Also a few exercises to try to turn breech baby naturally in the womb to avoid breech C section.
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Author:
Khushboo Kirale
- >> Post Created: April 1, 2022
- >> Last Updated: November 25, 2024
Medically Reviewed by: Dr. Veena Shinde (M.D, D.G.O, PG – Assisted Reproductive Technology (ART) from Warick, UK) Mumbai, India
Table of Contents
Your ultrasound scan by the 36th week of pregnancy confirms the baby’s position in the womb.
And if you are informed that you have a breech baby – whose position is the exact opposite to that of a baby in the optimal position for delivery i.e. head down position/ cephalic position – then your doctor might start talking to you about probable breech C section delivery and also make you aware of the possible chances of going into labor with breech baby, vaginal breech delivery and so on.
As an expectant parent of a baby who is in the breech position, you may have numerous questions like Does having a breech baby necessarily mean a breech C section delivery? Or if a vaginal breech delivery really possible? What is the best or ideal way to deliver a baby in the breech position?
We intend to address all these questions and more through this article to not only give various aspects that you could probably discuss with your doctor to possibly turn your breech baby naturally and so on…
Breech position delivery
As far as vaginal breech delivery/ breech baby normal delivery is concerned, once you know you are carrying a breech baby, it is suggested that you start preparing your mind for a breech C section delivery, as a vaginal breech delivery is a complicated affair and sometimes even dangerous (risk of injury and life to the baby) in this case.
Some doctors may be confident of a vaginal breech delivery, but most suggest breech C section.
Sometimes, doctors also recommend certain methods to attempt to turn the baby in a head-down position for a normal delivery if there is still time before the due date. We have discussed this ahead in the article.
Breech C section Delivery
If the baby remains put in the breech position even by the end of the pregnancy, then a planned breech baby C section is recommended to ease the process of childbirth, avoid complications ahead and further for the baby’s safety.
A breech baby C section has its own consequences as compared to a vaginal normal delivery, but in a breech birth, the risks of vaginal delivery outweigh the side-effects of a breech C section delivery.
A breech C section delivery or even just a Caesarean delivery can increase the chances of issues in future pregnancies. Placental problems, placenta health, difficulty with repeat C section surgery, and a slightly higher chance of stillbirth. Discuss the repercussions of a breech C section delivery with your doctor to understand and gauge the various implications.
If you go into labor before your planned breech C section, then your doctor will assess the situation; if the baby is ready to be born then it might be safer to go with a breech position and normal delivery.
A breech C section should be the preferred choice for a breech baby if:
- The gestation period of the baby is less than 28-30 weeks
- The baby is over 42 weeks’ gestation; this should raise the alarm bell for other factors
- The baby is larger (4 kg or more). An exception here can be a frank breech labor with good progress
- The baby has Intrauterine Growth Retardation (IUGR). This condition definitely calls for a breech C section delivery
- The mother has diabetes
- Labor is slow after 5 cm dilation or stops completely
- Labor is not progressing even though there are strong contractions and freedom of movement
- The baby does not descend into the mother’s pelvis during active labor
- The placenta is covering the cervix
- There is lack of confidence in the mother and/or the medical professional to go through a vaginal breech birth
- The medical professional is not able to gauge the breech baby’s spontaneous cardinal movements nor knows how to rescue the baby with breech maneuvers
- There are metabolic disorders like fertility issues, low thyroid function, conception through artificial insemination, etc. in the mother
- There is pelvic torsion or the pelvic outlet has a small diameter
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Complications during delivery of a breech baby
Pregnancy in breech baby is as normal as that in any other baby position; issues may arise only at the time of delivery.
Only with the baby in the ‘wrong’ position, there can be great risk to the baby’s health or even life. Therefore, a planned caesarean delivery is the safest and best in case of breech babies.
In earlier times, when C section wasn’t so common, doctors and midwives were trained to perform vaginal breech deliveries.
However, studies on the subject conducted across the world have confirmed that health complications for the baby and infant death during delivery are drastically lower in case of C section/ c section breech baby.
It is also interesting to note that as per The British Journal of Obstetrics and Gynecology, a vaginal breech delivery/ breech position normal delivery can also be as safe if done by a skilled and experienced medical professional.
However, a vaginal breech delivery/ breech position normal delivery carries the following risks (which are rare but very possible) –
- Physical injuries to the baby: The baby can suffer from broken or dislocated bones or even an injured skull.
- Umbilical cord damage: There are high chances that the umbilical cord exits the cervix before the baby (prolapsed cord). The chances of this is greater in footling and complete breech babies.
Also, as the baby attempts to come out, it can press against the cord, flattening or twisting it, affecting the heart rate and causing the oxygen to be cut off, resulting in nerve or brain damage.
- Head entrapment can happen if the baby’s body is born before the cervix is fully dilated. This is dangerous in two ways – umbilical cord damage and the head getting stuck.
Head entrapment is more common in premature deliveries, as the head is usually bigger than the bodies then.
- Physical injuries to the mother’s genitals through a vaginal breech delivery is possible because of the use of forceps and episiotomy.
Though the mother may suffer equally in case of both – vaginal breech delivery and breech C section – she can always be convinced that her baby will be safe at birth through a breech C section.
So don’t be dejected if your doctor still insists on a breech C section, as most medical professionals do not want to risk the baby’s life or health.
Can a breech baby be flipped before delivery?
After 37 weeks into pregnancy, breech babies have less chances of changing their position on their own. Medically, the most common method to attempt turning a breech baby into a vertex baby is the External Cephalic Version procedure (ECV), which is performed by a medical professional. It is done around the 37th week of pregnancy, in the hospital in case it turns into an emergency.
Here, the doctor will apply firm pressure with their hands on the belly to turn the baby in the head-down position inside the uterus.
Read more about the ECV procedure.
It is said to have 65% efficiency, but does carry a few risks. It is essential that all arrangements for a breech C section delivery are also made while performing this, in case of an emergency.
There are also certain cases when ECV is not recommended. Discuss the same with your doctor.
The success rate of ECV procedure will depend on –
- The amount of amniotic fluid present inside the uterus
- The time remaining for your due date
- The number of previous pregnancies
- The weight of the unborn baby
- The position of the placenta
- The baby’s position
The risks of trying to turn a breech baby through ECV include the following –
- Premature labor
- Premature rupture of the amniotic sac
- Blood loss (mother or baby)
- Emergency breech C section delivery
- Baby might turn back to breech position
The chances of these risks are small and conditional to your pregnancy.
There are also some methods to try at home, which may assist the baby to flip to the head-down position, but there is no scientific evidence confirming that they will definitely do. We recommend speaking to your doctor before attempting any of these.
- Exercise for breech babies – i.e. certain positions, postures and poses can encourage the baby to flip naturally before delivery:
- The Bridge position: Lie down on the floor with bent knees and feet flat on the ground. Then elevate your hips and pelvis in a bridge position and hold it for 10-15 minutes. You can repeat this exercise a few times each day.
- Child’s pose: Resting in a child pose for 10-15 mins helps relax the uterus and pelvic muscles. Besides this, going on your hands and knees, you can rock back and forth or even rotate your pelvis to make circles to stimulate baby’s activity.
- Inversion is when you allow gravity to help your baby flip its position. You exercise certain body inverting positions like doing hand stands in a swimming pool, keeping the pelvic region propped up with pillows, or keeping hips elevated using stairs.
- Applying essential oils on the belly might stimulate the baby to change its position. You have to take your doctor’s advice for everything recommended here, but for essential oils, it is a necessity as it may not be safe for some pregnant women.
- Music can possibly urge the baby to change its position. Place the speaker or headphones at the bottom of the uterus for this.
- Extreme temperatures can also help. Place something cold where the baby’s head is and something warm where its feet are. The baby will want to turn away from the cold towards warmth.
- You will need to visit a chiropractor who knows the Webster technique for this option. This can help align your pelvis and hips and relax your uterus. This may stimulate the baby to turn.
- Acupuncture can help balance the body’s energies, relax the uterus, and hence, encourage the baby’s movement.
Is it safe to attempt to flip a breech baby?
Once you know you are carrying a breech baby, it is natural that you may want to do everything possible to turn it into the optimal position for an easy vaginal delivery. However, it is important to understand that in some cases, attempting to turn the baby may hold more risks than benefits, and hence, it may not be safe.
If any of the following cases is true with you, trying to flip the baby’s position may not be safe –
- Vaginal bleeding
- Placenta previa; placenta covering the cervix partially or fully
- Low level of amniotic fluid
- A non-reactive non-stress test
- An abnormally small baby
- Low or high heart rate of the baby
- Premature rupture of membranes
- Carrying twins or multiples
It is obvious that an ECV procedure is NOT recommended in pregnancies that involve the above-mentioned conditions.
FAQs
1. How does labor begin if baby is breech?
A breech baby does not alter the first signs of labor, like contractions and rupturing of membranes.
However, if you have planned a breech C section delivery with your doctor, then you might have the surgery around your due date and there might not be labor pains at all.
The doctor might confirm the baby’s position once more before going ahead with the delivery.
2. What is being in labor with a breech baby like?
It is important that a woman in labor is provided with a calm and supportive environment. If you choose an epidural, then the chances of breech C section increase.
The baby’s heart rate is constantly monitored during a vaginal breech delivery and if all is well, it indicates the baby’s chance of a good outcome.
Any irregularities in the heart rate or if the labor stops progressing well, then it calls for an emergency breech C section delivery.
It is necessary that you try to stay calm, as relaxed muscles help the baby during delivery.
3. What if I go into labor early?
If you go into labor before 37 weeks of pregnancy, then the pros & cons of a vaginal breech birth and breech C section change and should be discussed in depth with the doctor.
4. What if I am having multiples and one of them is a breech baby?
If you are having twins or multiples and the first baby is breech, then the doctor will recommend a planned breech C section of twins/ multiples.
However, if the first baby is head-down, then the position of other baby/babies do not matter much, as after the first baby is out, the other/others have enough space to move, and hence, they may naturally turn into the optimal position.
5. Can my breech baby still turn after 36 weeks?
In the first pregnancy, if the baby is breech at 36 weeks, then the chances of it turning to the head-down position before labor is 1 in 8. If you have had a previous pregnancy and the current baby is breech, then the chances rise to 1 out of 3.
An ECV procedure is recommended only after 37 weeks.
6. How will a Frank Breech baby be delivered?
A frank breech baby can be delivered vaginally if –
- The gestation period of the baby is at least 36 weeks’
- The baby is average-sized
- You have previously given birth vaginally
- The size of your pelvis is large enough for the baby to pass through
- The baby’s head is flexed in the right position
- The doctor and his team have experience in vaginal breech delivery
- The baby is monitored constantly
- Arrangements for an emergency are made
For any breech baby that is in distress or is premature, a C section delivery is the obvious choice for birth. Even otherwise, a breech C section is always the preferred choice to avoid injuries or issues for the baby.
Conclusion
A breech baby position is one of the rare ones, and hence, needs extra care and specific expertise for the delivery.
A breech baby C section delivery is the safest (and hence, obvious) choice for delivery, but some women or their doctors might ask for or prefer vaginal breech delivery, which is also possible, but usually not recommended. There are loads of complications with regards to vaginal breech delivery as discussed above.
However, how to deliver a breech baby is a question that can only be answered after taking several factors into consideration.
Yes, you can try ECV or other methods to try to turn the baby in the optimal position before delivery or go for a vaginal breech delivery if there are no health complications (baby & mother) and if you have a doctor who has the expertise. Otherwise, a breech C section delivery is the way to go!
Have a safe and positive delivery!
Khushboo Kirale
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