Towards the end of pregnancy, your baby will have grown so big that they can't move around very much in your womb. At this time, most babies have taken up a position with their heads down. They enter the birth canal head first during birthing. A breech baby has their head up and is born bottom and feet first. Breech baby delivery has several risks associated with it and needs special care.
What Is a Breech Baby?
Most babies are head down when they're ready to exit your womb. This position, called the vertex presentation, is the most common. It is also the safest for vaginal delivery.
A breech baby presents the buttocks and perhaps feet. Their bottom is born first, followed by the body, and the head last of all (a situation called the after-coming head). A breech birth is challenging for your obstetrician and a higher risk for you and your baby.
If they are safely delivered, breech babies have an uneventful newborn period. Their growth, development, and health through life are not affected by being born feet first.
Apart from the vertex and breech, babies may also lie horizontally. This position is called a transverse lie and usually requires a cesarean delivery.
Breech Baby Causes
It is very common for a baby to be breech in early pregnancy. But by 36 to 37 weeks, most babies have turned naturally into the head-down position. About 3% to 4% remain in the breech position until the end of pregnancy.
It is often just a chance that your baby didn't turn and stayed breech. Here are some of the factors that increase the likelihood of having a breech baby:
- First pregnancy. The likelihood of your baby being breech is higher.
- Oligohydramnios. Too little amniotic fluid in your womb around your baby. Too much amniotic fluid (polyhydramnios) also increases the likelihood of a breech baby.
- Placenta previa. A low-lying placenta.
- Multiple babies. Twins or more.
Breech Baby Symptoms
Your pregnancy will be the same. A breech baby does not cause more or less nausea, vomiting, or other pregnancy symptoms. But you will feel your baby's kicks lower in your belly. You may feel your baby's head as a hard swelling below your ribs.
Your obstetrician will be able to know that you have a breech baby by feeling your abdomen. An ultrasound will also show your baby's position.
Can Your Breech Baby Be Turned?
Your obstetrician may offer you external cephalic version (ECV) at about 36 weeks. Your obstetrician will try to turn your baby around to bring their head down by applying pressure on your abdomen. You may find it a little uncomfortable, but it's safe for your baby.
Your obstetrician may give you medicine by injection to relax your uterus. This helps them to feel and turn your baby. If ECV is not successful, you and your doctor can decide to try another day. This procedure can be tried as late as the early stages of labor.
ECV works in about 50% of cases. If it works for you, your baby will come out head first (vertex presentation). Most breech babies are delivered by cesarean section. Using ECV to turn your baby around gives you a chance at vaginal delivery.
ECV is a safe procedure. But you may have bleeding from the placenta. Your baby's heartbeat may become irregular. Your obstetrician may have to perform an emergency cesarean section. This happens in only one case in 200, but you should have ECV in a hospital equipped for emergency cesarean sections.
Breech Baby Delivery
You should discuss your birthing options with your obstetrician well in advance. Your two options are a vaginal breech delivery and a planned cesarean section. A planned cesarean section is safer for your baby.
Vaginal delivery for your breech baby is similar to that for a vertex baby. You will have the same options for pain relief, cord clamping, and medication. But you should choose a hospital that can carry out an emergency C-section immediately if the need arises. About 40% of breech babies need an emergency cesarean section even if a vaginal birth has been planned. The hospital will have a pediatrician present at the birth to manage any problems your breech baby might have.
Your obstetrician may advise you against trying a vaginal delivery if:
- Your baby is a footling breech (one or both feet are below the bottom)
- Your baby is larger or smaller than average
- Your breech baby has their head tilted back (hyperextension)
- The placenta is placed low in your womb (placenta previa)
- You have any complications of pregnancy, such as pre-eclampsia
Breech Baby Cesarean Section
Your doctor may advise you to deliver by planned cesarean section at 39 weeks. By then, your baby's lungs are mature. Most women do not go into labor before this time. Planned cesareans are safest for your baby. Cesarean sections performed after labor has started have poorer outcomes.
What if you have planned cesarean delivery, but labor starts before that? You should go to the hospital immediately. Your obstetrician will assess you. If your labor has progressed and your baby is close to being born, they may decide a vaginal birth is safer.
While a planned cesarean section is best for your baby, it carries some risks for you, including:
- Excessive blood loss
- Blood clots in the legs
- Wound infection
- Damage to your urinary system during surgery
- A higher likelihood of cesarean section in future pregnancies
Breech Baby Risks
The largest part of a baby is their head. In a vertex presentation, if the head can't pass through the birth canal, a cesarean can be done. A breech baby's head gets stuck after the entire body has been delivered. This is a dangerous situation.
Your baby's umbilical cord might get squeezed, cutting off blood and oxygen. This can lead to brain damage within minutes.
If your water breaks, the umbilical cord might come out before labor starts, an extremely dangerous situation.
Breech babies are more likely to have congenital hip dysplasia, a condition which causes dislocation of the hip joint. This condition is also called developmental dysplasia of the hip (DDH) and congenital dislocation of the hip (CDH). An ultrasound of the hip 4 to 6 weeks after birth will detect this condition.
You and your breech baby are both likely to be healthy after the birth as long as you choose a well-equipped hospital for birthing. Long-term outcomes for breech babies are not different whether born vaginally or by cesarean section.
