The baby’s position in his mother’s womb has a big impact on the delivery. Generally, baby settles in the 'final' position during the 7th month of pregnancy; a breech birth can therefore be detected in advance when you go for a scan.
Also known as breech presentations, breech births concern 2 to 3% of babies. The baby’s bottom is positioned to come out first while the head is further up in the uterus.
A breech birth is described as a complete breech if the baby is sat cross-legged with his bottom lodged in his mother’s pelvis, pressing against the cervix. It is called a frank (or extended) breech if his legs are stretched out with his feet towards the top of the uterus.
Why does it happen?
Normally around the 7th month, the baby turns around into a headfirst position to fill the space of the placenta better (the placenta is wider at the top, where the baby's bottom and legs usually are). But sometimes the baby doesn’t turn:
- If the baby is premature he or she might not have had time to turn.
- If the baby has stretched his or her legs instead of bending them, there may be difficulty moving and turning.
- If there is too much or too little amniotic fluid, if the uterus is deformed, too tight or narrow at the top, or if you’re expecting twins, the baby (or babies) will be unable to move as much.
Unlike the head, the baby’s bottom is a lot softer so it applies less pressure on the cervix, which doesn't dilate as much as it would during a normal labour. The structure of the baby’s body also changes because the different parts of his body aren’t necessarily strong enough to cope with the different forces applied during a breech delivery. The dynamics change as the baby’s body comes under pressure in places that it wouldn’t do in normal labour.
- You may be advised to give birth by Caesarean section, particularly for a frank breech. This will take place at around the 39th week of gestation.
- However, It is still possible to have a vaginal delivery with a complete breech, if the mother’s pelvis is large enough and the baby isn’t too big.
Avoiding a Caesarean: external cephalic version
Additionally, there is a technique available that can alter the baby’s position in the womb. Towards the end of your pregnancy, your obstetrician might try to turn the baby around manually, using a procedure called an external cephalic version (ECV). By applying pressure on the abdomen, the doctor encourages the baby to turn.
ECV is recommended for complete breeches.
- Complications are rare but they can include inducing labour or causing the placenta to detach itself.
- It’s estimated that this technique has a 50% success rate but may vary greatly from obstetrician to obstetrician.
- Acupuncture or osteopathy can also sometimes help the baby to get in the right position.
- Moxibustion involves a herb being burned closed to the bladder acupuncture point on the toe. Many women find this highly effective in turning a breech baby.