happens on the day of the procedure?
The night before ECV is conducted, you will be advised not to eat or drink anything after midnight. This is precautionary just in case you end up needing surgery.
Before the procedure, you’ll have an ultrasound to confirm the baby’s position and if all other parameters are fine. You may be given medication to relax your uterus (don’t worry, it’s safe!).
Throughout the procedure, the baby’s heartbeat and position will be closely monitored through an ultrasound. This way, the doctor can immediately stop the procedure and take the requisite action in case any problems arise.
During the External Cephalic Version (ECV) procedure, the doctor continues to monitor your baby through an ultrasound to ensure your little one is okay.
Once the doctor locates the baby’s head, he will gently apply pressure to turn the baby to the head-first position. If the procedure is successful, your doctor will recheck everything, including your baby’s heart rate. When all seems normal, you will be sent home.
If the procedure is unsuccessful, your doctor will advise you regarding your delivery options or may suggest attempting ECV again.
Risks of ECV
Despite being considered a high success rate, ECV is not entirely risk-free. Some women may find it very uncomfortable, if not painful.
Though the risk of having complications is small, they include early onset of labour, premature rupture of membranes, blood loss for either the baby or the mother, or for the placenta to separate from the uterine wall, which leads to fetal distress and an emergency C-section.
Therefore, the doctor, under all circumstances, must conduct ECV in the hospital.
Webster Breech
This medical technique used to treat breech pregnancy is named after the late Larry Webster, D.C., who developed a specific chiropractic analysis and adjustment to change the position of breech babies.
Through this technique, chiropractors work toward establishing balance in the mother’s pelvis and reducing undue stress on her uterus and supporting ligaments.
Chiropractors recommend that women use chiropractic care throughout the pregnancy to establish better balance and optimise foetal positioning and development. It also helps increase the chances of more accessible and safer delivery for both mother and baby.
How Does Labour Start With a Breech Baby
If you’re carrying a breech baby, there are two main ways labour can start: natural induction or artificial induction.
Natural induction means that your body will go into labour on its own after undergoing all of its stages in preparation for birth.
Artificial induction means that doctors will use drugs or surgery to start labour before it naturally starts on its own. Both methods have risks and benefits, so you must talk with your doctor about which method is right for you and your baby before deciding on an induction method.
ALSO READ:
Pros And Cons of Different Vaginal Birth Positions During Labour
7 Signs That Labor Is 24 To 48 Hours Away And You Must Get Ready
Pregnancy Guide: Normal Delivery vs. Caesarean
Breech Delivery
Is Breech Delivery an Emergency?
Breech presentation itself does not always necessitate an emergency. However, the decision regarding the mode of delivery should be carefully considered.
Healthcare providers will assess various factors, such as the baby’s position, gestational age, and the mother’s health, to determine the safest delivery approach. In some cases, a planned C-section may be recommended to reduce the risks associated with breech birth.
Research shows that C-sections deliver a large majority of breech pregnancy babies. But a doctor may find it appropriate to attempt a vaginal delivery in some cases.
Vaginal Delivery
Some of the factors that can make attempting a vaginal birth conducive include:
- When the baby is full-term, not too big, and in the frank breech pregnancy position
- The mother’s pelvis has enough room, and the labour process is smooth and steady, with the cervix widening as the baby descends. Odds are better for women who have delivered vaginally before
- When the baby shows no sign of distress (while his heart rate is closely monitored)
- No pregnancy complications (including gestational diabetes or pre-eclampsia)
- When pregnant with twins and the first baby is head down while the other is breech (the first baby’s head may open up the cervix enough for the breech baby to pass through)
- When your doctor is trained and experienced in breech birth and has facilities for a C-section available nearby
However, a vaginal delivery for breech babies may include many severe complications such as:
- injuries to the baby’s skull, brain or limbs
- the head getting stuck in the birth canal
- cord prolapse that may result in slowing the baby’s supply of oxygen and blood through the umbilical cord
- increased risk of perineal tears or episiotomy
- prolonged and difficult labour
C-section
Most doctors recommend a C-section delivery for breech babies in the following cases:
- If your baby is in a footling or kneeling breech pregnancy position or any other position, that can make the delivery of the head more difficult. Don’t worry, as this isn’t a common occurrence
- When you are expecting twins
- If you have preeclampsia or any other condition that may put you or your baby’s health at risk
- When the baby is either too big (more than 4kg/8lb 13oz) or too small (less than 2kg/4lb 6oz)
- If you’ve had a c-section before
- If you have a narrow pelvis or a low-lying placenta
Breech Extraction vs Assisted Breech Delivery
Breech extraction and assisted breech delivery are two distinct methods for managing a breech birth, each with its own set of considerations.
Breech extraction refers to a more invasive approach where the baby is delivered vaginally through the breech presentation with the aid of forceps or vacuum extraction. This method is typically reserved for skilled healthcare providers in carefully selected cases.
In contrast, an assisted breech delivery involves a less invasive approach where the baby is guided out by the hands of a healthcare provider, without the use of forceps or vacuum.
The choice between these techniques depends on the specific circumstances of the birth, the experience of the attending healthcare provider, and the overall health of the mother and baby.
It’s crucial for healthcare professionals to evaluate each case individually and make informed decisions to ensure the safest outcome for both mother and baby during a breech birth. Remember to thoroughly discuss your delivery options’ possible risks and benefits with your doctor.
How to Avoid Breech Position in Pregnancy
While some factors affecting fetal position are beyond a mother’s control, there are techniques and approaches that may encourage babies to turn into the head-down position. These include exercises, such as the knee-chest position and pelvic tilts, chiropractic care, and acupuncture.
Discuss these methods with a healthcare provider or a trained specialist to explore safe and effective options for encouraging optimal fetal positioning.
Image Source: iStock
When it comes to breech presentations, there’s no one-size-fits-all solution. The key is to maintain open communication with your healthcare provider, discuss the available options, and make informed decisions that prioritise the health of both you and your little one.
Remember, every pregnancy and birthing experience is unique, and you’ve got a team of professionals ready to support you on this incredible journey. Stay positive, stay informed, and you’ve got this!
Updates by Pheona Ilagan
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