Breech Birth — Considering Your Options

Many healthcare providers will first suggest attempting to turn a breech baby into the vertex position. This is usually done in a procedure called an external cephalic version (ECV), which literally involves manually turning the baby head-down in a skilled maneuver.

This procedure is most likely to be successful earlier on in the pregnancy, because there is more space in the uterus and more amniotic fluid. This also unfortunately means that the baby may be able to turn back into the breech position.

If the version was unsuccessful, or the baby turned back to breech, or the parents decided not to attempt a version at all, there are two remaining options — a scheduled cesarean section or a vaginal breech birth. Due to the potential for complications during a vaginal breech delivery, cesarean section is considered a valid option in all developed, modern healthcare systems. Policy on breech vaginal birth varies throughout the western world.

Let's take a quick look at the policies in three different countries, to compare them:

• In the United States, the ACOG (American College of Obstetricians and Gynecologists) notes that a cesarean section is generally safer for a breech baby. It also states that the mode of delivery should depend on the obstetrician, who will almost always prefer a c-section due to lack of experience with vaginal breech birth. The ACOG says that vaginal twin delivery where the second baby is breech is less risky, and says that the mother should be counseled about the possible risks of vaginal singleton breech delivery. In practice, very few OBGYNs will do vaginal breech births.

• In Great Britain, the National Health Service (NHS) starts by recommending that women carrying a breech baby deliver in a hospital rather than at home. They recognize the risks associated with a vaginal breech delivery, and advise women against one in certain circumstances — like a large or small baby, a low-lying placenta, or having had a previous c-section. Yet, the healthcare system in the UK does not discourage breech birth as universally as happens in the US.

• In the Netherlands, generally perceived to have the most liberal maternity care policies, studies that show c-sections to be safer for breech babies are taken into account. Footling breech babies are always delivered by c-section. For other types of breech position, doctors in the Netherlands also look at risks associated with a c-section. The final decision is made jointly by parents and healthcare providers.

To put it simply, your options will depend on your local healthcare system to a great extent. Women who have a preference for a cesarean section will not have a problem obtaining one in any of the modern healthcare systems around the world. Vaginal breech birth may be an option for you if you meet certain requirements, depending on your location.

Medically speaking, vaginal breech birth is safest in the following circumstances:

• The mother has already had an uncomplicated vaginal delivery before, and has not had a cesarean section in the past.

• The baby is term, and not estimated to have either a large birth weight or a low birth weight — as determined by your healthcare provider.

• The baby is in a frank breech position and has already descended. Twins, which the second twin being in a breech position, is an alternative favorable factor.

• The baby's head is in a position that facilitates vaginal delivery, and the placenta is not located close to the cervix.

• The healthcare team is experienced in delivering breech babies vaginally, and the delivery takes place in an operating room so that an emergency c-section can quickly be carried out if necessary.

Good luck with making your decision. Do not hesitate to seek a second opinion or to specifically seek out doctors who have experience with breech deliveries, if you would prefer to have a vaginal birth. But also be flexible and prepare for a cesarean section.