A minority of babies does not turn, and remains in the breech position. What are the options for mothers who are expecting a breech baby?
What is the breech position?
There are three different kinds of breech positions. A frank breech is a buttocks-first baby with its feet pointing upward, a footling breech is a foot-first baby, and a complete breech is a buttocks-first baby whose legs and knees are also situated around the buttocks. These positions are all common during the earlier stages of pregnancy, when the baby frequently changes position. During the last few weeks before the baby is due to be born, he or she will ideally turn and settle into a head-first position. The moment your healthcare provider determines that your baby has not settled into the vertex position, they are likely to offer you two options trying to turn the baby, or undergoing a scheduled cesarean section close to your due date. Your healthcare provider is clearly concerned about the baby's breech position. What is the big deal with breech? Why can't a breech baby be delivered "normally" (vaginally, without attempts to turn it) as happened in the past during the time before ultrasounds became the norm?
Why is breech dangerous?
There are quite a few issues with the breech position, actually. You may be shocked to discover that:
- Breech babies are more likely to have a birth defect. This could be the very reason the baby did not turn vertex.
- Breech presentation is more common in pregnancies where there is too little or too much amniotic fluid (which once again can point to birth defects).
- Uterine abnormalities or large fibroids are more a frequent occurrence for mothers carrying a breech baby.
- Women with a history of premature labor are more likely to have a breech baby
- Breech presentation pregnancies are more common in women with placenta previa, where the placenta covers the cervix. Placenta previa always requires a c-section.
All of these factors indicate a potential need for additional care all in themselves, which you and your healthcare team can prepare for if you are aware of these things. Not all birth defects are diagnosed before birth, however, and the same goes for uterine fibroids which can be large enough to obstruct the birth canal. Add to these potential risk factors the problems with a vaginal breech delivery, and it is clear why doctors feel strongly about determining a baby is breech and undertaking action. With normal, head-first births the head puts pressure on the cervix and goes through first. After all that stretching, it is not hard for the rest of the baby's body to emerge. In breech births, the head comes last, and the cervix may not be dilated enough for the head to emerge. This is called head entrapment and can lead to death. Cord prolapse is a situation in which the umbilical cord emerges from the vagina before the baby does. This is extremely dangerous, because the baby relies on the umbilical cord for oxygen before it is born and can breathe. A vaginal breech delivery involves cord prolapse by definition. The baby's naval will come out before its head, thus trapping a portion of the umbilical cord between the head and the cervix and cutting off oxygen. After the baby's body emerges, it is crucial for the head to follow within minutes.
So, what should you do?
Breech babies can be turned, using methods such as an External Cephalic Version (ECV), in which medical professionals manually try to turn the baby head-first within the uterus. External Cephalic Versions are generally attempted between weeks 32 and 37 of pregnancy, but they are not always successful. Babies who were turned can also turn back before labor. So, should you have a cesarean section or a vaginal birth if your baby did not turn vertex coincidentally or through a version? Vaginal breech deliveries carry definite risks, especially if attempted under the supervision of healthcare providers with limited to no experience with such births. Cesarean sections also carry risks, however. You will have to discuss the risks vs benefits of both possibilities with your healthcare team before making a decision. Mind you, if you're in the US you may not even be able to find a doctor who will oversee a vaginal breech birth.