Everything You Wanted to Know about Breech Birth
Around 5% of pregnant women at full term has breech baby. Usually during the last weeks of pregnancy, around week 32- week 38, your baby will turn in a head down position with her head near your cervix which is the ideal delivery position.
However, sometimes the foetus fails to move to this ideal position with the baby’s buttocks or feet positioned to be delivered first and the head positioned near the top of uterus. Such position gives rise to breech birth which occurs in almost 1 out of 25 live births.
Breech position increases the chances of prenatal mortality by four times compared to ideal cephalic position. So, let’s start our journey by knowing about this pregnancy complication called breech birth.
What does it mean if your baby is in a breech position?
Right before birth, when your baby is born bottom first with its buttocks or feet positioned near the mouth of your cervix instead of the normal head first, it gives rise to breech position and the baby is called breech birth or breech baby.
In all pregnancies, the foetus lies in a longitudinal position during the earlier gestation period which normalize to head first position called cephalic position as it approaches full term by around the eighth month of pregnancy.
In most of the developed countries, breech babies are delivered by caesarean section which is considered to be the safest delivery method.
Most babies are in a temporary breech position during the third trimester, but they move to the normal head down position as it nears delivery. Premature babies and more than one baby in the uterus simultaneously mean one of them will be in a breech position.
If your baby is in a breech position, you will feel sharp kicks in your bladder and breathlessness as the baby’s head presses up against your diaphragm.
What are the Probable Causes of Breech Birth?
The failure of the baby to turn to cephalic position results in breech position. The probable causes for breech position have not been fully understood. Some possible explanations of breech birth include:
Insufficient intrauterine space due to uterine abnormalities:
The uterus is a hollow pear shaped. In some women, there may be abnormalities in uterine anatomy which might be innate or due to surgical procedures or any other severe diseases. Due to these anomalies, the foetus may not have enough space to move properly and turn in to cephalic position. Uterine anomalies can be detected by pelvic examination prior to pregnancy. Sometimes fibroids or abnormal growth of benign tumours may result in breech birth.
If the placenta is low lying to cover the cervix or located upwards near the top of uterus, the baby may not have enough space to flip.
Too much or too little amniotic fluid:
Volume of amniotic fluid results in breech birth. Too little amniotic fluid means difficulty for the foetus to flip around easily. Too much amniotic fluid means, the foetus has enough space to swim and rotate easily between breech and cephalic position and toggles up till delivery.
Sometimes there may be anomalies in the neural and muscular system of the foetus which results in breech position. Short umbilical cord is also a reason for breech position.
The intrauterine space becomes limited in case of presence of more than one foetus simultaneously. In such cases one or two babies may lie in breech position due to inadequate space for “swimming around” in the amniotic sac.
Apart from this, premature birth results in breech position as the foetus does not reach cephalic position at the time of delivery. Smoking during pregnancy will result in breech baby.
Being overweight and if one of the parents were breech at birth increases the likelihood of breech baby. Also if you have had previous breech baby, there are higher chances of subsequent breech birth.
What are the Risks Associated with Breech Position?
Most breech babies are born healthy; however the chances of birth defects are slightly higher than normal delivery.
- Umbilical cord prolapse: If the lowermost part of the baby do not completely fill the dilated cervix prior to birth after the amniotic sac breaks, the umbilical cord may drop down. After dropping down it may be constricted by the vaginal muscles and become compressed.
It is a very serious complication and may result in still born baby. Oxygen supply to the brain of the baby reduces drastically and the baby should be delivered immediately by caesarean section and given assisted oxygen supply.
Deprivation of oxygen also results in permanent neurological problem such as cerebral palsy. It is rare in babies born in cephalic position.
- Head entrapment: During full term delivery, the size of the hips and head are same. In breech position delivery, the hips dilate the cervical mouth and create enough space for the head to pass through easily.
However in case of premature delivery, the head maybe larger than the hips and hence it may get trapped in the cervix while other parts of the body emerge successfully. This rapid negotiation through the maternal pelvis by the head might result in injury to the brain. Such brain trauma may result in autism.
How is Breech Position Diagnosed?
The mother won’t be able to feel if her baby is in breech position. However if she experiences breathlessness or feel the baby’s head is pressing high up in the belly she must visit a doctor to diagnose this pregnancy complication.
At the beginning of third trimester the doctor may be able to locate the position of the foetus and its head and bottom after doing an abdominal exam by feeling the outside of the mother’s abdomen with her hand.
In breech position, the round and firm head of the baby will be in the upper part of uterus and the soft bottoms will be in the lower part of uterus. The doctor will then do an ultrasound examination for confirmation about breech position.
How is Breech Position Treated?
It is important for the mother to visit doctor regularly and take her suggestion for turning the baby to head first position. The methods for turning the baby are followed during week 32- week 37 of pregnancy with varying rates of success.
The caregiver may suggest some exercise to do at home for turning the baby in cephalic position. They may also do a medical procedure called external cephalic version which if successful will result in normal vaginal delivery.
- External Cephalic Version (ECV): This technique is performed only if the baby does not turn naturally by the 37th week. The doctor will use her hands on the mother’s abdomen to give firm but gentle push to try to turn the baby in head down position while the baby is still in mother’s uterus.
The mother will be given prior medication to dilate the uterus and this does not have any side effect on the baby. The baby’s heart rate is monitored during the procedure so that it is normal. This procedure is uncomfortable but not painful and has a high success rate.
However if the baby flips back to breech position after ECV, the doctor may plan to do it again though it gets tougher as the intrauterine space decreases. The mother will then have to go for a planned caesarean delivery.
The risk factors associated with ECV are small and it includes onset of labor leading to emergency caesarean section to deliver the baby, blood loss for the mother or baby or both, rupture of membrane and foetal distress.
- Webster breech technique: The success rate of this medical procedure to turn the baby naturally is about 82%. In this technique, chiropractors are used on the pregnant women to reduce pelvis stress and relax the uterus. It is preferable to perform this technique in the eight month of pregnancy.•
- Moxibustion: It is an ancient Chinese technique where your acupuncturist will burn mugwort herb near your smallest toe to increase foetal activity. This will lead to stimulating your baby and it will change its position on its own. Though there is not much success rate, there are no risks associated with it.•
- Hypnosis: Regular hypnosis of pregnant women into a state of deep relaxation from trained professionals has been found to have a small success rate during week 37 to week 40 of pregnancy.
How can Breech Baby be Delivered Safely?
90% of breech births are done by caesarean section as it is considered to be the safest method for breech baby.
However, the decision to perform c-section or vaginal delivery will be taken when the woman is in labor and all risk factors are taken into consideration. In breech birth the bottom part of the baby will emerge first and the head emerges at last.
In case of premature birth, the head may get stuck in the pelvis. Doctors then have to use forceps to assist the baby’s head out of the pelvis. Umbilical cord prolapse is another risk associated with breech delivery.
If vaginal breech delivery is opted, then the baby’s heart rate will be monitored continuously and if there are any signs of distress, then emergency caesarean section will have to be performed.
Hence most caregivers recommend caesarean delivery as baby’s head is too fragile to stretch the pelvis. Caesarean delivery is recommended under following cases:
- The doctor midwives or caregiver has inexperience in doing vaginal breech births.
- The mother has a low-lying placenta and has been diagnosed with a narrow uterus.
- Baby’s estimated weight is more than 4kg or less than 2kg.
- If the health of baby or mother or both are at risk due to pre-eclampsia or gestational diabetes.
- If the mother is expecting twins with the first twin in a breech position and had done caesarean delivery previously.