Baby Is in A Breech Position

As your due date approaches closer, it’s likely to get excited. You would even sense your baby in your uterus who is all set to be born. Usually, the baby's head is positioned near the mother's cervix. Although, in some cases, your little one can be positioned in a different manner, such as bottom or feet down. When such an instance occurs, it’s called a breech presentation. To help you further understand, we’ve lined up the cause of a breech presentation, how your gynecologist checks the position of your baby and what delivery options you may have if your baby is breech.

What Is Breech?

During your pregnancy, your baby has likely taken every opportunity to let you know she means business by kicking up a storm and doing countless somersaults. It's natural for your baby to move and shift positions within the uterus. Then, usually between 32 and 36 weeks of pregnancy, your baby will likely get into a head-down position in preparation for being born.

There is a small chance — just 3 to 4 percent — that your baby may not move into this head-down position by the time your pregnancy is full term. This is called a breech presentation. The chance of a breech presentation is higher if your pregnancy is not yet full term or if you go into preterm labour.

Types Of Birth Positions

There are many different types of positions, including a number of breech presentations, that your baby may take on before birth:

  • Frank breech presentation:

Your baby's bottom is positioned downward. This is the most common type of breech presentation.

  • Complete breech presentation:

Your baby's feet are positioned downward with her hips and knees flexed, almost cross-legged.

  • Incomplete breech presentation:

Your baby's feet are positioned downward with only one hip or one knee flexed.

  • Shoulder presentation or transverse lie:

This is a form of breech in which your baby is positioned horizontally in the uterus. Few babies remain this way at the time of delivery.

  • Footling breech:

One or both of your baby's feet are pointed downward.

  • Cephalic or vertex presentation (occiput):

Your baby is in the normal position for delivery. Her head is down and she’s facing toward your back.

In some cases, your baby may be in a downward position but with her face toward your front. If this happens in early labour, your baby may naturally turn to face your back on her own, or, later in labour, your provider may decide to manually assist the baby in getting into this position. If this doesn't work, your baby can still be delivered vaginally, but delivery may be prolonged and more painful.

What Causes A Breech Pregnancy?

As the baby and the shape of your uterus decides the presentation, it becomes difficult to clearly state one, single cause of breech pregnancy. But if any of the following factors apply to you, it may increase the risk of a breech baby:

  • If you've been pregnant before

  • If you previously had a breech baby

  • If you are pregnant with multiples

  • The uterus has more or less amniotic fluid than usual

  • If you have given birth to a premature baby

  • If the fetus has abnormalities that involve the muscular or central nervous system

  • The uterus has an abnormal shape or has abnormal growths, such as fibroids.

  • You have a condition called placenta previa, which is when the placenta covers the cervix.

Your healthcare provider likely already knows whether any of these factors affect your situation, but you might want to mention it just to be sure.

Diagnosis of A Breech Presentation

As discussed earlier, in normal pregnancies, a baby is not considered breech until 35 or 36 weeks. Around this period, the baby turns and positions himself in the ideal birth position. In some cases, babies turn their head-down or sideways before 35 weeks, which is quite normal. However, after that, as the baby grows he finds it difficult to turn. This leads to the diagnosis of a breech presentation.

During your doctor visits, leading up to your due date, your doctor will check if everything is on track. He is most likely to examine your abdomen to try to find out whether your baby is in the correct head-down position. If your provider suspects there may be a breech presentation, he may recommend an ultrasound exam to confirm it.

Can a Breech Baby Be Turned?

If your baby is breech, your provider may consider turning your baby so that vaginal delivery can proceed, if that’s in the cards for you anyway. Alternatively, your provider may recommend that cesarean delivery is the safer option.

Keep in mind, your baby's position might change at some point before delivery day, so your provider may recommend waiting and seeing.

If you are 37 weeks pregnant or more, your provider may recommend turning your baby through a process called external cephalic version or ECV.

ECV involves your provider placing hands on your abdomen and applying firm pressure in order to turn the baby. This procedure will most likely be done near a delivery room. Your provider may offer an epidural block to help with any pain this procedure causes.

An ECV is about 50 percent effective and there is a small risk of complications. You and your baby will be monitored closely before, during, and after the procedure to ensure that both of you are doing well.

If the ECV procedure is successful, your baby can be delivered vaginally, if there’s no other impediment.

Delivery Options for a Breech Baby

If your baby is in a breech position, the risks associated with a vaginal delivery are much higher than with a cesarean section. Risks include the umbilical cord cutting off his blood supply or his head or shoulders becoming stuck. That’s why, in some cases, your provider may recommend a cesarean delivery.

It could be that your provider’s level of experience in delivering breech babies might also inform the discussion you have with your provider about what’s right for your situation. Ultimately, your provider will recommend the best course of action for you and your baby based on your personal situation.

Twins and Breech Presentation

It's possible for twins to be delivered vaginally if the first baby — the lower-positioned twin — is correctly positioned with the head facing down. Of course, that's if the twin pregnancy is otherwise progressing well and there are no complications. If the second twin is in a breech position, the provider may do an ECV procedure to get this baby in the correct head-down position for a vaginal delivery, too.

If the first twin baby (the one lower down) is in a breech position, the provider may recommend a cesarean section. In case of triplets or multiple pregnancy, you will most likely require a cesarean section.

The Bottom Line

We understand that being stressed about a breech baby is the last thing you would want on your plate. But keep in mind that your doctor has witnessed such situations. He is armed with the best knowledge which will ensure that your precious little one enters the world safely. So, relax. In no time, you will be playing with your baby and stressing about his diaper change, while watching him grow.

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