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SugarTown Babies
Information Pages
Breech Presentations
Most babies get into a ‘head down’ (Cephalic) position
during the last few months of pregnancy.
Where this isn’t the case,and the baby’s position is
‘bottom down’, this is called a ‘breech presentation’.
Before the 36th week of your pregnancy,your baby will
have the space to change position quite frequently and
therefore it is quite common for your baby to be in the breech position.Where this continues into the later weeks of pregnancy, it may be that your baby will stay in that position as you approach the time to give birth (term 37-42 weeks).
Recent research suggests that, particularly if it is your first baby,it is safer for the baby to be born by caesarean section. However the research was carried out without due consideration for the experience of the caregivers and this may indeed be a very important consideration, ask your health professional whether they are competent at facilitating a vaginal breech birth.The option for a caesarean is only a recommendation and any decision should be based on your individual circumstances, and you still have a choice.
A lot of babies do turn round in the last couple of months. If your baby doesn’t turn on it’s own, then the baby can be turned by a skilled doctor who will undertake what is called ECV (external cephalic version). The practice of ‘turning’a baby by pushing it round gently from the outside went out of fashion some years ago – but for no good reason. Studies have now shown that it is safe and successful and should be available to you. ECV is best done when you are 37 weeks pregnant, although it can be done later – even in early labour.
You will need to go into hospital for ECV. It shouldn’t take more than half an hour and someone can stay with you. You lie on a couch while the doctor does an ultrasound scan to check th exact position of your baby.You might be offered a drug to relax the muscles of your uterus.
The doctor then puts one hand on the baby’s head and one hand on the baby’s bottom, and pushes gently to turn the baby round.
- 1:5 babies will turn at 37 weeks themselves
- 7:10 babies at 37 weeks will successfully turn by ECV
- 1 in 20 chance that your baby will turn back
Whether or not the baby turns may be related to the skill of the person doing the turning.This may also be affected by a number of factors,such as the way your baby is lying, whether the breech is ‘engaged’, and the amount of fluid around the baby. ECV can be uncomfortable but it should not be painful.There have not been any studies of what women think about it.
If ECV doesn’t work, it can be repeated a few days later. If this still is unsuccessful, this may mean you will have to discuss, usually with your obstetrician, whether to have a caesarean section or plan to give birth vaginally.
There are various other options open to women that have a breech presenting baby in the late stages of pregnancy. Several complimentary therapies have been put forward as options. These include
There is much anecdotal support in favour of trying these therapies,
in particular moxybustion which has been in some trials evaluated as
being very favourable almost on a par with ECV.
Please discuss this with your qualified natural/ Complimentary
practitioner. Please note we will be establishing a practitioners list
on this site ASAP, to include recommended and certified practioners.
If your baby remains in the breech position as you get near to term,it
is likely that you will be advised to have an appointment with a doctor
at a local consultant unit so that you can discuss your options for
giving birth.
It has been the practice for several years now for hospitals to advise
women,especially those giving birth to their first baby, to opt for a
planned caesarean section.
Although the recent research largely supports this, each woman is an
individual, and it is your circumstances that need to be discussed
according to what are seen as the most important ‘risk’factors for you and your baby.
It has been identified that where women with a baby in the breech position actually labour, half of them will give birth vaginally.There are many reasons for this, and if you wish to consider having a vaginal birth, you might find it helpful to talk to your doctor or midwife about this.To some extent the success of a vaginal breech birth may depend on who is available to help you at the time of your labour; the skill and experience of the person delivering your baby undoubtedly will have an effect on everyone’s confidence in what is becoming a less common occurrence than it was even 20 years ago.Vaginal breech births are, therefore, still 50% successful and you can give birth vaginally even if you have had a caesarean section before.
The evidence suggests that a planned caesarean section reduces the risk of harm for the baby born at term.This research has compared a planned caesarean section for breech presentation with a vaginal breech birth at term. Some doctors and midwives (me included) question whether the research considered all the factors in coming to the above conclusion.
Therefore,there are doctors and midwives who will consider vaginal breech birth at term as a ‘safe’ (safe is never assured in any method of birthing) choice,where there are no concerns about the health of the baby and where this is undertaken with support from expert practitioners. However,some factors, for example where a baby is premature, will make a big difference to the risk for the baby of going through labour in the breech position. This will probably affect the advice you will be given and,ultimately, the choice you make between having a planned caesarean section or vaginal birth.
The one big difference in the studies between vaginal birth and caesarean section for breech babies was with the health of the mothers following the birth, as those who had caesareans were more likely to experience pain and to develop an infection.
You might be advised to have a caesarean section if your baby is considered to be of above average weight or is not lying in agood position.You should talk to your obstetrician to make sure that you understand the reasons for this advice.
If you do have a breech baby and you have not had any complications during your pregnancy, you should be offered the chance to have your baby turned using ECV. If your local maternity service does not offer ECV because they do not have experienced staff, you can ask to be referred somewhere else.
You should be offered the opportunity to discuss your individual needs and preferences about how you want to give birth with your midwife and obstetrician, and be given sufficient time to think through your options.
