Your baby-to-be is breech -- what should you do?

by Laura Sussely-Pope

breech babyYou found out at your appointment that your baby-to-be is breech -- sitting comfortably with her head pressing against your tummy.

What should you do?

First take a couple deep breaths. At 32 weeks about 1/4 of babies are in the breech position. Most of them flip around to a head-down position in the next few weeks.

Only 3 to 4 percent remain in that position at 37 weeks.

What are your options if your babe stubbornly remains bottoms down?

For as long as women have been having babies, a small percentage have been born breech -- foot, leg or bottom born first, head emerging last.

A brief history of breech birthing trends

Until the late 1950s, most breech babies were born vaginally. At that time, surgical deliveries became common for breech births.

Fast forward to 2000 -- a large study by Hannah, et al, suggested that a vaginal breech birth was less safe for the baby than a planned c-section. The ACOG recommended that planned vaginal delivery of a term singleton breech was no longer appropriate. This decision resulted in the present statistics: 90 percent of all breech birth in the U.S. are delivered by c-section.

Since that time, several additional publications, including a follow-up by the same researchers found no difference in outcome between breech babies born vaginally and by schedule c-section. They did find the moms fared worse when their babies arrived by cesarean.

The 2010 ACOG statement says that the planned vaginal delivery of a breech baby may be reasonable. Because few practitioners have the skills and experience to deliver breech babies vaginally, c-section will be the preferred mode for most physicians.

Making a choice -- vaginal or cesarean

While most babies turn head down between 28 and 32 weeks, some don't turn until during labor. You can try to encourage your womb-dweller to make the flip. Among methods moms-to-be use are tilt positions, chiropractic care, light and music, acupuncture, water, homeopathy, external cephalic version and moxibustion.

You've tried these and your baby's still breech. Can you give birth vaginally? Your chances of delivering a healthy breech baby vaginally increase with the following:

• Your baby is frank breech, with the feet straight up
• You've had baby vaginally prior to this birth
• Your baby seems a normal size
• You have no pelvic or uterine anomalies

You and your baby have the green flag for a vaginal birth. For best results, look for a birth attendant experienced in breech presentation. You may have to change providers.

Mary Cronk, MBE, a respected independent midwife, shares tips from many years of experience birthing babies vaginally.

✓ Allow labor to start on its own. Don't augment with pitocen if labor is slow or there's poor progress.
✓ Use whatever position feel comfortable during the first stage. Many moms opt for hands and knees.
✓ Eat and drink if you're hungry or thirsty and your birthing place allows it.
✓ Minimize vaginal exams until to avoid rupturing membranes.
✓ Listen to the baby's heart tone frequently.
✓ Opt out of a routine episiotomy

Looking ahead

In the last two to three years, studies have stated that vaginal breech births are as safe for babies and safer for mom. Organizations have followed with recommendations that it is a safe option for a majority of breech births. Yet the numbers haven't changed significantly because too few doctors have been trained in this delivery option.

What happens next may depend on women -- their choices, their preference and their pressure. If your baby-to-be is breech, would you prefer a vaginal birth? Can you find the resources in your area to facilitate your choice?

Photo courtesy of iStockphoto.