During the earlier stages of pregnancy babies shift and change position frequently, but in the final trimester of pregnancy there's less room for manoeuvre in the uterus and most babies settle into a head-down position for birth by eight months. A small number of babies however, settle into a less-favourable position with feet or bottom set to be born first, known as the breech' position. This is quite common at the beginning of the third trimester, but of full-term babies only around 3% are in a breech position.
There are several kinds of breech position, the most common is the frank breech where the baby's bottom is ready to be born first, with the feet raised up by the head. The complete breech is where the baby's legs are bent so that the feet and bottom are together, and in the footling breech one or both of the baby's feet are below the bottom and will emerge first.
Some higher risks are associated with vaginal breech birth, which is why most breech babies in the UK are now born by caesarian section. There is a higher, but still usually small, risk of a prolapsed umbilical cord - when the umbilical cord emerges with the baby's body and becomes compressed between the baby and mother, dangerously limiting the flow of oxygen to the baby. There is also a risk that your baby's head will become stuck in your pelvis, which is more common for premature babies as the head is often still larger than the baby's bottom. Should they occur, both these complications endanger the baby and will require an emergency c-section.
Why do babies adopt breech positions?
There is a clear reason for a baby to be in the breech position in only a few cases, including: when the baby is of a set of twins or higher mulitiples, where there is too much amniotic fluid, in some cases of placenta praevia, with some congenital abnormalities (in which case it should be detected in one of the scans), or where the shape of the uterus encourages the baby keep its head up. For most babies who adopt the breech position it could be simply that they find this position most comfortable.
What will happen if my baby is breech in the last trimester?
Routine antenatal checks often reveal that babies are in the breech position early in the last trimester and most of these babies will turn head-down of their own accord. If your baby is still breech at full term, at 37 weeks, you may be offered an external cephalic version, or ECV, where your practitioner externally manipulates your baby's position. Where it is undertaken, ECV has around a 50 - 70% success rate for breech babies (and higher for transverse, or sideways presenting, babies) depending on the practitioner. But you should be aware that there is a very small risk of the procedure causing placental abruption or fetal distress which would result in an emergency caesarian section: If you do have an ECV your baby's heart rate will be closely monitored and you'll often have a scan during the procedure to alert doctors to any such difficulties. Some doctors use a drug to relax the uterus during an ECV. In some instances an ECV isn't suitable, for example: if you've had certain complications in pregnancy, you have a multiple pregnancy, you have placenta praevia, there is too little amniotic fluid or you've had more than one previous caesarian.
Can I have a vaginal delivery if my baby is still breech at term?
As we've said, in the UK, most breech babies are now born by caesarian section, however, that doesn't mean that a vaginal birth is out of the question. A caesarian section is usually suggested because it's statistically safer than a vaginal breech birth even though with proper, skilled birthing assistance the risks to the baby of injury or asphyxia are still very low in vaginal births.
Three main factors will influence whether or not a vaginal breech birth is a realistic option: Firstly the circumstances of the breech: the exact position, size and condition of your baby and the details of any previous births. Secondly whether labour starts spontaneously and progresses well, and thirdly whether you have access to birthing assistants with appropriate skills and experience.
- If your baby is particularly large, or your pelvis small in relation to your baby then a caesarian will usually be recommended. This is more likely if you haven't previously given birth vaginally or if you have had a previous difficult labour. If your baby is in the footling position then the chances of a prolapsed umbilical cord are higher and a caesarian is recommended. If your baby is in a position known as 'stargazing', with the neck extended and looking upwards then a caesarian will be done. The stargazing position is very uncommon, however, occurring in only 3-5% of breech births.
If you go into labour spontaneously with a breech baby then you will be very closely monitored for signs of labour not progressing normally and for signs of fetal distress. In either event a caesarian section is highly likely.
As vaginal breech births become less common, it becomes correspondingly more difficult to find birth assistants with the relevant expertise and experience and this is something you'll need to bear in mind if you would prefer to have a vaginal birth. If you are using NHS care then the option of a vaginal breech birth may not be supported in your area.
Can I do anything myself to encourage my baby to turn?
There are complementary therapies that are scientifically unproven as helping to turn a breech baby, but that are recommended by some midwives and other mums. Do talk to your doctor before trying any of these:
Exercises - Many mums try to use gravity to encourage their baby to turn, raising their pelvis for between 5 and fifteen minutes at least twice a day. You can either lie on your back and raise your pelvis off the horizontal- supported by a cushion, or go on all fours and rest on your forearms.
- Acupunture - Some doctors are very enthusiastic about acupuncture, others unconvinced and while there is some evidence to support its efficacy for turning breech babies it is far from conclusive. The acupressure point of your little toe is regularly stimulated with a heated needle, moxibustion or massage.
- Hypnotherapy - There's some evidence that women who use deep-relaxation methods in the final weeks of pregnancy have a higher chance of a breech baby turning.
- Homeopathy - Probably the most contentious of all complementary therapies. If you're interested in homeopathic treatment you should consult a qualified homeopath.