As you near your due date it’s normal for your baby to be positioned in the womb head first toward the birth canal. This is often referred to as a cephalic presentation.
Some babies can be positioned bottom or feet first (breech) and more rarely lying sideways (oblique or transverse). These presentations occasionally result in problems in women aiming for a vaginal birth, in late pregnancy and sometimes at caesarean section. Breech babies can be frank (extended legs), complete (sitting cross legged) or footling (feet first).
How common are breech babies?
- At 30 weeks about 20% of babies are breech.
- At term only about 3% are.
What causes it?
Often a specific cause can’t be found but certain factors may contribute such as:
- An abnormally shaped uterus
- Fibroids in the uterus
- A low-lying placenta
- A higher or lower than normal level of amniotic fluid
- A previous breech
- Having had babies before slightly increases your risk
- A short cord
- Twin pregnancy
- An abnormality with the baby – this is rare
What are the risks and complications?
The risks of a breech vaginal delivery are contentious but there is now a relatively large body of evidence from which we draw conclusions.
There is a very small but significant increase in the risk of babies being unwell or passing away during vaginal breech birth when compared to other types of delivery (Cochrane 2015). Because of this, the rate of caesarean delivery is much higher with breech presentations and most practitioners are relatively unfamiliar with Breech vaginal births- but they do still occur from time to time. There is also a small risk of complications with the umbilical cord when the waters break in the late pregnancy and during labour.
What are the management options?
As you approach term you have three options: 1) Caesarean section, 2) External cephalic version (ECV) or 3) Breech vaginal birth.
Generally vaginal birth with a breech baby is discouraged but may be offered in certain circumstances with careful discussion prior.
The two preferred options are either an elective caesarean section or an attempt at spinning your baby around also known as external cephalic version (ECV) so that you can go on and attempt a vaginal birth.
External Cephalic Version (ECV)
ECV involves an Obstetrician massaging your baby round to the correct position with their hands. This can be attempted in suitable pregnancies following careful review. An ultrasound and fetal heart rate monitoring (CTG) are performed before and after the procedure to check on your baby’s well-being and its suitability to proceed. Factors such as the baby’s position, the location of the cord and the fluid level will be checked.
Most doctors administer a medication prior to commencing to relax the uterus to ease the turn.
ECV is successful roughly 50% of the time with slightly lower success rates in those having their first baby.
Risk considerations with ECV:
- About 1 in 200 attempts results in serious fetal compromise requiring immediate caesarean section.
- Minor complications such as breaking the waters, a small amount of bleeding or transient fetal heart rate abnormalities occur in about 1 in 25 attempts.
