What Is A Breech Birth?

A breech birth is the delivery of an unborn baby bottom end first. By your 36th week, your baby will be so large, it won't be able to move around. As a result, the position that it has assumed by this point is likely to be the same position that he or she will be in when labor starts. Most babies settle into an upside down position in the uterus. But some babies settle into a breech position. In breech, the baby's bottom is in the uterus, while the legs are folded in front of its body.

Is My Baby in Breech Position?
There are generally no identifiable symptoms. However, some women can tell the position of the baby by where they feel it kicking. Most women cannot tell what position the baby is in at any given moment.

Diagnosis
Your doctor or midwife will be able to tell the position of your baby by feeling it through the wall of your abdomen. Another clue to the position is the location where the heartbeat is heard best.

The only way to really be sure, however, is to do an ultrasound exam. Using this technique it is very easy to tell the position of your baby.

What Causes a Breech Birth?
Though there doesn’t seem to be a genetic connection to a breech presentation, there are some factors that seem to increase the chances of a baby presenting in a breech position.

• Smaller than average fetuses are not cradled snugly in the uterus; this allows them to move more freely and to possibly orient themselves into a breech position.
• If there is more than one fetus, one can push the other into a breech position.
• Some women have an unusually shaped uterus or have fibroids within the uterus. In other cases, a woman’s uterus is stretched due to previous pregnancies thereby increasing the chances of having a child rest in a breech position.
• Aberrant amniotic fluid levels have an impact on the position and ease by which a fetus can move. Unusually high or low levels can have contributing effects.
• With placenta previa, the placenta can cover the cervical opening, increasing the chances of a breech delivery.

What Are the Dangers?
The biggest part of the fetus's body is usually its head. During birth, if the head fits through the mother's pelvis, the rest of the baby's body should slip out quite easily. However, if the baby is born bottom first, it's possible that the body will fit through the mother's pelvis, but the baby's head could get stuck at the level of the chin. This condition, known as a trapped head, is very dangerous.

If the baby's head does get trapped, the possibility of injury is high because the umbilical cord usually stops pulsating after the baby's body is born. This, in turn, cuts off the oxygen supply from the mother to the baby. If the baby's head is still inside the uterus, then baby cannot yet breathe alone; so it is essential to deliver the baby as quickly as possible.

The risks of vaginal breech delivery can be avoided by delivering the baby through a cesarean section.

Correcting Breech Presentations
Although the vast majority of fetuses eventually settle into head-down or vertex position, some do not; however, there are ways to try and get the fetus to turn right side down. In a procedure called external cephalic version (ECV), a physician uses ultrasound guidance to shift the fetus by applying their hands on the mother’s abdomen and pushing.

Delivery and Breech Presentations
There is still some controversy surrounding whether vaginal delivery or surgical delivery is best for breech presentations. It is likely that for some women, the vaginal route is perfectly safe; however some physicians routinely perform cesarean sections for breech presentations, believing that this is the safest for the baby. If a vaginal delivery is attempted, the procedure is carefully monitored and if all continues satisfactorily, it is allowed to continue. A wide episiotomy is often made to help the delivery proceed. If complications arise, the doctor may then perform a cesarean section.

Treatment
Cesarean section is the most common way to deliver a breech baby. This surgical procedure carries more risk for the mother, but many women prefer to take the risk of surgery on themselves rather than let the baby face the risks of breech delivery.

Normal vaginal birth. This should only be attempted if an ultrasound shows that the baby is in a favorable breech position. Most babies will do very well during a breech delivery, but it is always possible that the baby will be injured.

For more information on birth presentations such as breech, visit our birth presentation article.

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