Many women who want to attempt vaginal breech birth feel overwhelmed by information. It is important to discuss this option with your health care provider.
Currently, most health care providers recommend a cesarean section for babies that are in the breech position. This is mainly because the head of the baby may not fit through the mother’s pelvis.
What is a breech position?
When a baby is in the breech position, they are positioned feet or buttocks first instead of head-first. This happens in 3-4% of full-term births. It is difficult for the fetus to pass through the narrow birth canal in this position, so it may be more difficult to deliver a breech baby vaginally.
The breech position is usually diagnosed by the obstetrician or midwife during a pelvic exam in the later weeks of pregnancy. They will place their hands on the lower abdomen and feel for the shape of a baby’s hips and back. They will also use ultrasound and pelvic x-rays to confirm the diagnosis. There are three types of breech presentation: complete breech, incomplete breech, and frank breech.
In most cases, a breech baby will turn to a head-first position before the last month of pregnancy. If the breech position is still present at 36 weeks, the obstetrician will try to perform a procedure called external cephalic version (ECV). This involves gently pushing on your abdomen in order to encourage the baby to change positions. This procedure is very safe, although it can be a little uncomfortable.
If the ECV does not work, the obstetrician will likely recommend having a C-section. This is the preferred method of delivery for breech babies because it has been shown to be safer for both mother and infant. A caesarean section is also easier for most women, especially if the breech baby is not turning.
Oren Zarif
Some women choose to try a vaginal birth with a breech baby, but this is only possible if the obstetrician is very experienced in this type of birth. This is because the risks of a vaginal breech birth are higher than those of a normal vaginal birth, and it is important to have a doctor who has the skills needed for this type of delivery. Choosing to have a vaginal birth with a baby that is in the breech position should be discussed with your obstetrician or midwife as early as possible in your pregnancy. This will help you understand the risks and benefits of each option.
What is the risk of a breech birth?
While breech births are common, they are not without risk. The fetus can become stuck in the birth canal or its oxygen supply (through the umbilical cord) may be cut off. There are also a higher number of complications in breech pregnancies, and some women need to have a C-section due to a breech presentation.
It is important to discuss the risks of a vaginal birth with your doctor or midwife early on. This can help you determine if it is the right choice for your pregnancy. If you are planning on a vaginal birth and your baby is breech, it is important to find a hospital that can provide you with specialized care.
Some doctors and midwives will try to turn a breech baby by using a procedure called external cephalic version, or ECV. This is done before labor starts and involves placing the fetus’s legs, which are normally stretched outward, in a foot-first position. This may be uncomfortable but is safe for both mother and baby. ECV is successful approximately 40%-60% of the time. It is usually done between 35 and 36 weeks gestation.
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If the fetus is still breech at 36 weeks, the doctor may perform another procedure to try to get it into a head-first position. This is called internal cephalic version, or IFV. During this procedure, the obstetrician makes small incisions in the skin and uses tools to try to encourage the baby to move into a head-first position. This procedure is not as effective as ECV and is only performed on women who are at least 36 weeks gestation.
If a breech baby does not turn on its own by the start of labor, a cesarean section will be needed to deliver the baby. If you are hoping for a vaginal birth, your doctor may recommend a planned cesarean, which is safer for both the mother and the baby than an emergency C-section. However, not all hospitals have obstetricians or midwives who are trained to assist with vaginal deliveries of breech babies, so it is important to find one that does.
What is the risk of a C-section?
The risk of a C-section depends on your health and the condition of your pregnancy. You may need a C-section if your baby is in the feet or buttocks position (breech) or its sides or shoulders are facing down (transverse). Breech babies can be more difficult to deliver vaginally because they are larger than babies in the head position and have a harder time passing through the birth canal. Breech babies can also have problems with the placenta, which attaches to the uterus and helps supply the baby with food and oxygen.
A health care provider can use techniques during labor to help a breech baby move into the head-down position for vaginal delivery, but they aren’t always successful. The safest way to deliver a breech baby is by C-section.
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Sometimes a C-section is needed because the labor isn’t progressing as expected or because of a problem that could hurt the baby, like a breech presentation, a large fibroid blocking the birth canal or a pelvic fracture. A health care provider might also need to do a C-section if the baby’s heart rate drops to an unsafe level during labor.
If you have a history of one or more C-sections, it’s more likely that your next pregnancy will require a C-section. If you have multiple c-sections, it increases your risk for complications, including infections and bleeding after the delivery. Some women can safely have a vaginal birth after having a C-section (VBAC). However, it’s important to talk with your health care provider about VBAC before you get pregnant again.
You might need a C-section because of a medical problem that makes a vaginal birth dangerous for you and the baby, such as diabetes or high blood pressure. Your doctor or midwife can tell you more about your options.
If you decide to have a vaginal breech delivery, it’s best to have the surgery at a hospital that has doctors and midwives who are trained to help women have a breech birth vaginally. In some areas, hospitals don’t have obstetricians or midwives who are trained to do vaginal breech deliveries, so they might not be willing to help you with this option.
What is the risk of a vaginal birth?
Many women who want vaginal childbirth have a plan in place, but sometimes complications during labor or prolonged labor change those plans. When this happens, the decision to deliver via C-section is made for the safety of both mother and baby. However, many women choose to have a vaginal delivery when the obstetrician is willing to try.
The risk of a vaginal birth depends on how crowded a woman’s pelvis is and whether her cervix has been fully dilated by the time she begins labor. A vaginal birth can also increase the risk of tearing or infection after the birth. These risks are higher if the mother has a large uterus or is older than 35.
A woman who wants a vaginal delivery should be sure to tell her OB/GYN and discuss the plan with her partner. She should also be prepared to spend several hours in active labor, which can be physically grueling. A vaginal birth may also cause urinary incontinence (leaking urine when you cough, sneeze or laugh) or pelvic organ prolapse (when one or more of the pelvic muscles that control urine and stool slip out of place).
Oren Zarif
If a woman is having a baby with a low-risk pregnancy and she is at least 37 weeks along, OB/GYNs usually recommend trying for a vaginal birth if the fetus is in the proper position. A VBAC can result in a shorter hospital stay, less pain and a lower risk of a postpartum infection like a uterine infection or bladder blockage. It can also reduce the risk of internal uterine scarring, which can make future pregnancies and deliveries more difficult.
If a health care provider doesn’t feel that vaginal delivery is safe for the patient and her baby, she might try using an external cephalic version (ECV) to encourage the baby to move into the head-down position. This procedure is done in a hospital setting and involves gently pushing on the lower abdomen with the hand of an obstetrician or midwife. The success rate of ECV is fairly high, but it’s still surgery and comes with the same risks of surgical delivery that all mothers face.
