What is breech?
Breech means that your baby is lying bottom first or feet first in the uterus instead of in the usual headfirst position (53). At some stage throughout your pregnancy, you may be told that your baby is in the breech position. If so, there are many factors to consider.
How many weeks pregnant are you?
Your gestation is very important, as it’s not until your 37th week that any intervention should take place. Before 37 weeks gestation, your baby still has room to turn on his/her own into a head-down position. After the 37th week the chances of the baby moving into the head-down position decrease, but it is still possible.
What type of breech presentation is your baby?
There are three different positions:
- Complete: Baby’s head is up; her buttocks are down, and she’s sitting cross-legged.
- Frank: The most common position, baby’s bottom is down with his legs pointing upward and his feet near his head.
- Incomplete (footling): Baby is head-up with one or both feet hanging down (meaning she’d come feet-first if birthed vaginally)(54).
Can your baby be turned?
There are methods to consider for trying to turn your baby. These can be a combination of medical, traditional or positional techniques.
External Cephalic Version (ECV) – This is where practitioners use their hands on the woman’s abdomen to try to turn the baby to headfirst gently. The overall success rate of this procedure is just over 50%. How likely it is to succeed will depend on a few factors.
These factors include:
- if you have had a baby before,
- where your placenta has implanted,
- how much fluid is around the baby, and
- what position your baby is sitting in (55).
We do not recommend attempting an ECV after your labour has already started.
Moxibustion is a method of turning a baby where an acupuncturist burns the mugwort herb near your smallest toe. This method stimulates an acupuncture point and prompts the baby to wriggle her way to a head-down position) (56). Anecdotal (by experience) evidence supports this technique for correcting a breech presentation. However, limited scientifically derived proof exists to support the use of moxibustion for this purpose (56).
Optimal positioning is a term used to describe a range of movements and positions that may assist the baby to flip head down (57).
What are your birth choices?
Your breech baby may be born vaginally or by caesarean section, depending on the combination of your circumstances. There are risks and benefits associated with both vaginal breech and caesarean section birth. You should discuss these options with your midwife and obstetrician before making plans for the birth of your baby.
Making your decisions
Before you decide what kind of birth you want, there are other factors to consider. There may be other risk factors that you or your baby have that need to be discussed:
- Do you have a Large for Gestational Age baby (a baby greater than 4000gms)?
- Do you have a Small for Gestational Age baby (a baby less than 2500gms), or Intrauterine Growth Restriction (IUGR)?
- Have you had a previous caesarean section?
- Do you have pre-eclampsia?
- Do you have Gestational Diabetes?
- What support does your birth facility offer?
- Is there too much or too little fluid around your baby?
- Do you have a low-lying placenta?
- In which position is your baby?
If you decide to birth your baby vaginally, make it a priority to choose a breech-birth experienced practitioner. This experience will be crucial to the information and the care that you receive.
Make sure that the facility you choose to birth in supports this option as well as having the facility for a caesarean section if necessary. Do your homework. Gather all the information from your healthcare providers as well as doing your research. Your research will help you to make a well informed, educated decision. Be wary of online information, including heavily flawed studies.
Click here to watch the trailer for ‘A Breech in the System’ – an Australian documentary about one woman’s breech decision-making journey. You may also like to watch this video of vaginal breech birth.
While most of the time, you will know in advance that your baby is breech before you go into labour, this is not always the case. This presentation is called an ‘undiagnosed breech’. A woman who knows she has a breech on board before she labours has time to discuss her options and what type of birth she wants.
A planned vaginal birth can be a safe and empowering experience when you have people with breech experience attending your birth. However, this is planned well in advance.
In the case of an undiagnosed breech, you don’t always have these options. The birth that is safest for you and your surprise breech baby will depend on many factors. These include how your labour is progressing and available support. All obstetric doctors and midwives train for vaginal breech births, but not many get the opportunity to practice these skills and gain practical experience.
A woman in labour with an undiagnosed breech on board may not have access to skilled birth attendants. In these cases, it may be that a caesarean section is the safer option. If you are labouring well or your baby is almost born continuing with a vaginal birth may be safer. It is an individual situation and will depend on your circumstances.
Rebecca Johnson (BMid)/Dr Janelle McAlpine (PhD), Clinical Midwives
Photos by Andrew Rafalsky and Alila Medical Media used under license from Shutterstock.com