All About Delivering A Breech Baby

In breech presentation, usually, the fetal heart sounds are heard right above the umbilical region and you may feel a sense of discomfort as the baby presses his head under your diaphragm, just below your ribs. Ultrasound is important for detecting the position of the fetus, amount of amniotic fluid, and even the placental location.

Types of Breech Positions

Depending on the source, there are four main kinds of breech namely:

Frank breech

In this breech, the bottom of the baby comes out first followed by her or his flexed legs at the hip and extended at knees. This is the most common type of breech. It constitutes around 65 to 70 percent of the total breech births.

Complete breech

In this type of breech, the baby’s knees and hip are usually flexed or sitting cross-legged or with a feet lying beside the buttocks

Footling breech

In this type of breech, either one or both feet of the baby comes first and the buttocks are placed high up. The condition is common in premature babies

Kneeling breech

Here the fetus is in a kneeling position with either one or both extended legs at the hips and usually flexed at the knees. This condition is very rare.

When is it Possible to Determine The Baby’s Position?

Your doctor will be able to inform you about the position of the fetus by the start of the third trimester by palpating the baby from the abdomen.

At 36 weeks of pregnancy, the position of the baby is not clear by abdominal examination so the doctor clarifies the situation by doing an internal examination and feeling the fetal part in your pelvis. However, a better and most reliable confirmation about the position is done by getting an ultrasound done.

What Causes A Breech Position?

Your baby is more likely to settle himself in a breech position if:

• This is a multiple pregnancy
• You have had a history of a premature birth
• Your uterus has either too much or too little amniotic fluid
• You have a condition of placental pervia or fibroids

How To Turn A Breech Baby?

Between the 32nd and 37th week of pregnancy, turning a breech baby can be tried, though always in consultation with the doctor. Varying techniques are applied and all have different success rates. You and your doctor will together arrive at a technique that suits you both.  It is important to closely monitor the baby for any risks.

Techniques To Change Breech Position

Mentioned below are some techniques that may help in bringing breech presentations to normal presentations. However, no valid proof is present to establish their safety. Make sure you consult your doctor before attempting them.

ECV or External Cephalic Version

ECV or the external cephalic version is a specialized procedure done by externally applying pressure from the abdomen and trying to manipulate the fetus in a head-down position. The success rate of turning breech fetus to cephalic is 58 percent, while ECV is 90 percent successful in bringing transverse lie to normal position.

One of the main complications of the external cephalic version is premature separation of the placenta from the uterine wall.

Chiropractic: Webster Breech Technique

Chiropractors apply techniques that reduce the stress on a woman’s pelvis, thus relaxing the uterus and the surrounding muscles, making if viable for the baby to turn position. This technique is generally applicable in the 8th month of pregnancy.

How To Turn A Breech Baby Naturally?

Here are a few natural ways that turn a breech baby into a normal position. Please note that none of these has any scientific backup.  None of the studies have revealed that a mother’s position affects the position of the fetus. Gravity

Allow the gravity to rectify the presentation of the fetus. Some people believe that you can follow the following two positions twice a day from 32 weeks of pregnancy.

• Simply lie down on your back and slowly lift your pelvis to about 8 to 10 inches above the floor. Take a pillow to support and stay for at least 10 to 15 minutes in this position
• You can also get down on your knees with the help of your forearms and stay for at least 10 to 15 minutes

Moxibustion

This is an ancient Chinese method of stimulating main acupressure points by burning herbs. The expert usually burns mughwort-a herb, close to the acupressure points of your toes. The Chinese belief is that this would stimulate a baby’s activity and causes it to change its position on its own.

Hypnosis

Some experts are of the opinion that pregnant women practicing hypnosis (‘a state of profound relaxation’) from 37 weeks to 40 weeks of pregnancy are more prone to get their fetus to come down to normal presentation.

Music

All babies do respond to music, and so many pregnant women try and use the sound to turn a baby. You can do it by placing headphones on the lower part of the stomach. This prompts the baby to turn in the direction of the sound.

Important Factors Influencing The Safety Of Breech Baby

The first most favorable type of safe breech vaginal delivery is frank breech and the complete breech is the second safest type of breech. The risks such as head entrapment and cord prolapse are common with kneeling and footling type of breech.

Following are some of the important factors affecting the safety of breech babies:

Birth Attendant’s Skill

An important factor for the safety of the breech baby is the experience and skill of the birth attendant. Doctors who have seen or assisted in breech deliveries previously are more efficient in the delivery breech. More often the  dangers of delivering a breech baby vaginal delivery are due to the errors made by attendants or caregivers

Parity

Parity implies the number of times a female has conceived. The possibility of safe vaginal delivery is more in a woman who has already given birth vaginally in comparison to the one who has not delivered vaginally.

Fetal size and Maternal Pelvic Size

A woman having a spacious and roomy pelvis is likely to have a vaginal breech delivery.

Hyperextension of the Fetal Head

An ultrasound helps to diagnose it. Hyperextension or stargazing position accounts for less than 5 percent of the breech babies.

In such cases, Cesarean deliveries are an absolute must.

Maturity of the Baby

Complications are more frequent in premature babies if delivered through the vaginal route.

Progress of Labor

Normal progressing, spontaneous labor needing no significant intervention is a positive sign.

Second Twins

In a twin pregnancy, if the first one is born in cephalic presentation, the chances of the second one being a safe breech delivery are more. A breech birth is the birth of a baby in breech presentation.

Risk Of Breech Presentation

Most commonly, the risk involes the use of forceps to push the baby’s head outside the birth canal. Compression of the umbilical cord, because the baby’s biggest part of the head comes out the last, may also happen, thus distressing the baby by decreasing the oxygen supply to the baby.

In such an event, doctors go for an immediate c-section to safely deliver the baby. The failure of the fetal head to negotiate the maternal mid-pelvis can bring about head entrapment. Injury to the brain and skull may occur due to the rapid passage of the baby’s head through the mother’s pelvis, more likely in preterm babies.

Delivering A Breech Baby Naturally

Doctors consider Cesarean when it comes to delivering a breech baby. If you would prefer a vaginal birth, you need to discuss the same with your doctor and weigh the risks associated. If you have had a vaginal delivery earlier, and a well-trained, experienced birth doctor is available, you can vouch for it provided the doctor rules out any complications and risks with the birth.

A mother can deliver a full-term baby in the frank breech presentation vaginally if the baby does not show any signs of distress during the birth. The baby also needs to be able to pass through the mother’s pelvis safely. So one has to consider the size of the baby as well.

FAQ’s

1. Are Breech Babies More Painful To Deliver?

There will not be significant changes in pain mode. The most difficult aspect of a vaginal breech birth is the timing of the delivery of the baby’s head, which is the biggest section of the body. It is possible that the woman’s pelvis will not be big enough to accommodate the delivery of the head if the breech baby’s pelvis or hips are delivered first.

2. Can Your Water Break With A Breech Baby?

Yes, it can. If your water breaks and the baby is breech, you should go to the hospital straight soon. This is due to the increased likelihood of the umbilical cord being delivered before labor begins. The consequences for your newborn might be devastating.

3. Is Breech Baby Always A Girl?

The breech presentation does not indicate the gender of the baby. Yet, there is an interesting truth. In breech presentations, girls are more born than boys. A study of all singleton breech births in Hungary between 1996 and 2011 found that girls were much more likely to be delivered in this position than boys.

4. Are Breech Babies Big?

Babies that are born breech are often smaller than those who are born in the traditional cephalic position. Since breech presentation and huge size may raise the danger of catastrophic delivery problems, this correlation may be viewed as a positive selection towards cephalic presentation with increasing fetal size.

As compared to babies born in the normal cephalic position, breech babies tend to be smaller. With the potential for catastrophic delivery complications associated with breech presentation and extreme size, this may be nature’s method of mitigating those risks.