What should I know if my baby is in a breech position?

Head’s up! And that is exactly what a breech pregnancy is–when your baby is positioned head up that his buttocks, feet, or knees are poised to come out first, instead of his head, at the time of delivery.

In the early stages of pregnancy, breech position is quite common.

But as the third trimester progresses and the due date approaches, nearly 97 percent of babies turn naturally to the head-first position. However, about three to four percent of babies may still remain in a breech position.

Types of Breech Pregnancy Positions

A breech baby may be lying in one of the following positions:

• Frank breech. This is the most common breech position where the baby’s bottom is near the birth canal, with the thighs against the chest, legs pointing upward, and feet up by the ears.
• Complete breech. In this position, the baby’s hips and knees are flexed. The legs are folded with feet beside the bottom.
• Footling breech. The baby is positioned with his head up, while one or both feet are positioned downwards. The baby would come feet first in this position, if delivered vaginally.
• Kneeling breech. In this breech pregnancy position both knees are set to come first, and the feet are folded up behind the baby’s thighs.

Causes and Risk Factors

It’s not always possible to know the reason for babies to wind up in a breech pregnancy position. Sometimes it’s just a matter of chance that a he doesn’t turn by his due date.

Sometimes, as in the case of premature delivery, the baby simply didn’t have enough time to turn head down.

However, there are certain factors that may lead to a baby remaining in the breech position. These include:

• Abnormally-shaped uterus. This could be present either from the mother’s birth or may develop later due to any surgery including a C-section, a severe uterine infection, or a uterus with abnormal growths such as fibroids (benign tumors of muscular and fibrous tissues that develop in the wall of the womb).
• Low-lying placenta (placenta previa). This condition may prevent the baby from having enough space to position himself correctly.
• Fluid imbalance. A small amount of amniotic fluid allows the baby to flip around too much; a large amount of amniotic fluid, on the other hand, makes it difficult for the baby to “swim” around.
• Down Syndrome or any other disability. In some rare cases, about one in 10 babies may have a physical disability with the muscular or central nervous system that can cause a breech pregnancy.
• Pregnancies of multiples. When there is less space to move around, one or more babies may not be able to turn into head-down position.
• Short umbilical cord. This can get wrapped around the baby thus limiting his movement.
• History of premature delivery. This may cause a preterm birth which doesn’t give the baby enough time to come into the head-down position.

Studies have also found that some first-time mothers who have a tight abdomen or strong core are more likely to experience a breech pregnancy.

Similarly, mothers who have birthed about five or more times are more likely to have a loose womb and may have breech birth subsequently.

When to Worry

Normally, by around 34 weeks of pregnancy, most babies will flip into the correct position. But if the baby remains in the breech position and is set for birth, don’t fret; it is most likely he will be born healthy.

However, if have any of the risk factors mentioned above, it’s likely you will experience a breech pregnancy. This will put your baby at a slightly elevated risk for certain birth defects.

In fact, it could be due to a birth defect that your baby failed to move into a head-down position prior to delivery. Your doctor should diagnose any defects, in most cases, prior to your delivery.

Lifestyle and Home Remedies

If your baby doesn’t naturally turn by week 37, you may attempt to coax him into a head-first position. Try some of these natural techniques–but seek your doctor’s approval first:

• Pelvic tilts to strengthen your abdominal muscles. On the floor, lie flat on your back with your knees bent. Raise your pelvis about 10-12 inches off the floor, and hold it up for 10-15 seconds. You can support your hips using a pillow if necessary to avoid any stress on your body.
• Yoga position, such as bending down on your knees in a dog position. Place your forearms on the floor in front of you and buttocks higher than your head. Rock back and forth.
• Playing music, taped recordings or even having your partner speak near the bottom of your belly may stimulate your baby to move towards the sound.
• Relaxation techniques, such as meditation and maintaining good posture (sitting upright on an exercise ball helps), opens up the pelvic area. This makes it easier for your baby to move around.
• Cold press near the top of the stomach, as suggested by some mothers, can make the baby uncomfortable. The sensation may send the baby downwards.
• Moxibustion, an ancient Chinese technique, involves burning herbs to stimulate key acupressure points.
• Hypnosis involves inducing a state of deep relaxation during a mother’s 37 to 40 weeks of pregnancy. This relaxes the uterus and coaxes a baby to turn down.

Note that these haven’t been proven effective, but some moms swear by it.

Treatments and Drugs

External cephalic version (ECV)

Medically, the only proven way to get your baby into a head-down position is to attempt an ECV.

ECV is a non-surgical technique wherein the doctor tries to push the baby into the head-down position by applying firm but gentle pressure on your abdomen using his hands. The procedure is usually done at the end of pregnancy, around 37 weeks of gestation.

Studies have found ECV to have a high success of about a 58 percent rate in turning breech babies and about a 90 percent rate in the case of babies lying sideways (or a transverse lie). However, it’s possible for the baby to flip back into a breech position even after a successful ECV.

ECV is not recommended for women with certain conditions such as: vaginal bleeding; low lying placenta; low levels of amniotic fluid; premature rupture of the membranes; or those who have a baby with an abnormal fetal heart rate; or those who have twins or a multiple pregnancy.

What happens on the day of procedure?

The night before ECV is conducted, you will be advised not to eat or drink anything after midnight. This is precautionary for just in case if you end up needing surgery.

Before the procedure, you’ll have an ultrasound to confirm the baby’s position and if all other parameters are fine. You may be given medication to relax your uterus (don’t worry, it’s safe!).

Throughout the procedure, the baby’s heartbeat and position will be closely monitored through an ultrasound. This way, the doctor can immediately stop the procedure and take the requisite action in case any problems arise.

During the External Cephalic Version (ECV) procedure, the doctor continues to monitor your baby through an ultrasound to ensure your little one is okay.

Once the doctor locates the baby’s head, he will gently apply pressure to turn the baby to the head-first position. If the procedure is successful, your doctor will check everything again, including your baby’s heart rate. When all seems normal you will be sent home.

If the procedure is unsuccessful, your doctor will advise you regarding your delivery options or may suggest attempting ECV again.

Risks of ECV

Despite considered to have a high success rate, ECV is not entirely risk free. In fact, some women may find it very uncomfortable if not painful.

Though the risk of having complications is small, they include an early onset of labor; premature rupture of membranes; may cause a bit of blood loss for either the baby or the mother; or may cause the placenta to separate from the uterine wall which leads to fetal distress and an emergency C-section.

Therefore, the doctor, under all circumstances, must conduct ECV in the hospital.

Webster breech

This medical technique used to treat breech pregnancy is named after the late Larry Webster, D.C., who developed a specific chiropractic analysis and adjustment to change the position of breech babies.

Through this technique, chiropractors work towards establishing the balance in the mother’s pelvis and the reduction of undue stress to her uterus and supporting ligaments.

Chiropractors recommend women to make use of chiropractic care throughout the pregnancy in order to establish better balance and optimize the fetal positioning and development. It also helps in increasing the chances of easier and safer delivery for both mother and baby.

Birth Options for a Breech Pregnancy

Vaginal Delivery

Some of the factors that can make attempting a vaginal birth conducive include:

• When the baby is full-term, not too big, and in the frank breech pregnancy position
• The mother’s pelvis has enough room, and the process of labor is smooth and steady with the cervix widening as the baby descends.  Odds are better for women who have delivered vaginally before
• When the baby shows no sign of distress (while his heart rate is closely monitored)
• No pregnancy complications (including gestational diabetes or pre-eclampsia)
• When pregnant with twins and the first baby is head down while the other is breech (the first baby’s head may open up the cervix enough for the breech baby to pass through)
• When your doctor is trained and experienced in breech birth and has facilities for a C-section available nearby

However, a vaginal delivery for breech babies may include many severe complications such as injuries to the baby’s skull, brain or limbs; head getting stuck in the birth canal; cord prolapse that may result in slowing the baby’s supply of oxygen and blood through the umbilical cord; increased risk of perineal tears or episiotomy; and prolonged and difficult labor among others.

C-section

Most doctors recommend a C-section delivery for breech babies in the following cases:

• If your baby is in a footling or kneeling breech pregnancy position, or any other position that can make the delivery of the head more difficult. Don’t worry as this isn’t a common occurrence
• When you are expecting twins
• If you have pre-eclampsia or any other condition that may put you or your baby’s health at risk
• When the baby is either too big (more than 4kg/8lb 13oz) or too small (less than 2kg/4lb 6oz)
• If you’ve had a c-section before
• If you have a narrow pelvis or a low-lying placenta

Research shows that a large majority of breech pregnancy babies are delivered by C-section. But a doctor may find it appropriate to attempt a vaginal delivery in some cases.

Remember to have a thorough discussion about the possible risks and benefits of your delivery options with your doctor.

When to Call the Doctor

Here are two important things to take note of if your baby remains in the breech position:

First, if your water breaks and you go into labor before your baby’s bottom is engaged, there’s a risk that your baby’s umbilical cord may be swept down into your vagina.

In such a situation, contact your doctor immediately. While waiting for the ambulance, get on your hands and knees with your head down and your bottom up. This will help shift your baby’s weight off the cord to allow oxygen to pass via the placenta.

Second, babies born in breech position before 36 weeks or who remain in that position at or after 36 weeks must have an ultrasound examination to check for developmental dysplasia of the hip within six weeks of the birth.

This also applies for babies in a multiple pregnancy even if only one of them was breech.

Also read: Breech baby delivered naturally to Singapore mom

Republished with permission from: theAsianParent Singapore