Breech

Babies can be breach for a number of reasons.

Sometimes a baby is breech because of factors that prevent it from turning such as too much or too little fluid in the womb, the position of the placenta or an issue with the pelvis or womb such as fibroids.

Sometimes it is just a matter of chance that the baby has remained breech rather than turning.

The vast majority of breech babies are healthy, however for a few being breech can indicate that there is a problem with the baby which has prevented it from turning. This will usually have been picked up during antenatal screening and scans but may be discovered after birth.

Breech babies can turn to head first by themselves up to the point of labour. However if your baby is breech after 36 weeks it is less likely to turn by itself.

External Cephalic Version (ECV)

We recommend you try an ECV from 36 weeks of pregnancy onwards. This involves an obstetrician trying to turn your baby through your tummy into a head down position. For more information please read our information leaflet.

You may also like to watch this video:

Complementary therapies

There is also some evidence that moxibustion, a herbal Chinese therapy, and acupuncture may help in encouraging your baby to move.

This is not currently available from the NHS, so we recommend you use an appropriately qualified practitioner to give you advice and treatment if you choose this route.

Some clinician’s advise that optimal fetal positioning may help; this would involve you getting into some positions to maximise the space in your pelvis and encouraging your baby to move around. You may also read about chiropractic techniques and other complementary therapies for encouraging breech babies to turn and we would advise you take specialist advice for these if you wish to look into them.

Depending on your situation your choices may include:

• Planned caesarean section
• Vaginal birth

The Royal College of Obstetricians and Gynecologists (RCOG) currently recommend that you have a planned elective caesarean section at about 39 weeks pregnant, however we are here to support and advise you about your birth options so that you can make an informed choice.  You will be referred to a consultant to discuss your options and you will also be able to speak to a supervisor of midwives for further information and support.

Vaginal breech birth

One research study suggested that breech babies were less well around the time of birth when they were born vaginally compared to being born by elective caesarean section. However at 2 years of age the study found there were no differences in the development or wellbeing between babies born vaginally or by caesarean section. More recent research suggests that women and breech babies who are full term (over 37 weeks) and are otherwise healthy and well in pregnancy and who go into labour spontaneously are just as well around the time of birth when compared to those babies born by caesarean section, but with less risk to the mother.

The benefit to having a vaginal birth for the mother is that you will have less chance of heavy bleeding, infections and complications in subsequent pregnancies and births. You will have more chance of being mobile after the birth, have a quicker recovery and be in the maternity unit for less time after birth. The benefit for the baby is that it will have better preparation for breathing after birth as labour squeezes the lungs and promotes hormones that help the adaptation to being outside the womb.

The possible risks to having a vaginal breech birth to the mother is a chance of requiring a caesarean section during labour (estimated to be about 15-20% of all planned vaginal breech births need to have caesarean section in labour) and damage to the perineum / pelvic floor during birth. The possible risks to the baby of being born vaginally (normally) are an increased chance of the baby needing help immediately after birth (this would be needing some support with breathing at birth – for this reason we advise you have your baby in a maternity unit where neonatal support is available). Some breech babies need help for their bodies and heads to be born; if clinicians need to help your baby to be born there is an increased chance the baby may have bruising due to the maneuvers we use (note that these maneuvers can be needed during a breech caesarean section delivery too).

It is suggested in studies that having a clinician with knowledge, skills and confidence in vaginal breech birth may influence the outcome for you and your baby. At BSUH we have a number of midwives and obstetricians who have experience in vaginal breech birth and all our midwives and obstetricians have regular updates on how to support vaginal breech birth. However we acknowledge that, as most known breech babies are born by caesarean section the experience and confidence with breech birth is limited at the moment. For this reason we usually approach care as a team, pooling our knowledge and skills. There is always a Consultant Obstetrician and Supervisor of Midwives on call 24hrs/7days a week who can offer support and guidance. We suggest you consider who you would like with you in your birth plan.

Most breech babies do very well after birth. Some babies keep their legs in the air for the first few days as this is the position they have been in the womb for some time. Although this may look a bit strange it is nothing to worry about and the legs will come down in their own time.

Breech babies will have a higher chance of hip problems in early life due to their position in the womb, so we will ensure the baby’s hips are checked within the first 3 days of life. We will also offer you a scan of the baby’s hips within the first few months. This appointment should be sent to you after you are home from the unit (usually within 6 weeks).

BSUH: Information for women if their baby is lying bottom or feet first during the later part of pregnancy

BSUH: Information about your External Cephalic Version (ECV)

RCOG: Breech baby at the end of pregnancy

Association for Improvement of Maternity Services (AIMS): Breech Presentation – Caesarean operation versus normal birth

breechbirth.org.uk