Breech Presentations:
There are typically 4 different types of breech presentation:
1. When a baby is found to be bottom first with their feet near their head, this is called frank breech.
2. When a baby is found to be bottom first with their legs crossed (imagine a baby sitting upright with their legs Indian style), this is called complete breech.
3. When a baby is found to have one or both feet in position to be born first, this is called a footling breech.
4. When a baby is found to have a shoulder or arm in position to be born first, this is called transverse. This is a very rare situation.
The cause of breech presentation is unknown. There are several situations that can occur which increase the chances of a breech presentation. Infants who are born premature are more likely to be breech. This is likely due to the child being born before they’ve turned head down. Women who are carrying multiples more frequently experience breech babies. More babies mean less room to move around in utero.
Women who have experienced a breech baby in the past are more likely to experience another.
Placental Anomalies:
Placental anomalies can also cause a baby to be breech. Doctors can tell which position a baby is in by feeling it through the abdomen. The location of audible heart sounds are also an indicator of a baby’s position. The best and most definitive way to diagnose a breech presentation is by ultrasound exam.
External Cephalic Version:
When a woman reaches around 36 weeks gestation and finds their baby is breech, the most common technique performed is called an external cephalic version. An external cephalic version is a medical procedure in which a doctor externally manipulates a fetus in hopes of making it flip head down. External cephalic versions come with some risks, including amniotic sac rupture or fetal distress, which results in an emergency c-section. Versions can also be very painful for the woman. The success rate varies and even with a successful version, a baby can flip back into breech presentation.
Solutions and Techniques
There are many techniques women try to help make their baby flip head down.
Walking is not only great exercise for mom; it can also help flip a breech baby. Moms are encouraged to walk daily. Some women have had success flipping their breech baby with swimming. Allowing the body to immerse in water helps the body change pressure. Other women also swear by doing somersaults in the water. Women are encouraged to swim as often as they can tolerate. Taking warm baths may also help a woman relax, which might also aide the baby in flipping. Getting on the floor on hands and knees several times daily may also encourage a baby to turn.
Sometimes, no matter what a woman does, a baby will just not cooperate. When this is the case, the woman needs to discuss birthing options with her doctor or midwife. Head down is the preferable position for labor. Generally, the head is the largest part of a baby’s body. If the head can fit through the pelvis, the rest of the body should be able to as well.
This does not mean that women who have a breech baby can not have a successful vaginal delivery. What it does mean, however, is that the risk for serious and/or permanent injury can be greater. Babies born vaginally breech are at a higher risk for complications related to the umbilical cord. Since the head is usually the last part of the body to be delivered, severe umbilical cord compression can occur. Before a baby is born, the umbilical cord is its only source for nutrients and oxygen. When the cord is compressed and the baby can not be delivered rapidly, brain damage can occur.
Women who choose to vaginally deliver a breech baby should seek the help of a doctor or midwife who has experience with vaginal breech deliveries. It’s important to keep in mind that even with the most experience birthing team, injuries and complications can arise.
Many times, the delivery method of choice for doctors is a caesarean section. A C-section carries more risks to the mother, but many women opt to place more risk with their own health then risk the health of their baby.
A lot of research and debate has been done about delivering a breech baby. The best advice available is to read as much information as you can if you’re faced with a breech birth. Make whatever decision you do an informed one.
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