A breech baby is a child who is not in a headfirst position in the mother's uterus. This means the baby’s rear and/or legs are closest to the bottom of the uterus, and that the baby would be born feet first or bottom first. The typical baby is born headfirst and this is a much safer position for the baby and mother.
Lots of babies are in the breech position for some time during the pregnancy. Toward the end of the pregnancy, most babies turn so that their heads are closest to the cervix. At about 32 weeks gestation though, most babies are still breech.
A few things may cause the breech position though the reason why some babies are breech is not always known. Sometimes a twin may be in a breech position. Other times higher than normal volume of amniotic fluid results in the baby staying in breech. Most babies will turn around in the last eight weeks of pregnancy but some babies may be larger and simply get trapped.
If your obstetrician notices the baby is still breech in the last few months of pregnancy, he/she may recommend some exercises that can help encourage the baby to turn. As the pregnancy nears its end though, doctors and moms have to make decisions about how to successfully deliver a breech baby. Under most circumstances, doctors prefer to perform a cesarean section (c-section) if the baby is still breech.
Another option is to perform an in-hospital procedure at about 36-37 weeks to manually turn the baby from the outside. This is called external cephalic version, and has about a 40-70% success rate. In a hospital, the doctor or midwife, uses his or her hands to try to rotate the baby out of the breech position.
This cannot be performed if there is fetal distress or during some high-risk pregnancies. In low risk pregnancies the procedure may be well worth trying since vaginal birth is lower risk to the mother than c-section. The biggest complication of external cephalic version is the risk of premature labor, but delivering at 36-37 weeks is thought fairly safe.
Some mothers opt for vaginal birth of a breech baby and doctors may support this if the breech position is relatively safe, and also if certain circumstances exist. If the woman has given birth before and has a larger or roomier pelvis, some breech presentations may not pose much trouble during labor. There are four breech positions and if vaginal labor is being considered doctors want to look for what is called a frank breech or complete breech.
In a frank breech, the baby is folded over, and is born bottom first, with feet up at the head. In a complete breech the baby’s legs are similar to a cross-legged position and are close to his/her hips. The baby’s head must not be gazing upward, since a breech baby born in this position may die or may have a severely injured spine. Other potential risks to the breech baby include compression of the umbilical cord or cord prolapse, which can cause brain death and brain damage. Brain injury can also occur when the baby’s head passes through the birth canal, since this is rapid rather than gradual.
Due to the potential for fetal harm, most doctors encourage moms with a baby in breech presentation to have a c-section. Though the risks of c-section are higher to the mother than those associated with a vaginal birth, they are lower for the baby. It can be a difficult choice, but many doctors really don’t support moms making this choice. Instead they strongly recommend that moms don’t risk the potential health of a soon to be born child. In developing countries though, risk of cesarean may be much higher, and it is more usual for a breech baby to be born vaginally.