Breech Presentation: Your Birthing Options

by Jackie Hershwitz

Breech PresentationAt one of your third trimester prenatal visits, your doctor or midwife might tell you that your baby is in the "breech position." Picture your little one sitting upright on the lower part of your uterus, with legs folded. Learn how this can affect your birthing choices.

Many babies continue to somersault until sometime between 34 and 37 weeks when they turn on their own. A few never get around to going "head-first." About 3 percent of full-term babies are still breech at birth.

In the past, most breech infants were delivered by planned cesarean section. That trend could be changing. Recent research suggests if certain criteria are met, your baby can arrive via a vaginal birth.

Identifying a Breech Baby

Your doctor or midwife feels your baby's shape through your abdomen and uterus. If the bumps identified as head and bottom suggest the baby's in a breech position, you may have an ultrasound to confirm the finding.

Breech Positions

Breech babies sit in one of three positions:

Frank breech: The baby's buttocks are aimed at the birth canal, the hips flexed, with the thighs against the chest, and feet up by their ears.

Complete breech: The buttocks are down and the hips flexed with thighs against the chest, but the legs are folded at the knees and the feet are near baby's bottom.

Footling breech: The baby's hips are not flexed as much and the feet pointed down and will come out first.

What Causes a Breech Presentation?

Breech is more common when:

  • The mom has had more than one pregnancy
  • The baby is born before 37 weeks
  • There's more than one baby in the uterus
  • The uterus has too little or too much amniotic fluid
  • The uterus is abnormally shaped or have abnormal growths, such as fibroids
  • The placenta covers all or part of the opening of the uterus

Encouraging a Breech Baby to Turn

If your baby hasn't flipped head-down by 37 weeks, talk with your doctor or midwife about your options.

The Webster Technique:
This chiropractic technique releases stress on a pregnant woman's pelvis. It relaxes the uterus and surrounding ligaments, allowing a breech baby to turn naturally.

External version:
Your doctor or midwife might suggest manually turning the baby. An external cephalic version starts with a uterus-relaxing drug. Using ultrasound, your provider will apply pressure to the baby's bottom and guide the head, encouraging a somersault. During and after the version, you'll have a stress test to ensure your baby's okay.

Slant board:
Some women swear that they have gotten into a slant-board position and had their babies jump to head-down! Elevate your hips 12 inches off the floor, three times a day. You can use large pillows or lay on a padded board.

Music, visualization and affirmation: Other successful methods of turning a breech baby include soft music played at mom's lower abdomen, hypnosis, visualizing the baby in an optimal birthing position and talking with and encouraging your baby.

Birthing Options

About half of the babies who are rotated manually, turn right away. Others flip, then turn back several times. Some prefer the "heads-up" position. If your baby's breech when you go into labor, you might still have the option of a vaginal birth.

OBGYN societies do not suggest that physicians automatically opt for cesareans in the event of breech births. The ACOG and the RCOG state that a vaginal birth is safe for full-term babies, provided certain criteria are met.

The revised guidelines are based on a comprehensive review of research and clinical evidence of the safety of vaginal breech births compared with that of cesarean breech birth. The analysis of the outcome showed no difference between vaginal and abdominal deliveries of breech babies.

If you want a vaginal breech birth, your doctor will be supportive if:

• Your baby is full-term and frank breech presentation
• A midwife or doctor trained and experienced at breech birth will be present
• Anesthesia is available and cesarean delivery can be performed on short notice
• Nothing to make giving birth vaginally more risky

You'll be advised to have a cesarean if:

• Your baby is premature
• Your baby is footling breech or kneeling
• Your baby weighs more than 8 pounds, 6 ounces or less than 4 pounds, 6 ounces
• An ultrasound shows your baby's neck tilted far back
• You've had a previous cesarean birth
• You have a low-lying placenta

Benefits of a Vaginal Breech Birth

Delivering your breech baby vaginally offers benefits to you and your baby.

Your benefits:
• Less blood loss
• Less risk of infection
• No complications associated with surgery
• A faster, less painful post birth recovery

Baby's benefits:
• Babies born vaginally have less risk of breathing problems
• Passing through the birth canal exposes your baby to healthy bacteria

Risks of a Vaginal Delivery

In a breech birth, the baby's head is the last part to emerge. Sometimes forceps are used to guide the baby's head out.

If your baby's buttocks are not securely engaged, the umbilical cord can get squeezed as the baby moves toward the birth canal, slowing the baby's supply of oxygen and blood.

Because cesareans had been previously recommended for all breech births, health care professionals may not be as familiar with how to perform vaginal breech delivery. You might have difficulty finding an obstetrician who has enough experience to offer breech delivery.

Have you had a breech birthing experience? What's your story?

Medical references:
- Hehir, M. (June 2012) Changes in vaginal breech delivery rates in a single large metropolitan area. American Journal of Obstetrics & Gynecology. Volume 206, Issue 6 , Pages 498.e1-498.e4.
- Glezerman M. (January 2006)
Five years to the term breech trial: the rise and fall of a randomized controlled trial. National Institute of Heath Publication.