Breech Presentation

Usually a few weeks before birth, most babies will move into delivery position, with their head moving near the birth canal. If this does not happen, the baby's buttocks and/or feet, will be in place to be delivered first. This is called a breech presentation. Breech births occur in about 1 of 25 full-term births.

What are the different types of breech presentations?

  • Frank breech: The fetus's buttocks are aimed toward the birth canal and the legs stick straight up in front of the body. The feet are near the head.
  • Complete breech: The buttocks are down, with the legs folded at the knees and the feet near the buttocks.
  • Footling breech: One or both of the fetus's feet are pointing down and will come out first.

What causes a breech presentation?
The causes of breech presentations are not fully known. However, a breech birth is more common when women have:

  • Had more than one pregnancy
  • Had more than one fetus in the uterus
  • Had a premature delivery
  • A uterus that has too much or too little amniotic fluid
  • An abnormal shaped uterus or a uterus with abnormal growths, such as fibroids.
  • Placenta previa

How is a breech presentation diagnosed?
A few weeks prior to the due date, the doctor may place his/her hands on the mother's lower abdomen to locate the baby's head, back, and buttocks. If the doctor thinks the baby is in a breech position, an ultrasound may be used to confirm. Special X-rays can also determine the baby's position, and measure the pelvis to determine if a vaginal delivery of a breech baby may be attempted.

Can a breech presentation mean something is wrong?
Most breech babies are born healthy. However, they do have a higher risk for certain problems than babies born head first. Birth defects are slightly more common in breech babies. A birth defect may be the reason they have not moved into the right position before birth.

Can a breech presentation be changed?
The best time to try to turn a breech baby is between 32-37 weeks of pregnancy. There are many different types of methods to use and all have different levels of success. Talk with your health care provider on which options they feel would be best for you to try.

MEDICAL TECHNIQUES

External Version
External version is a non-surgical method in which a doctor can help move the baby within the uterus. A medication to help relax the uterus might be given as well as an ultrasound exam, to better check the position of the baby, the location of the placenta, and the amount of amniotic fluid in the uterus. Gentle pushing on the lower abdomen can turn the baby into the head-down position. Throughout the external version, the baby's heartbeat will be checked closely so that if any problems should occur, the doctor will stop turning immediately. Most attempts at external version are successful; however as the due date gets closer this procedure is more difficult.

Chiropractic Care
The late Larry Webster, D.C., of the International Chiropractic Pediatric Association, developed a technique which enabled chiropractors to release stress on the pregnant woman's pelvis and cause relaxation to the uterus and surrounding ligaments. The relaxed uterus would make it easier for a breech baby to turn naturally. The technique is known as the Webster Breech Technique.

The Journal of Manipulative and Physiological Therapeutics reported in the July/August 2002 issue that 82% of doctors using the Webster Technique reported success. Further, the results from the study suggest that it may be beneficial to perform the Webster Technique in the 8th month of pregnancy.

NATURAL TECHNIQUES
The following two techniques often suggested by Physical Therapist, Penny Simkin, are things you can try at home for free, with no risks involved.

The Breech Tilt
Raise hips 12' or 30cm off the floor using large, solid pillows three times daily for 10-15 minutes each time. This is best done on an empty stomach,and at a time when your baby is active. Concentrate on your baby and not tensing your body, especially in the abdomen area.

Using Music
We know that babies can hear sounds outside the womb, so many women have used music or taped recordings of their voice to try to get their baby to move towards the "noise!" Headphones placed on the lower part of your abdomen, playing either music or your voice, has encouraged babies to move towards the sounds and out of the breech position.

There are also homeopathic remedies that women have found to very successful in breech situations. Contact your local holistic practitioner about the use of Moxibustion or Pulsatilla in turning breech babies naturally.

Vaginal delivery versus cesarean for breech birth?
Sometimes doctors do not know if a vaginal delivery is possible for a breech birth until a woman is in labor. However, the following are necessary factors in order for a vaginal birth to be attempted:

  • The baby is full-term and in the frank breech presentation.
  • The baby does not show signs of distress as its heart rate is closely monitered.
  • The process of labor is smooth and steady; the cervix is widening and the baby is moving down.
  • The doctor estimates that the baby is not too big or the mother's pelvis too narrow for the baby to pass safely through the birth canal.
  • Anesthesia is available and a cesarean delivery can be performed on short notice.

What are the risks and complications of a vaginal delivery?
In a breech birth, the baby's head is the last part to emerge, and it may be harder to ease it through the birth canal. Sometimes forceps are used to guide the baby's head out. Another potential problem is cord prolapse in which the umbilical cord can get squeezed as the baby moves toward the birth canal, slowing the baby's supply of oxygen and blood.

If a vaginal delivery is attempted, electronic fetal monitoring will be used to monitor the baby's heartbeat throughout labor. A cesarean delivery may be considered if there are any signs that the baby may be in distress.

When is a cesarean delivery used with a breech presentation?
Breech babies who are premature are often delivered by cesarean birth. Premature babies are small and fragile, and because the head is relatively larger, their bodies don't stretch the cervix as wide as full-term babies do during birth. This means that there may be less room for the head to emerge.

Reprinted with permission from American Pregnancy Association.