What is a Breech Birth?
A breech birth is where your baby is in a bottom-down position. If this is your first baby, he will probably settle into a head-down position in your pelvis around the eighth month of pregnancy. This is called a vertex or cephalic position. When labour begins, nearly all (96 per cent) babies are lying head down in the uterus, but a few (about 3-4 per cent), will settle into a bottom-first, or breech, position.
What if my baby is still breech towards the end of my pregnancy?
From 36 weeks, your doctor or midwife may offer you the chance to have your baby turned manually into a head-down position. This process is called external cephalic version (ECV).
ECV is more likely to work if you’ve given birth before. Sometimes, a baby refuses to budge or rotates back into a breech position.
An ECV may be not recommended if you have bleeding during your pregnancy, your baby has a short umbilical cord, you have oligohydramnios (less amniotic fluid), you have a scar on your uterus, you are carrying more than one baby or that you are likely to need a caesarean section for other reasons.
If my baby is in a breech position when I go into labour, will I have to have a caesarean?
Most, but not all, breech babies in Australia are currently born by caesarean.
In Australia, 87.1 per cent of babies who were in a breech position at full term (37 weeks or more of pregnancy) were born by caesarean section. This figure includes single babies as well as twins and more, where often there is one baby in a breech position. More than 95 per cent of singleton babies (where there is only one baby) who are breech at full term are born by caesarean section. In most cases the caesarean is planned and the mother does not go into labour, though for 20 per cent of singleton breech babies the mother does go into labour before the baby is born by caesarean. In this situation the caesarean is usually more urgent.
A review of the research on breech birth in 2004 suggested that it was safer for breech babies to be born by caesarean section compared with a vaginal birth.
Some midwives and doctors challenge the research on which this review was based. They feel that a normal birth is just as safe, provided that the midwife or doctor has the special skills needed to help a woman give birth to a breech baby vaginally.
Further studies have supported the view that where there are experienced doctors available and strict guidelines applied, vaginal birth can be as safe as caesarean birth. There is also no evidence that the way a term breech baby is born has any effect on his long term health.
What if I go into premature labour?
If you have a breech baby and go into premature labour, your doctor will discuss with you whether a vaginal birth or a caesarean section would be better. The research isn’t clear at present whether it’s safer for premature babies to be born vaginally or by caesarean.
Although many obstetricians prefer to deliver premature breech babies by caesarean, it is not recommended as a routine approach. If there are no other complications, it seems that a vaginal birth should be the first choice for premature breech babies but the final decision should be made by you and your doctor.
What factors would make me more likely to have a vaginal birth or a caesarean?
If you want a vaginal birth, your doctor may be more likely to be supportive if:
- your baby is continually monitored
- a midwife or doctor trained and experienced at breech birth will be present at the birth,
- facilities for a caesarean (if needed) will be available nearby
- that you plan to have a large family that may be made more risky by having a scar from a previous caesarean section
- you have a strong preference for a vaginal delivery and you understand the risks
- and, finally, there are no other features of your pregnancy that would make giving birth vaginally more risky
You may be advised to have a caesarean if:
- your baby is a footling breech (baby’s foot or feet are below its bottom) or kneeling breech (baby is in a kneeling position) – both of which are uncommon
- your baby is large (over 3.8 kilos)
- your baby is small (less than 2 kilos)
- your baby is in a certain position, such as, if an ultrasound shows that the neck is very tilted back (hyper-extended)
- you have had a previous caesarean birth
- you have a narrow pelvis
- you have a low-lying placenta
- you have pre-eclampsia or another condition that means the health of either you or your baby is at risk
Before making a final decision, you and your doctor should evaluate your situation and discuss the possible risks and benefits of both a caesarean section and a vaginal birth so that the two of you can choose what’s best for you and your baby.
You may also want to consider your caregiver’s experience. More recently trained obstetricians usually have less experience of vaginal breech births than older obstetricians because most breech births are now caesarean. This may be a factor in deciding whether to plan for a vaginal or caesarean birth.
Some independent midwives may be prepared to support your choice to have a vaginal breech birth though you would have to pay for their services. A publicly-funded homebirth would not be available for a breech baby. Most obstetricians would recommend against planning a breech birth at home.
Alternatively, your doctor may have a colleague who is willing to help you or you could ask around to find a doctor who is more comfortable with providing assistance in your circumstances.
As the number of breech vaginal births continues to fall, it may be harder for you to find an obstetrician who has the skills and knowledge needed to deliver your breech birth vaginally.
The safest way to deliver a breech baby is an area where the views of midwives and obstetricians are still changing. It is clear that some feel that the pendulum has swung too far in the direction of caesarean section. Some feel that the skills and experience in vaginal birth of breech babies has been lost in the meantime, which reduces the likelihood further of women who want to give birth vaginally being supported in their choice.