Breech is the term used to describe a situation where the baby is in a different position versus head first at the time of delivery. The natural and expected position at the time of delivery is head down. The baby usually moves into this position a few weeks prior to delivery. Breech births occur in about 4% of all births.
What are the different types of breech presentations?
A breech birth is the term given to any baby not in the head down first position. However the positions may vary and each has its own term:
- Frank breech: The term when the baby’s bottom is presenting first. The feet are pointed towards the head.
- Complete breech: The term used when the baby’s bottom is presenting first and the legs are folded placing the feet near the bottom.
- Footling breech: The term for when the baby’s foot or feet are presenting first.
Causes of a breech birth:
There is little known on what causes a breech birth, but there have been characteristics where a breech birth is more likely to be experienced:
- Subsequent pregnancies
- A pregnancy with multiples
- A history of premature delivery
- Low or high levels of amniotic fluid
- Abnormalities of the uterus (i.e. fibroids).
- Placenta previa
diagnosing a breech presentation:
In most cases your healthcare provider will use their hands to feel for the baby’s bottom and/or head. If there is any question about breech positioning; your provider will use a sonogram to verify the position of the baby. In some cases a breech baby may still be delivered vaginally; your healthcare provider will be measuring for that possibility.
Changing a breech position:
There are a variety of methods to help turn a breech baby. Your healthcare provider may have a preference, so it is important to talk to your provider. In most cases, any interventions to change a breech baby will be carried out between weeks 32-37 of your pregnancy There are many different types of methods to use to try and change a breech position. Here is a list of possible techniques:
External Version: External version is a non-surgical method in which a doctor can help move the baby within the uterus. A medication to help relax the uterus might be given as well as an ultrasound exam, to better check the position of the baby, the location of the placenta, and the amount of amniotic fluid in the uterus. Gentle pushing on the lower abdomen can turn the baby into the head-down position. Throughout the external version, the baby’s heartbeat will be checked closely so that if any problems should occur, the health care provider will stop turning immediately. Most attempts at external version are successful; however, as the due date gets closer this procedure is more difficult.
Chiropractic Care: the Webster Breech Technique was developed by the late Larry Webster, D.C., of the International Chiropractic Pediatric Association. This procedure relieves pressure and stress on the pelvis allowing the uterus and ligaments to relax. This helps the baby turn naturally. The Journal of Manipulative and Physiological Therapeutics reported in the July/August 2002 issue that the Webster Technique proved success for 82% of doctors who used it to try and change a breech position.
The Breech Tilt: This is a natural technique that may be done in the comforts of your own home. Raise hips 12″ or 30cm off the floor using large, solid pillows three times daily for 10-15 minutes each time. Try to do this on an empty stomach and during a time when your baby is moving. Focus on relaxing and not tensing your stomach muscles.
Using Music: Some women have reported success by using taped recordings of their voice or music to help draw their baby downward. The easiest way is to place headphones on the lower part of your abdomen. The belief is that the baby will be attracted to the music or to your voice and try to move closer to it.
Moxibustion or Pulsatilla are homeopathic methods that have been reported to bring about a change in a breech position. It is best to talk to your healthcare provider and a holistic provider before using these methods.
Risks and concerns of a vaginal delivery:
The baby’s head is the last part to be delivered and may experience challenges. Your healthcare provider may need to use forceps to complete the delivery. Additionally, cord prolapse can occur as the baby moves through the canal. The cord can be pinched reducing or blocking the baby’s supply of blood and oxygen.
Electronic fetal monitoring will asses the baby’s heartbeat and monitor any stress to the baby. If there are any complications your healthcare provider may elect to forgo the vaginal delivery and move into a cesarean.
When is a cesarean delivery used with a breech presentation?
Cesarean deliveries are frequently used for breech positions. Your healthcare provider may elect to use a cesarean delivery on a breech baby who is presenting prematurely. These babies are fragile and the cesarean delivery will put less stress on the baby.
Compiled using information from the following sources:
William’s Obstetrics Twenty-Second Ed. Cunningham, F. Gary, et al, Ch. 24.
Danforth’s Obstetrics and Gynecology Ninth Ed. Scott, James R., et al, Ch. 21.
American Pregnancy Association, http://www.americanpregnancy.org