The vast majority of babies will make their way into the proper head-down, or cephalic position in their mother’s uterus, in preparation for delivery. For the approximate 3% of babies who decide that they want to take another way out, and settle into a breech position, medical intervention may be necessary to ensure a safe delivery. Normally, a baby is delivered head first, but in the case of a breech baby, the bottom, leg or legs, or arm is situated to come out first. This can put both the baby and mother at risk during delivery because the baby can become stuck in the birth canal, or the umbilical cord can be compromised or damaged.
There are four different types of breech positions:
- Frank Breech: The baby’s feet are up near the head and the bottom is situated to come out first — this is a common type of breech position.
- Complete Breech: In this position, the baby is the same as in the frank position, but his legs are crisscrossed, Indian-style.
- Footling Breech: The baby’s feet are situated to deliver first. Either one or both legs may be presented first.
- Transverse Lie: In this position, the baby is lying sideways across the cervix, and a leg or arm is situated to come out first.
By the beginning of your third trimester, your doctor should be able to determine your baby’s position without the use of an ultrasound. He can feel your abdomen to see if your baby is properly positioned. Even though approximately 25% of babies are breech at this point, the majority will get into the correct position by themselves.
If your baby has not moved into the cephalic position by 37 weeks, your doctor may decide to try to turn the baby by trying an external cephalic version (EVC), which involves manually turning the baby around externally. For regular breeches, EVC is successful about 58% of the time, and about 90% of the time for transverse lie breech positions. EVC is also more successful with moms who have already had babies.
EVC cannot be performed on moms pregnant with multiples, or who have other complications such as placenta previa, previous c-sections, vaginal bleeding, low levels of amniotic fluid or a small baby. Complications of EVC include placental abruption, drop in heart rate for the baby, and rupture of the amniotic sac.
Due to the risks associated with EVC, it should be performed in the hospital by a doctor who is properly trained and has experience in the procedure. Most likely, your doctor will have an anesthesiologist standing by, in case you need an emergency c-section. Before you have the EVC, your doctor will assess the baby’s heart rate, and determine the exact breech position by ultrasound.
Many women would rather not have an EVC due to the risks and because it is a very uncomfortable, if not painful procedure. Studies have shown that babies in the breech position should be delivered via cesarean section due to the inherent risks in attempting a vaginal delivery. In some cases, however, a breech delivery may get the green light from a doctor if the mother’s pelvis is large enough to facilitate the delivery, if the baby has no abnormalities and if the mother’s labor has started on its own.
Although there are alternative methods of turning a baby in the breech position, which include herbal, acupressure, maternal positioning and hypnosis, none of these have been proven in medical studies to be effective. It is best to follow the advice of your doctor if your baby is in the breech position when you are full term.