Breech baby

Breech baby

Breech baby

Most babies lie in a head down position in the womb, but a minority lie in the breech position – referred to as bottom or feet first.

How common is it?

As many as one in five babies lie in the breech position 28 weeks, but by late pregnancy (usually around 36 weeks) most have turned into the head down position.

By this stage only about 3 per cent of babies are still breeches.

Are there different types of breech presentation?

Yes:

  • Complete or Flexed breech: Where your baby’s bottom comes first, with the knees bent up and the feet tucked in beside the buttocks and thighs against the chest.
  • Extended Breech: Your baby sits bottom first with thighs against the chest and feet up by the ears. This is the most common type of breech presentation.
  • Footling Breech: Your baby’s feet are below their bottom.

Why do babies get in the breech position?

It can be just down to chance, but sometimes there are more obvious reasons, including:

  • Too much or too little amniotic fluid – making it difficult for the baby to turn.
  • Low lying placenta
  • More than one baby in the womb

Why is the breech position a problem?

It can make labour more difficult for various reasons including:

  • The umbilical cord may slip down and become compressed, depriving your baby of oxygen
  • Your baby may suffer damage to her hip joints because of the pressure being exerted on her bottom half during labour
  • The delivery may be more complicated, as the largest part of your baby’s body ( the head,) will be delivered last and this may need an obstetrician skilled in these types of delivery, who may have to use forceps (see assisted delivery)

Do babies turn on their own if you wait long enough?

If a baby hasn’t turned by 36 weeks it is unlikely to do so and you may be advised to have a procedure called External Cephalic Version.

How are babies turned?

The Royal College of Obstetricians and Gynaecologists (RCOG) recommend all women pregnant with breech babies at 36 weeks apart from those with specific medical conditions see below When is ECV not recommended) are offered a procedure called External Cephalic Version (ECV).

ECV is where an obstetrician or specially-trained midwife exerts gentle pressure on your tummy to encourage your baby to do a somersault and lie in the head down position. It may feel uncomfortable (stop your obstetrician or midwife if you are in pain though and they can change position.)

How successful is ECV?

It has a 50 per cent success rate – some babies just won’t budge and there are others who do turn, but then turn back again.

What are the risks of ECV?

It’s a safe procedure, but there is a 0.5 per cent chance that your baby’s heart rate may drop so low that they have to be delivered immediately by caesarean. For this reason ECV should always be done in a hospital which has facilities to deal with emergencies.

Is ECV suitable for everyone?

No – not in the following situations:

  • You need a c-section for another reason
  • You’ve experienced vaginal bleeding in the previous week
  • Your womb is not the normal pear shaped
  • Your waters have been broken before you go into labour

Is there anything else I can do to get my baby to change position?

  • Experts say there’s no evidence that sitting or lying in a certain position will encourage your baby to change position – but some old wives’ tales recommend getting down on all fours or crawling as if scrubbing a floor.
  • Moxibustion: This is a Chinese medicine technique used to encourage babies to turn in the womb. It involves burning the dried leaves of a herb called Artemisi vulgaris, near the toe. It might sound a bit wacky, but some research has suggested it might work. Find a qualified acupuncturist if you want to give it a try.

What’s the best method of delivery if my baby still won’t turn after ECV?

Current advice from the RCOG says a caesarean section is the safest method of delivery for the baby around the time of birth; however they also acknowledge that a caesarean has slightly higher risks for you.

If your baby is coming prematurely (before 37 weeks) your obstetrician should discuss the specific risks v benefits of a caesarean vaginal delivery with you.

Is it still possible to have a vaginal delivery for a breech baby?

The RCOG says this is a choice – but isn’t safe for all women and only supports vaginal deliveries of breech babies if the obstetrician is trained in them, there are emergency C-section facilities available and no high risks in your pregnancy.

Any vaginal labour for a breech baby will need foetal monitoring and may need forceps to help deliver your baby’s head.

When is a vaginal breech delivery not recommended?

Obstetricians may strongly recommend against a vaginal delivery if:

  • Your baby is in the footling breech position
  • Your baby is classed as big (300g or more) or small (less than 200g)
  • You have a narrow pelvis
  • You have a low lying placenta
  • You have pre-eclampsia ( a pregnancy high blood pressure condition)

A mums says..

‘Florence was breech until 36 weeks when I had an ECV in hospital. It was a bit uncomfortable - lots of pushing my tummy around - and I was anxious about her heart rate - but thankfully it worked a treat and Florence was born vaginally.’
Sarah Baldwin, mum to Florence two months.

Comments

Submitted by lillypc19 on Tue, 22/05/2012 - 20:31.
I am 34 weeks withs my 2nd. Had no problems with my first but this babie is breech and has been since at least my 20 week scan. I remember feeling a big movement before i had my scan and then they told us then it was breech. Have not felt another movement like that which tells me it is comfortable their. Have got midwife tomorrow and i am expecting the same news. I have a feeling this babie is going to be stubborn. Really hoping that it will move while it still has abit of room in their because i really dont want a section.
Submitted by maj314 on Tue, 24/04/2012 - 15:22.
Am a high risk patient, have hypertension, high bmi, under active thyroids, and also gd. Just told this morning @ 38 wk checkup that baby was not in breech position, but rather sideways. Got a Ecv booked 4 tomorrow, rather worried, is it going to be painful? don't understand how this happened.
Submitted by cazzmania on Sat, 21/01/2012 - 13:26.
I had a ECV at 38wks, 4 days. I was very nervous but keen to get baby to turn as I did not want a section (this is my first baby). It was really uncomfortable but bearable. Unfortunately baby did'nt budge so I asked if we could try again - at least I knew what to expect now! Tried again two days later and baby still would not budge so I have been given a date for my section. My baby seems to have been in this same position since about 35 wks and has not been particularly active so Docs said that its unlikely that it will move. I would recommend this proceedure as it's only literally five minutes of pain (compared to longer in child birth) for a potential positive outcome. I would say that it is a good idea to buy some Arnica as I was particularly tender after both attempts. Hopefully your attempts will be more successful but don't give up. I am getting my head round having a section, I have got to go with what is best and safest for me and baby now
Submitted by same81 on Sat, 24/12/2011 - 14:57.
I was booked in for a ECV at 38 weeks, the procedure was not painful but just uncomfortable. unfortunately the baby's bottom was already engaged and it just wouldn't turn. after 4 attempts the doctor advised us to have a elective c-section at 39 weeks. Its my first baby and I was hoping for a normal delivery, I guess baby's safety comes first.
Submitted by lisac34 on Mon, 05/12/2011 - 12:06.
i am on my forth pregnancy ,i am currently 37 plus 3 days pregnant .all my previous deliveries was by c section due to all babies being breech this baby is also breech i was told this is due to the shape of my uterus . it can be very uncomfortable baby being breech .i was told that because i have already had 3 previous sections i may not realize i m in labour so any pain i get i have to go straight into hospital the only thing with this is i am constantly in pain as i also have spd and veriositys of the vaulva and suffer with my back any way ,i will be so happy when my little one is finally in my arms this has been such a long and painful pregnancy and certainly my my last
Submitted by laurenislaysime on Sat, 16/07/2011 - 10:04.
I found out my son was breech at 28 weeks, by 36 he still hadn't turned. I refused an EVC because I was paranoid the cord was around his neck (which it was). I opted for a c-section at 39 weeks. After he was born I was told by the obstetrician my uterus was bicornuate (heart shaped), and my poor little man had been stuck in half of my uterus. It was amazing no one had picked this up in any of my scans!
Submitted by Longers1981 on Mon, 16/05/2011 - 16:50.
Just got back from the midwife's and been told that my baby is breeched- even though we thought the baby was head down a fortnight ago. Got a scan on Thursday-I'm hoping that the baby's had a change of heart by then-ECV's don't sound particularly pleasant and Id rather not have a C Section if I can avoid it. Fingers crossed!!
Submitted by amandabryce on Sun, 15/05/2011 - 13:49.
i had a ECV at 37 weeks as my baby is breech it was really painfull and have burising round my tummy.It would of been worth it if it had worked but it didnt and i have to have a c section at 39 weeks.Its my 3rd baby but first section and im really nervous. really would of liked an normal birth.
Submitted by laalaa2908 on Sat, 07/05/2011 - 01:18.
The doctors and midwives persuaded me to have an ecv, I have never felt so much pain!! I was left with bruising all around my tummy. One person managed to get my baby from breech to almost head down but she could not carry on as her arms were hurting as my baby was being a bit stubborn! She went to get a doctor and before he got into the room my baby had moved back into the breech position. They then kept me in hospital as i refused them to do it any more as it was too painful. I started to get a few contraction feelings and they said they would perform a c-section to get baby out. About 5 mins before i was due to go into have it done, the surgeon did a scan and discovered that overnight my baby had turned herself into the head down position!!!! All this put me through so much unnecessary pain and nerves. I would never put myself through all that again. They ended up sending me home and let me wait until she was ready to be born.
Submitted by tebbybear2011 on Sat, 30/04/2011 - 12:21.
hi, i am 32 weeks pregs with my 3rd and he is breech and they say he is 5 pounds 14oz, will he turn because he big, and his feet is over his face
Submitted by MrsSchwartz on Tue, 26/04/2011 - 16:17.
The Midwives didn't know my son was breech until his foot came out!!! Luckily everything was ok and he was delivered normally. Although everything was ok I was still a bit miffed that no one noticed even though I had been in the hospital all day linked to monitors as they were starting the Labour off as I was two weeks overdue but I suppose these things can happen and it certainly hasn't affected him in any way!
Submitted by dobbie872 on Sat, 12/03/2011 - 12:29.
I am 36 weeks and beeen told that my baby is breach. I am hoping to have the baby turned in a week or so, but was worried about it being too painful and not working. It is good to hear that it does work and the pain/discomfort is worth it.
Submitted by Actone on Fri, 11/02/2011 - 17:30.
I think there's a misprint when it says 'classed as big (300g) or more or small (less than 200g) - both of these would be minute babies!
Submitted by QUELITA on Wed, 02/02/2011 - 23:10.
I said to more than one midwife that I thought that my son was breach, but got checked twice (37 and 38 weeks) and was told that he was engaged. I went into labour and got to the hospital when I was 9 centimetres dilated. Unfortunately when the midwife checked me she also noticed my son was in fact breech; he had both of his feet down. I had to have an emergency caesarean. I was never told what happened. I don't know why no one actually realised he was breech.
Submitted by QUELITA on Wed, 02/02/2011 - 23:09.
I said to more than one midwife that I thought that my son was breach, but got checked twice (37 and 38 weeks) and was told that he was engaged. I went into labour and got to the hospital when I was 9 centimetres dilated. Unfortunately when the midwife checked me she also noticed my son was in fact breech; he had both of his feet down. I had to have an emergency caesarean. I was never told what happened. I don't know why no one actually realised he was breech.