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What does it mean if my baby is breech?
Breech is a term used to describe your baby's position in the womb. It means she's bottom-down instead of head-down.
Babies are often active in early pregnancy, moving into different positions. But by around 8 months, there's not much room in the uterus. Most babies maximize their cramped quarters by settling in head down, in what's known as a cephalic or vertex presentation. But if your baby is breech, it means he's poised to come out buttocks or feet first.
When labor begins at 37 weeks or later, nearly 97 percent of babies are set to come out headfirst. Most of the rest are breech. (In rare cases, a baby will be sideways in the uterus with his shoulder, back, or arm presenting first – this is called a transverse lie.)
There are several types of breech presentations:
- Frank breech (bottom first with feet up near the head)
- Complete breech (bottom first with legs crossed)
- Incomplete or footling breech (one or both feet are poised to come out first)
See what these breech presentations look like.
How will I know if my baby is in breech position?
By the beginning of your third trimester, your practitioner may be able to tell what position your baby is in by feeling your abdomen and locating the baby's head, back, and bottom. About a quarter of babies are breech at this point, but most will turn on their own over the next two months.
If your baby's position isn't clear during an abdominal exam at 36 weeks, your caregiver may do an internal exam to try to feel what part of the baby is in your pelvis. In some cases, she may use ultrasound to confirm the baby's position.
If your baby is in breech position, you may feel her kicking in your lower belly. Or you may feel pressure under your ribcage, from her head.
Why would a baby be in breech position?
We don't usually know why. While sometimes a baby with certain birth defects may not turn to a head-down position, most babies in breech position are perfectly fine. Here are some things that might increase the risk of a breech presentation:
- You're carrying multiples
- You've been pregnant before
- There's too much amniotic fluid or not enough amniotic fluid
- You have placenta previa (the placenta is covering all of part of the opening of the uterus)
- Your baby is preterm
- You were a breech delivery, or your sibling or parent was a breech delivery
- Advanced maternal age (especially age 45 and older)
- Your baby is a low weight at delivery
Girls are more often in breech presentation than boys.
What if my baby is still breech close to delivery?
Babies who are still breech near term are unlikely to turn on their own. So if your baby is still bottom down at 36 weeks, your caregiver should offer to try to turn your baby to the more favorable head-down position, assuming you're an appropriate candidate.
This procedure is known as an external cephalic version (ECV). It's done by applying pressure to your abdomen and manually manipulating the baby into a head-down position. (If your caregiver is not experienced in this procedure, she may refer you to someone who is.)
ECV has about a 58 percent success rate in turning breech babies (and a 90 percent success rate if the baby is in a transverse lie.) But sometimes a baby refuses to budge or rotates back into a breech position after a successful version. ECV is more likely to work if this isn't your first baby.
Not all women can have ECV. An EVC won't be attempted if there's any concern about the health of your baby or if:
- You're carrying multiples
- You have too little amniotic fluid
- You have placental abruption or the placenta is covering your cervix
- You have certain reproductive system abnormalities
And, of course, you won't have a version if you're going to deliver by cesarean anyway – for example, if you have a placenta previa, or have had more than one previous c-section.
Are there risks associated with having an ECV?
Having a version isn't entirely risk-free and some women find it very uncomfortable. You'll want to discuss the pros and cons with your caregiver.
Severe complications, while relatively rare, can occur. For example, an ECV may cause the placenta to separate from the uterine wall so that your baby has to be delivered right away by c-section. The procedure may also cause a drop in your baby's heart rate, which, if it doesn't resolve quickly on its own, will require an immediate delivery.
For these reasons, a doctor will do the procedure in a hospital with facilities and staff available for an emergency c-section in case any complications arise. You'll be told not to eat or drink anything after midnight the night before the procedure, in case you end up needing surgery.
What is an ECV like?
When you go in, an IV is started and blood may be drawn. Women who are Rh-negative should get an injection of Rh immune globulin after the procedure unless the baby's father is also Rh-negative. Your baby's heart rate will be monitored before, during, and after the procedure.
You'll have an ultrasound beforehand to check your baby's position, the location of the placenta, and the amount of amniotic fluid. The ultrasound will be repeated after the maneuvers are performed. Some doctors also use ultrasound during the procedure.
Some studies show higher success rates for ECV when uterus-relaxing drugs are used.
Your caregiver will place her hands on your abdomen and apply firm pressure to guide the baby into a head-down position. Sometimes two people perform the procedure together, and sometimes ultrasound is used to help see how the baby is moving.
The procedure is usually done near a delivery room so that if there's a problem, you can have a c-section quickly.
If my baby doesn't turn, will I have a c-section?
It depends, and it's something you'll want to talk with your caregiver about ahead of time. Discuss your preferences, the advantages and risks of each option (vaginal and cesarean delivery of a breech presentation), and her experience.
In the United States, most breech babies are delivered via cesarean. In rare circumstances, if you're at low risk of complications and your caregiver is experienced delivering breech babies vaginally, you may choose to have what is called a "trial of vaginal birth." This means that you can attempt to deliver vaginally but should be prepared to have a cesarean delivery if labor isn't progressing well. You and your baby will be closely monitored during labor.
You may also wind up having a vaginal breech delivery if your labor is so rapid that you arrive at the hospital just about to deliver. Another scenario is if you have a twin pregnancy where the first baby is in the head-first position and the second baby is not. The biggest risk of a breech delivery is when the body delivers but the head stays entrapped within the cervix. A baby who delivers head-first will make room for the breech baby.
However, the vast majority of babies who remain breech arrive by c-section. If a c-section is planned, it will usually be scheduled for no earlier than 39 weeks. To make sure your baby hasn't changed position in the meantime, you'll have an ultrasound at the hospital to confirm his position just before the surgery.
There's also a chance that you'll go into labor or your water will break before your planned c-section. If that happens, be sure to call your provider right away and head for the hospital.
What alternative techniques might I try to coax my baby to turn?
Below are some alternative methods you may hear about. There's no proof that any of them work or are even safe. Consult your practitioner before trying them.
- Let gravity help. Get into one of the following positions twice a day, starting at around 32 weeks. The idea is to employ gravity to help your baby somersault into a head-down position.
Be sure to do these moves on an empty stomach, lest your lunch comes back up. And make sure there's someone around to help you get up if you start feeling lightheaded.
Lie flat on your back and raise your pelvis so that it's 9 to 12 inches off the floor. Support your hips with a pillow and stay in this position for five to 15 minutes.
Alternately, get on your knees with your forearms on the floor in front of you, so that your bottom sticks up in the air. Stay in this position for five to 15 minutes.
Be aware that there's no conclusive proof that the mother's position has any effect on the baby's position. And if you find these positions uncomfortable, stop doing them.
- Ask your caregiver about moxibustion. This ancient Chinese technique burns herbs to stimulate key acupressure points. To help turn a breech baby, an acupuncturist or other practitioner burns mugwort near the acupressure point of your pinky toes. According to Chinese medicine, this should stimulate your baby's activity enough that he may change position on his own.
Some studies show that moxibustion in combination with acupuncture and/or positioning methods may be of some benefit. Others show moxibustion to provide no help in coaxing a baby into cephalic position.
If you've discussed it with your caregiver and want to give it a try, contact your state acupuncture or Chinese medicine association and ask for the names of licensed practitioners.
- Try hypnosis. One small study found that women who are regularly hypnotized into a state of deep relaxation at 37 to 40 weeks are more likely to have their baby turn than other women. If you're willing to try this technique, ask your caregiver whether she can recommend a skilled hypnotherapist.
Having a gentle c-section