What is a breech birth?
Right before birth, most babies are in a head down position in the mother's uterus. Sometimes, the baby is in a bottom first (or feetfirst) position. When a baby is in that position before birth, it's called a breech birth or breech baby. Many babies are breech early in pregnancy, but most of them turn to the headfirst position near the end of the pregnancy. Babies who are born early are more likely to be breech. If more than one baby is in the uterus at a time, one or more of the babies may be breech. Abnormal levels of amniotic fluid around the baby may result in a breech birth. As you get closer to your due date, your doctor will be able to tell by physical exam, ultrasound, or both if your baby is breech.
Can a breech baby be delivered without a cesarean?
More complications can occur if the baby is breech. When breech babies are delivered vaginally, they are more likely to be injured during or after delivery than babies who are delivered headfirst. Breech babies who are delivered vaginally are also more likely to develop a birth injury where the baby's hip socket and thigh bone become separated. Complications with the umbilical cord are also more likely in breech babies who are delivered vaginally. For example, the umbilical cord is more likely to be flattened during delivery, which can cause nerve and brain damage due to lack of oxygen.
Some breech babies can be safely delivered through the vagina, but doctors usually deliver breech babies by cesarean delivery (also called a C-section). Risks are also involved with cesarean delivery, such as bleeding, infection, and longer hospital stays for both the mother and her baby.
Can I do anything to help if my baby is breech?
It's very important to see your doctor regularly throughout your pregnancy. Your doctor can tell if your baby is breech and help plan what to do. Some doctors will plan to deliver the baby by C-section. Others may give their patients exercises to do at home that may help turn the baby to the headfirst position. Some doctors try to turn the baby in the mother's uterus using a procedure called external cephalic version. If this procedure is successful and the baby stays in a head down position, a normal vaginal delivery is more likely.
What is external cephalic version?
External cephalic version is a way to try to turn a baby from breech position to head down position while it's still in the mother's uterus. Your doctor will use his or her hands on the outside of your abdomen to try to turn the baby.
When is external cephalic version done?
External cephalic version is done at the end of pregnancy, usually around 37 weeks of gestation.
Who can have external cephalic version?
Many women who have normal pregnancies may have external cephalic version. Women who cannot have it are women who have one of the following:
- Vaginal bleeding
- A placenta that is near or covering the opening of the uterus
- A low level of fluid in the sac that surrounds and protects the baby
- An abnormal fetal heart rate
- Premature rupture of the membranes
- Twins or other multiple pregnancy
What are the risks of external cephalic version?
Risks of external cephalic version are small, but include:
- Onset of labor
- Premature rupture of the membranes
- A small blood loss for either the baby or the mother
- Fetal distress leading to an emergency cesarean delivery
- The baby might turn back to the breech position after the external cephalic version is done.
Although the risk of having these complications is small, some doctors prefer not to try an external cephalic version.
What can I expect if my doctor and I decide to try external cephalic version?
External cephalic version is usually done in the hospital. Before the procedure, you will have an ultrasound to confirm that the baby is breech. Your doctor will also monitor your baby's heart rate to make sure that it is normal. You may be given medicine through a vein in your arm or through a shot to relax the muscles in your uterus. This medicine is very safe, with no risk to your baby. An epidural might be placed to make sure you are completely relaxed. While you're lying down, the doctor will place his or her hands on the outside of your abdomen. After locating the baby's head, the doctor will gently try to turn the baby to the headfirst position.
What happens after the procedure?
When the procedure is completed, your doctor will monitor your baby's heart rate again. If everything is normal, you won't have to stay in the hospital. If the procedure is not successful, your doctor will talk to you about the possibility of having a vaginal delivery or a cesarean section. Your doctor may also suggest repeating the external cephalic version.
What is the success rate of external cephalic version?
The average success rate is about 58%. Even if the procedure works at first, there's still a chance that the baby will turn back around to the breech position. The success rate of external cephalic version depends on several factors, including the following:
- How close you are to your due date
- How much fluid is around the baby
- How many pregnancies you've had
- How much your baby weighs
- How the placenta is positioned
- How your baby is positioned
- External Cephalic Version by Andrew S. Coco, M.D., M.S., and Stephanie D. Silverman, M.D.(American Family Physician 09/01/98)
Copyright © American Academy of Family Physicians
This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.