Vaginal Delivery of a Breech Baby

In this discussion you will learn what a breech baby is and what the risks are for a breech delivery. You will find out when it is considered safe to allow a vaginal delivery of a breech baby and what your health care provider will do to make sure the delivery goes smoothly.

What is a breech baby?

A breech baby is a baby in the breech position in the uterus. This means that the baby is in a position where the bottom, knees, or feet would come out before the head in a delivery through the vagina (birth canal).

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 up under your ribs. You may also feel the baby kicking low in your pelvis. Your health care provider may be able to feel the baby's head. The baby's heartbeat may be heard above your navel (belly button) rather than in your lower abdomen. An ultrasound scan 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, but by the 32nd week most babies are in the head-down position. When there are twins, often one of them is in the breech position.

If your baby is in the breech position, your health care provider may try to turn the baby to the head-down position after 36 weeks. He or she may use a procedure called external cephalic version to do this. If it is not successful, your provider will leave your baby in the breech position until you deliver. Most babies change position by the time labor begins. By the time of delivery, only about 3% of babies are still breech.

What are the risks of a breech delivery?

A breech delivery is the birth of a baby bottom-first or feet-first instead of head-first. Because your breech baby's head will be the last part to come through the birth canal, special problems might occur that could make vaginal delivery unsafe. If the baby's head is not delivered quickly after the rest of the body, there is a risk of brain damage, suffocation, and death.

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 much time for your baby's head to mold itself. It may then be harder for the head to pass through the birth canal.

Also, because 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 difficult 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.

If your pelvic bone structure is too small or the baby's head is too big, the head may have trouble even moving into the birth canal, making a vaginal delivery dangerous or impossible.

When is it safe to have a breech baby with a vaginal delivery?

A breech baby can be delivered vaginally instead of with a cesarean section if:

• The progress of labor is not slowed or abnormal in any way.
• Your baby's head is not too large.
• Your baby weighs less than 8 pounds but more than 5 pounds.
• Your baby's feet are not hanging down below its bottom and ready to come out first (footling breech).
• Your baby's legs are extended out straight at the knees (frank breech) instead of bent up to the abdomen (complete breech).
• Your baby's head is flexed with the chin tucked on the chest.
• Your pelvic bone area is wide enough.
• You have not had a cesarean section in the past.
• Your baby's heart rate does not slow abnormally during labor.
• Your health care provider has experience in vaginal breech deliveries.
• Your weight before pregnancy was less than 180 pounds.
• A delivery room is available and equipped for an emergency cesarean delivery if it were to become necessary.

Before delivery your health care provider may order an x-ray to measure the size of your pelvis and an ultrasound to determine the size of the baby, the type of breech, and the position of the head. Your provider will then determine whether a vaginal delivery or cesarean delivery is the best and safest way to deliver your baby.

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

During the delivery, you will be instructed to breathe and push as for a normal delivery. While your baby is coming out through the birth canal, your health care provider or an assistant will press down firmly on your abdomen over the top of your uterus to help the delivery.

Your health care provider will probably perform 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 health care provider may use forceps to ensure a smooth delivery while protecting your baby's head. If necessary, a cesarean delivery will be done.