When Baby is Breech: What You Need to Know

Even as your baby’s accommodations become increasingly cramped, she’ll still perform some pretty remarkable gymnastics during the last weeks of pregnancy until — between week 32 – 38 weeks (usually around week 36) — she finally settles head-down.

In this ideal delivery position, her head is near your cervix and she’s facing your back. However about 3 to 4 percent of babies are still hanging out head-up by the time they’re full-term, in one of the following breech positions:

• Frank breech: The most common breech position, baby’s bottom is down with his legs pointing upward and her feet near his head.
• Complete breech: Baby’s head is up, her buttocks are down and she’s sitting cross-legged.
• Footling breech: Baby is head-up with one or both feet hanging down (meaning she’d come feet-first if delivered vaginally).

Just because your baby is bottom-down in the weeks before your due date doesn’t mean she’ll be breech when it comes time for delivery. Some babies don’t let on what end will ultimately be up until a few days before birth. But if your full-term baby stays in breech position come D-day, a vaginal birth can be difficult, sometimes impossible, for you. Fortunately there are some steps your doctor and you can take to change direction before you go into labor.

DIAGNOSING A BREECH BABY

In the weeks before your due date, your doctor or midwife will determine your baby’s position by feeling the outside of your abdomen and uterus with her hands. If your baby is breech, her round and firm head will be toward the top of your uterus and her softer and less round bottom will be lower in your uterus. If your practitioner suspects your baby might be breech, she’ll do an ultrasound for confirmation.

CAUSES

Although doctors sometimes can’t determine why a baby winds up in a breech position, some possible reasons include:

• Uterine abnormalities. Usually the uterus is shaped like a hollow upside-down pear — but in some women, it develops differently or is misshapen, usually detected by a pelvic exam or ultrasound before or during pregnancy. Abnormalities are often present from birth, but they may develop later in life due to scar tissue resulting from surgery (including C-section), a severe uterine infection or fibroids (benign tumors that grow in the wall of the uterus). As a result, a baby may not have enough space to flip.
• Location of the placenta. If your placenta is low-lying, covers the cervix or is located up near the top of your uterine wall but blocking the space near your baby’s head, she may not be able to wiggle her way into a downward position.
• Volume of amniotic fluid. Too little or too much amniotic fluid can also cause a baby to be in a breech position. Not having enough fluid makes it more difficult for your baby to “swim” around, while having too much means she has too much space and can flip between breech and a head-down position right up to delivery.
• Fetal abnormalities. Very rarely, a problem with the baby’s muscular or central nervous system can cause a breech presentation. A short umbilical cord can also limit a baby’s movement.
• Multiple gestation. If you’re pregnant with multiples, one or more of the babies may not be able to get in the head-down position since there’s less space to move around.

RISK FACTORS

Just because you meet one of the following conditions doesn’t mean your baby will be breech — and it’s possible to have a breech baby without having any of these risk factors:

• Previous breech. If you’ve had a previous breech baby, you run a somewhat higher chance of subsequent babies turning breech as well, since the factor that caused it before may still be present.
• Premature birth. The earlier your baby is born, the higher the chance she’ll be breech: About 25 percent of babies are breech at 28 weeks, but by 34 weeks, the number drops to 7 percent.
• You or your partner was breech. If you or your partner were breech at birth, there’s a higher chance your own baby will be breech, according to some research.
• Smoking. Studies show that smoking during pregnancy may increase the likelihood of a breech baby.
• Your weight. Gaining more than the recommended amount of weight or having a higher BMI at term ups your odds of having a breech baby.

WHAT YOUR DOCTOR CAN DO

If your baby doesn’t turn naturally by week 37, your practitioner may attempt to do an external cephalic version (ECV). During an ECV (also known as a “version”), your doctor or midwife will place his hands on your stomach and push the baby into the head-down position using firm but gentle pressure. You’ll be given medication to relax your uterus (don’t worry — it won’t affect your baby). A version tends to be uncomfortable but not painful, and more than half of all attempts are successful. Sometimes, however, babies flip back into the breech position after being successfully inverted. If this happens, your practitioner can try flipping baby again — but this usually gets tougher the closer you are to your due date, since there’s less room for baby to move around.

WHAT YOU CAN DO TO TURN BABY BEFORE BIRTH

If baby is still breech by week 37, you too can try to coax her into a head-first position. Again, there’s no research to prove any of these methods work — but since they won’t cause any harm (and they’re free!), they’re worth the effort:

• Rock back and forth gently on your hands and knees with your buttocks higher than your head.
• Do five minutes of pelvic tilts several times a day.
• Maintain good posture (sitting upright on an exercise ball can help), which opens up the pelvic area and can make it easier for your baby to make her move.
• Play music or have your partner speak near the bottom of your belly and wait for your baby to (hopefully) follow the tune.
• Place a bag of frozen veggies near the top of your stomach (some experts and moms think the uncomfortable cold sensation sends baby headed in the other direction).
• Visualize your baby in the head-down position.

That said, these methods will not, in all likelihood, have any effect on baby’s position. The only proven way to get your baby into a head-down position is to attempt an ECV.

WHAT HAPPENS IF YOUR BABY IS STILL BREECH ON DELIVERY DAY?

If your membranes haven’t ruptured (for instance, you arrive to the hospital for a scheduled C-section), your doctor may attempt a version before delivery. But if you’re at term, your water has broken or you’re having contractions, it’s too late for a version.

Although research shows that nearly 90 percent of breech babies are delivered by C-section, some doctors and midwives feel it’s reasonable to attempt a vaginal delivery in some cases. A vaginal breech delivery is more likely possible if:

• Your baby is full-term, in the frank breech position and not too big
• Your pelvis is roomy enough for your baby to pass through safely (odds are better if you’ve delivered vaginally before)
• You’ve experienced no pregnancy complications (includinggestational diabetes or preeclampsia)
• Your baby shows no signs of distress
• You’re 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)
• Your provider has experience doing vaginal breech births

That said, the vast majority of complications (umbilical cord prolapse; injuries to the baby’s skull, brain or limbs; baby’s head getting stuck in the birth canal; prolonged and difficult labor; increased risk of perineal tears or an episiotomy) occur during a vaginal delivery attempt. So if you request a vaginal delivery but your doctor says a C-section is necessary, it’s for good reason.

Odds are good that your baby will be in the head-down position by time delivery day arrives — but if she remains bottom-down, you’ll need to be flexible in your childbirth plans. And even if your practitioner green-lights attempting labor, it’s just that: an attempt. If your cervix dilates too slowly, if your baby doesn’t move down the birth canal steadily or if other problems arise, you’ll likely have a C-section. So talk your options over with your practitioner now to be prepared for any possibility come delivery day.

Most importantly, remember that though you may feel disappointed things didn’t turn out exactly how you envisioned, those feelings will melt away once your bundle of joy safely enters the world.

Source: whattoexpect