Breech Baby: Vaginal Delivery

What is a breech baby?

By the time a pregnancy reaches full term, most babies are in a position in the uterus that will allow their head to be delivered first when they are born. However, in some pregnancies, the baby is bottom first. This is called a breech position. It means that the baby's bottom or feet will come out before the head when the baby is born. This can be a difficult delivery. It requires a healthcare provider with special skills and experience with breech births.

How will I know if my baby is breech?

If your baby is in the breech position, you may feel the baby's head moving under your rib cage. Or you may feel as if you have a hard knot under your ribs. You may also feel the baby kicking low in your pelvis. However, usually it’s hard for you to know your baby’s position.

Your healthcare provider may find that the baby is breech by feeling the baby's head through your belly or by feeling the baby’s feet or bottom during a pelvic exam. The baby's heartbeat may be heard above your belly button rather than in your lower belly.

An ultrasound exam can show the baby's position.

How often are babies in the breech position?

The breech position is common in early pregnancy. About one third of all babies are breech at 24 weeks. However, most babies are in the head-down position by the 32nd week.

When there are twins, often one of them is in the breech position close to the due date.

What happens of the baby is still in the breech position close to the due date?

If your baby is in the breech position, your healthcare provider may try to turn the baby to the head-down position after 36 weeks. Your provider may use a procedure called external cephalic version to do this. If this doesn’t work, your provider will leave your baby in the breech position until you deliver. There’s a good chance that the baby will change position by the time labor begins. If the baby does not turn and is still breech, under very special circumstances you may be able to try delivering the baby vaginally (through the birth canal). In most cases your provider probably will recommend a cesarean delivery (C-section) to avoid problems for you and the baby.

What are the risks of a breech vaginal delivery?

The head is the largest part of the baby that must fit through the birth canal. During a normal head-first delivery, there is time during labor for your baby's head to slowly mold itself so that the diameter of the head is smaller. The head can then pass through the birth canal more easily.

When your baby is breech, the baby's bottom, instead of the head, molds to the birth canal. Once the bottom has been delivered, the abdomen, chest, arms, and head follow quickly. This does not allow enough time for your baby's head to mold itself. It may then be harder for the head to pass through the birth canal. Also, if your baby's head (the largest part of the body) does not enter the birth canal first, the cervix (opening to the birth canal) may not open as much as it should. This may make it hard for the baby's head to pass through the cervix. The risk is especially high for premature babies weighing less than 5 pounds because their small bodies may not stretch the cervix enough for the relatively large head. The cervix may close around the baby's neck, so that the head gets stuck inside the uterus.

When the head has trouble moving into the birth canal, a vaginal delivery may be dangerous or impossible. The baby could be injured or even die.

When can a breech baby be delivered vaginally?

The most common situation for successful vaginal delivery of a breech baby is the birth of twins when the first baby delivers head first and the second twin is not larger than the first twin. In this case, the first baby is able to stretch and dilate the birth canal enough to allow the second twin to pass through more easily. Sometimes, when a second twin is breech, your provider may reach inside the uterus after the first baby is born, grab the second twin’s feet, and pull the baby out. This is considered to be reasonably safe when it is done by someone experienced with this type of delivery.

When there is only 1 baby in the breech position, most providers do a C-section to reduce the risks. If you are interested in trying a vaginal delivery with a breech baby, you will need to discuss it with your provider. In general, vaginal delivery may be a possibility if:

  • Your healthcare provider has experience in delivering breech babies.
  • A delivery room is available that is equipped for an emergency C-section if it is needed.
  • The size of your pelvis is large enough.
  • You have had a previous successful vaginal delivery of a baby that was the same size or bigger.
  • Both you and the baby are not having any problems before or during labor.
  • Your baby weighs between 5 and 8 pounds and ultrasound shows that the baby is in a good position for a vaginal breech delivery.

There may be other factors to consider as well. To help determine the best and safest way to deliver your baby, you may have a special X-ray to measure the size of your pelvis. You may also have an ultrasound scan to check the size of the baby, the type of breech position, and the position of the head. (If you have an X-ray, special techniques will be used to keep the X-rays at safe levels for your baby. However, in most cases, X-rays are not needed.)

Will I have to do anything different during a breech delivery?

During the delivery, your healthcare provider may tell you to breathe and push as you would for a normal delivery. While your baby is coming out through the birth canal, your healthcare provider may press down firmly on your belly over the top of your uterus to help the delivery. Ultrasound may be used in the delivery room, especially if you have twins.

You may have an episiotomy to make your baby's delivery easier. An episiotomy is a 1- to 3-inch cut made from your vagina towards your rectum to make the opening bigger. The episiotomy is stitched up after the delivery.

Your healthcare provider may also need to use special forceps to ensure a smooth delivery while protecting your baby's head.

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