Short on time? Then the key things to know are:
- A breech presentation is when a baby is lying upright, with its bottom or feet in the pelvis
- There is no specific reason why babies lie in the breech position, but there are some risk factors, such as: previous breech presentation; placenta praevia; due to the shape of the uterus; having already had lots of babies
- A baby in the breech position will be confirmed by an ultrasound scan
- Most women will be offered an EVC (external Cephalic Version), which attempts to turn the baby, at 37 weeks if the baby remains in the breech position
- It is your choice to opt for a vaginal breech birth or a caesarean section if the baby remains breech
What is breech birth?
Breech presentation is when a baby’s bottom or legs are presenting first, i.e. head up. It occurs in around 4% of all pregnancies at full term. Sometimes the baby can be breech during the pregnancy but turn at some point during the 3rd trimester and become cephalic (head down).
There are 3 different types of breech presentation:
- Frank breech: This is when the legs are extended and the feet are up around the baby’s head.
- Footling breech: When either one or both feet are below the baby’s bottom.
- Complete or flexed breech: When the legs are folded at the knee.
Why is a breech birth dangerous?
Studies have shown that a breech birth can lead to more complications than when a baby is presenting head first. Primarily, obstetricians are concerned that the cervix may not become fully dilated before the baby’s body is delivered, therefore leaving the head stuck and unable to pass through. This is a risk during any birth but has a higher chance if the baby is breech.
Why do babies breech?
Most of the time there is no specific reason why a breech presentation occurs, but it tends to be more common in women that have had breech babies before.
Other reasons could be:
- If you are carrying twins
- If you have had lots of babies before
- If you have one or several large uterine fibroids
- If you have a low lying placenta
- If there is too much or too little fluid around the baby
- If you have an uncommon shaped uterus (called a bicornuate uterus or a septate uterus)
How is a breech presentation picked up?
The midwife will check the presentation of the baby at every antenatal appointment. If she is concerned that the baby might be breech you will be referred for an ultrasound scan to confirm at around 36 weeks.
If the ultrasound scan confirms that the baby is indeed in a breech position then most hospital trusts would offer women an external cephalic version (ECV).
Some women are able to feel when their baby is breech, this generally feels as if the lower ribs are very bruised, as this is where the head (the biggest and hardest part of the baby) is lying.
What is an ECV?
An ECV (external cephalic version) is where one of the doctors tries to manipulate the baby into a head first position by applying pressure on your abdomen. It is a completely safe procedure although it can be a little uncomfortable. It is usually about 50% successful.
If it is not possible to turn the baby or if they turn back to a breech presentation (sometimes when you try to move those babies round, they just keep going in a 360 degrees full circle!) then it is time to consider your options. Those being, to either plan for a vaginal breech birth or a caesarean section.
Can you give birth naturally if your baby is breech?
A vaginal breech birth is when you allow labour to occur spontaneously and continue to labour normally. Before you choose to have a vaginal breech birth, you will need to have a discussion about the type of breech position your baby is in. It is not recommended that you proceed with a vaginal delivery if your baby is:
- A footling breech: When either one or both feet are presenting first and below the baby’s bottom
- If your baby is larger than average
- If you are suffering from any pregnancy problems such as pre-eclampsia
If you choose to try for a vaginal breech birth, you would be advised to give birth in an obstetric led unit, your baby will be continuously monitored throughout the labour and you should (as always) be provided with a calm atmosphere and continuous support.
Can you have a home birth breech?
It is not recommended to have a breech birth at home. There will undoubtedly be some midwives that are comfortable offering this service independently, but most obstetric teams would advise to deliver a breech baby in your local maternity ward.
Is breech birth more painful?
A breech birth is no more uncomfortable than a birth where the head is presenting, as the uterus is still having to work very hard with the contractions to push baby down and out.
What if I decide to have a caesarean section?
If you decide to opt for a caesarean section then all the normal risks of this type of surgery would apply. If you go into labour before your scheduled caesarean, you will be assessed when you arrive at the hospital and if it is safe to do so, they will proceed with the operation as planned. If the labour has progressed quickly, and you are close to giving birth, it may be safer at this point to go for a vaginal delivery.
If you go into labour before 37 weeks of pregnancy there is a significant difference in your risks and benefits of a vaginal breech over a caesarean section delivery and this would be discussed with you at the time.
At no point should you feel coerced into making a decision on what type of birth is best for you, if you have a breech presenting baby. It is important that you have all the information and all the research available to you before you make a decision.
Want to speak to someone about your pregnancy? Book an appointment with one of our private midwives at a time that suits you to get specialist advice with any concerns.
Kate, Naytal Midwife
Kate has been a Midwife within the NHS for more than 15 years and supports women to work harmoniously with their bodies and tune into their intuitions.