Turning A Breech Baby
When you consider your options regarding the birth of your baby, there are many different factors to consider: home delivery vs. hospital delivery, whether or not to have pain relief, and the possible use of a birthing pool. However, even the best laid plans can be rendered useless by a baby that refuses to present head down.
What exactly is a breech baby?
A breech position is classed as one where the baby is lying either feet or bottom first, rather than head down. During the course of pregnancy, it is very common for the little one to keep you guessing by moving around, sometimes presenting in the perfect head down position, and other times lying the other way around. In actual fact, until 32 weeks, just under one in five babies prefer to rest in a breech position. But by 37 weeks, this number has dropped to just one in 25.
Some babies clearly have a mischievous nature, as after causing weeks of concern by steadfastly refusing to budge from breech, when labour starts, they quickly flip round to engage head first in the perfect position. It is therefore very difficult to get an accurate idea of whether any intervention will be needed for those lying in a less than ideal way in the weeks coming up to your due date.
However, before you start contemplating what might happen if you go into labour with a breech baby, there are some tricks you can try yourself to gently nudge your little one into moving.
Tricking the breech baby!
One of the most successful methods is simply by crouching with your knees up to your chest; in one study, 65 out of 71 babies lying breech turned after the mother adopted the position. To give it a go, you need to kneel with your hips flexed at just over 90 degrees and your bottom in the air, making sure your thighs do not put any pressure on your bump. Hold this position for 15 minutes if you can and repeat every two hours during the day, for five consecutive days.
If you have not suffered from any pelvic, back or hip pain during your pregnancy, you could also try a gentle rolling action. Lying on your back, lift your hips slightly, keeping them flexed and your knees also slightly bent. Then carefully roll from one side to another for ten minutes, repeating the action three times every day.
A specific type of acupuncture, known as moxibustion, is also believed to assist in turning breech babies, but not enough is known at the moment to recommend it completely and research is ongoing into its effectiveness.
A breech baby that refuses to move
Sometimes, despite your best efforts, your little one will stubbornly refuse to move, meaning that you either consider a breech birth or medical assistance to try and turn them round.
If you opt for the latter, doctors can attempt a move known as external cephalic version (ECV), but there are no guarantees that it will work. The more successful attempts usually involve babies which are lying in plenty of fluid and are high up in your womb. Women who have had a baby before are often more likely to have a successful ECV.
A general anaesthetic is not needed, but medication to relax the muscles in the uterus will be administered this increases the likelihood of success. ECV is deemed to be a very safe procedure, having been tested robustly. The Royal College of Obstetricians and Gynaecologists' recommendation is that 'all women with an uncomplicated singleton breech pregnancy at 36 weeks should be offered external cephalic version'.
During ECV, the doctor simply places her hands on the bump and helps to gently encourage the baby to perform a somersault. This is an acrobatic move which some babies seem to enjoy and kick to help complete the turn! Women who have had the procedure describe the sensation as uncomfortable but not painful. There is a very small chance of complication and if this happens, a caesarean section will be performed immediately. As ECV is not performed on premature babies, there should be no risk in delivering early if needed.
While the manoeuvre is extremely successful, around one in 20 babies just flip back to their original position afterwards. It is possible to have a second ECV on another day, but the viability of this varies on an individual basis.
The birthing options with a breech baby
You've tried knee to chest, you've tried rolling and your doctor has even given ECV a go, but your baby just isn't budging. So, what now?
There are three different categories of breech. Whichever one your baby has adopted will, to some extent, dictate your birthing options.
Frank breech is the 'best' option and this is where the baby is lying with his thighs up against his chest and his toes up around his ears. Flexed breech is the next most ideal position where once again, the thighs are up against the baby's chest. In this case, the knees are also bent so his calves are lying against his thighs. The most difficult kind of breech is known as footling, where the hips are not quite as bent and the feet are dangling below his bottom.
A worldwide study has been conducted on methods of delivery for breech birth. These results show that generally having a caesarean section was the safest option. In the last 11 years, the number of women opting to deliver vaginally for breech babies in the UK as well as the US and Canada has plummeted.
Nevertheless, it is still possible to have a vaginal birth, providing that the baby is within a normal weight range. A baby who is too big or too small means a section will be needed. Frank breech is the easiest position to try vaginally, but general consensus is that flexed breech is possible too. A vaginal delivery is unlikely for any woman unlucky enough to have a baby in the footling position.
Other factors that may make a vaginal delivery more difficult include a narrow pelvis, a low-lying placenta, a 'star gazing baby' (one that has the neck tilted backwards) as well as any medical conditions such as pre-eclampsia. If you have a history of giving birth by caesarean, the doctors are also likely to recommend avoiding a vaginal delivery.
For mums who want to give themselves the best chance of delivering a breech baby vaginally, asking to be under the care of an obstetrician who has considerable experience of breech babies is highly recommended, even if it means moving to a hospital slightly further away.
Mothers carrying twins are far more likely to have to have a caesarean as there is not enough room to turn babies when there is more than one on board. If the first baby is head down and the second one is breech, potentially it could be possible to perform ECV. However, because multiple pregnancies tend to birth earlier and with lower weight babies, the chances of a vaginal birth are very slim.
Keep an open mind
If you have your heart set on a vaginal delivery, it can be devastating to find out that your baby is breech, but by trying some of the above techniques there is a chance to persuade your little bundle to get into the right position. However, any birth is subject to surprises along the way, so keep an open mind about what might happen on the big day. Getting you through the delivery safely and helping your baby to make his or her way from your womb and into the world with as little trauma as possible has to be the priority. In all likelihood, once the birth has passed and you look down at the little red-faced bundle in your arms, the method of delivery will not matter anyway.