Avoiding breech birth

Around 15 per cent of babies are breech (bottom down) until week 32 of pregnancy. Most of these babies turn and we tell you how to help your little one along...

No one really knows why babies turn when they do, but childbirth expert Sheila Kitzinger says it’s probably because their heads are the heaviest parts of them, which means they naturally gravitate downwards in the amniotic fluid. With a first baby, the head is often engaged in the pelvis by 36 weeks of pregnancy, but subsequent babies don’t generally engage until you’re in labour, so there is always a possibility of your baby turning at the last minute.

Why breech babies happen

You may discover that your baby is breech at a routine check done by your midwife or doctor and then have a scan to confirm this. While there’s often no particular reason why your baby hasn’t settled head down, it could be due to:

* The shape of your uterus - a small number of women have a heart-shaped uterus, called a bicornate uterus, which makes it easier for your baby to stay in the breech position

* The shape of your pelvis

* A low-lying placenta

* Fibroids (benign tumours of the uterus)

* Premature babies and twins are also particularly prone to breech presentation

* How much amniotic fluid you have - too much means your baby has more room to move around

Getting into position

It’s good to know what breech position your baby is in, as it might make a difference to the type of birth you go for. According to consultant obstetrician Richard Johanson of the North Staffordshire Hospital, roughly a third of breech babies are born by vaginal delivery, a third by elective Caesarean and a third by emergency Caesarean.

Frank breech

The most common position is the frank breech, in which your baby’s bottom sits in your pelvis, and his legs extend straight up, so his feet are in front of his face or by his ears. This type of breech is the easiest to deliver vaginally.

Flexed breech

The second most common is the flexed breech, in which your baby floats with legs bent and possibly crossed, like a sitting buddha. This is the most common type of breech in women who have had a baby before and you should be able to have a vaginal delivery.

Footling breech

The footling breech is the least common and is when one or both feet dangle down into the cervix. With this type of breech a Caesarean is normally recommended as there is a danger that the baby’s feet or umbilical cord will come through the cervix before the cervix is fully dilated.

This baby’s for turning

There are tried and tested ways of encouraging your baby to turn. Obstetricians and midwives often recommend simple daily exercises to encourage your baby to shift. These are based on the premise that the Western ‘couch potato’ lifestyle is partly to blame for breech positions. In other societies, where chairs don’t exist and women squat on the floor, breech babies are far more rare. Try these:

* Make a point of sitting with your pelvis higher than your knees, so you’re not slouched in an armchair.

* Spend some time every day kneeling on the floor, leaning on your forearms and/or elbows with your bottom in the air - a sort of praying to Mecca position.

* Crawl around the living room for 10 minutes two or three times a day. Although it can be a bit hard on your knees, it can be made a bit more fun with some music on (rock that pelvis!).

* Try alternative therapies: acupuncture, homeopathy and reflexology are popular choices.

External cephalic version

This is basically a form of massage designed to turn your baby. It has to be done by an experienced obstetrician, as there are risks involved. If it doesn’t work first time, or if the baby turns back again, it can be done more than once. ‘Every woman should be given the choice to have this,’ says Richard Johanson.

However, many obstetricians won’t attempt it, because of the very small risk that the placenta may become damaged or the cord may tangle. ‘Some may not feel experienced enough and refuse, but it’s always worth asking for a second opinion if your consultant is reluctant to try,’ says Melanie Every of the Royal College of Midwives.

Risks

There are a couple of risks to be aware of with breech delivery. When a baby is delivered in the headfirst position you’ve got plenty of time for pushing and delivery because the umbilical cord is still inside your womb. With a breech delivery, when the umbilical cord is delivered with your baby’s body, you’ll need to push your baby’s head out pretty quickly. Also, in the final stages of labour, if you become exhausted or your baby is distressed, doctors can normally help out with a forceps or ventouse delivery. This won’t be possible with a breech baby.

Planning a breech birth

The way a breech birth is dealt with can vary, not only between hospitals, but also between obstetricians, so you’ll need to discuss what your obstetrician’s approach is and what’s likely to be best in your case. A lot of obstetricians do prefer the Caesarean option because they feel it’s safer for the baby and vaginal delivery is more unpredictable. But there are obstetricians who feel that a vaginal delivery is acceptable as long as your baby’s size has been checked by ultrasound and, if possible, your pelvis size by X-ray.

The delivery

It’s important to be kept informed at every stage of labour. Here’s what to expect:

Vaginal delivery

Although most women having vaginal deliveries are allowed to walk around in the early stages, you’ll be carefully monitored during labour. You may also be advised to have an epidural to stop the desire to push too early. In general, you’ll only be encouraged to start pushing when your doctor or midwife can see your baby’s bottom in your vaginal opening. Your legs will then be put in stirrups so that the midwife can deliver your baby’s legs and body. A doctor will help to deliver your baby’s arms and head, and you’ll normally need an episiotomy.

Caesarean

A Caesarean may be necessary if:

* Your pelvis is too small or shaped in such a way that your baby can’t pass through safely

* Your baby is considered to be large

* Your baby is a footling breech

You’ll probably be offered an epidural Caesarean so that you and your partner can see your baby being born.

To find out more

Your local National Childbirth Trust teacher will be able to put you in touch with other mothers who have been through the same experience. Ring the national number 0870 444 8707 for your local branch details.

Your stories

‘We decided a Caesarean was the best option’

‘My midwife told me my baby was breech during the final weeks of my pregnancy, so I was naturally a bit concerned. At 37 weeks I went to the hospital for a scan to check on his position and was delighted to be told that he’d moved into the head-down position and was two-fifths engaged.

'When my waters broke at 40 weeks, I noticed they were stained with meconium. Because I was worried my husband, Mark, and I immediately went to the hospital where I was scanned to check everything was alright. To my surprise, we were told the baby had moved back to the breech position. The doctors were very considerate and said it was my decision whether to go for a natural delivery or Caesarean, but they advised having a Caesarean to avoid any complications.

'After a brief chat, Mark and I decided the Caesarean route was the best option. If I’d gone for a vaginal delivery there was a high risk of a long labour and a forceps delivery involving an episiotomy. I decided I’d rather have it over and done with as quickly as possible. I was prepared for theatre and within 10 minutes Taylor was born safely.’

Karen from Croydon, is mum to 10-week-old Taylor

What the experts say

‘If you opt for a vaginal birth, check what your hospital’s policy is over monitoring and epidurals. Some consultants do not induce breech pregnancies because they feel that spontaneous labour gives the best chance of a vaginal birth. Above all, never be disappointed if you end up having an emergency Caesarean in labour after trying for a vaginal breech delivery. Quite rightly, medical staff tend to be particularly cautious in these circumstances and your baby’s safety is paramount.’

Anne Deans, consultant obstetrician at Frimley Park Hospital in Surrey