What is a breech presentation?
By 3–4 weeks before the due date, most babies move so their heads are down near the birth canal (vagina). If this does not happen, the buttocks, the feet, or both may be in place to come out first during birth. This is called a breech presentation. It happens in 3–4% of full-term births and requires special planning for how the baby will be born. If your baby is in a breech presentation, your doctor may recommend cesarean delivery.
What factors increase the chance of breech presentation?
It is not always known why a baby is in a breech presentation. Breech presentation is more common, however, when:
- The woman has had more than one pregnancy.
- There is more than one baby in the uterus (twins or more).
- The uterus has too much or too little amniotic fluid (the fluid that surrounds the baby inside the uterus).
- The uterus is not a normal shape or has abnormal growths, such as fibroids.
- The placenta covers all or part of the opening of the uterus (placenta previa).
- The baby is preterm.
How can my health care provider tell if my baby is in a breech presentation?
One way for your health care provider to tell which way your baby is facing is by doing a physical exam. Placing his or her hands at certain points on your abdomen, the health care provider feels the shape of the baby. By feeling where the baby’s head, back, and buttocks are, he or she can tell the position of the baby. An ultrasound exam may be used to confirm the position. In this test, a device is moved across the abdomen. The sound waves it produces make an image of the baby that can be seen on a screen.
What is external cephalic version (ECV)?
If the baby is breech, your health care provider may suggest external cephalic version (ECV). ECV is a procedure in which the health care provider lifts and turns the baby from the outside. It can improve your chance of having a vaginal birth.
How is ECV performed?
To turn the baby, the health care provider places his or her hands at certain positions on your abdomen, then lifts and turns. In some cases, a second person helps turn the baby.
When is ECV done?
Most often, ECV is not tried until you are at least 36 weeks pregnant. If it is done before then, the baby may still change position.
Can ECV be done for all breech presentations?
Your health care provider will assess your health and the state of your pregnancy to see if ECV is an option for you. Certain conditions may increase the risks associated with ECV or decrease the chance of its success. If you or your baby has any of these conditions, ECV may not be recommended.
How successful is ECV?
More than one half of ECV attempts succeed. Some babies, however, move back into a breech presentation. If that happens, ECV may be tried again. ECV tends to be harder to do as the time for birth gets closer. As the baby grows bigger, there is less room for him or her to move.
How are most breech babies born?
Most breech babies are born by planned cesarean section. Like any major operation, a cesarean section carries risks. These risks occur in a small number of women, are usually easy to manage, and are as follows:
- Infection
- Bleeding
- Problems from pain-relieving medication
It is not always possible to plan a cesarean delivery. The baby can turn into a breech presentation shortly before labor begins. In that case you will not know that you need a cesarean until you give birth.
What are the risks of having a vaginal breech birth?
The risk of injury to a baby can be higher in a vaginal birth. There is also a greater chance of cord prolapse — the cord slipping through the cervix into the vagina before the baby is born. This can damage the cord and stop the flow of blood through it to the baby.