Breech Babies & Breech Births: Common Pregnancy Questions Answered About Delivering a Breech Baby by Dr. Alan Lindemann

Pregnant mothers may immediately worry when they hear their baby is a breech baby. What is a breech baby? What are some of the options for delivery if your baby is breech? Is a vaginal breech delivery dangerous?

Here are my thoughts to help shed light on the subject of breech babies and breech birth.

Q. What is a breech baby? 

In most pregnancies, as your baby nears time for delivery, your baby will move into a position with the top of his or her head down against your cervix, facing your back. However, there are several other positions a baby may take in the uterus that would be labeled a breech presentation. For example, your baby may be positioned with its buttocks against your cervix, with its feet against your cervix, or even positioned across your uterus from side to side (called a transverse lie).

Q. Can I deliver a breech baby vaginally? 

There are three ways to deliver a breech baby: 

1. vaginal breech
2. C-section
3. external cephalic version

The only breech position which can be safely delivered vaginally is when the baby’s buttock is against your cervix. Sometimes the baby may be moved into a head-first position manually with a maneuver called external cephalic version (ECV).

Q. How is external cephalic version (ECV) done? 

With ECV, your baby is manually turned to a head-first position by moving the baby in a forward summersault direction, although some physicians use a backwards summersault movement. Doing an ECV is easier at 32 weeks pregnant than at 37 weeks; however, waiting until 37 weeks often allows the baby to turn into position on its own.

Studies show that 57 percent of babies who are breech at 32 weeks and 25 percent of babies who are breech at 36 weeks will turn head-down by delivery. An ECV can be very painful if you aren’t given 0.5 mg of terbutaline to relax the uterus and prevent contractions from starting when moving the baby. Also, if your baby’s placenta is in the front of your uterus, there is some risk of abruption and umbilical cord damage, so ECV should be avoided in this situation.

Q. How successful are ECVs?

ECVs are successful about half the time. Three factors which decrease the success rate of ECVs:

1. first pregnancies
2. low amniotic fluid
3. a placenta attached in the front of the uterus under your navel (anterior placement)

Q. What is the most important part of delivering breech babies?

Whether the breech baby is delivered by C-section or vaginally, the most important part of the delivery is being sure the baby’s head and neck is flexed, which means that the baby’s chin is tucked in. Having the baby’s chin tucked under makes the head circumference small enough to be delivered vaginally. To flex the neck, you put pressure on the back of the baby’s head with your hand over the mother’s bladder. This only works if the baby’s head is face-down.

Q. Is a vaginal breech birth dangerous? 

In my experience, delivering breech babies vaginally has been uneventful. If my patient and I planned for a vaginal delivery, that was accomplished. I’ve delivered breech twins vaginally without difficulty. We were prepared for delivering the twins surgically, but it wasn’t needed. The twins were 39 weeks and both weighed 7 1/2 pounds. Breech vaginal birth is not complicated if you know how to do it and you stay calm.

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