A Breech Baby Can Change How You Deliver

A breech baby refers to a fetus who is not in a head down or vertex presentation. Usually, this means the baby’s bottom or feet are in the position to come out first. About 3-4% of term babies are breech.

Factors That May Lead to a Breech Baby

It's more common to have a breech baby if:

• You've been pregnant before
• You have excessive or low amounts of amniotic fluid
• You are carrying multiples
• Your uterus has growths or anomalies
• Your baby is preterm
• Your placenta is low-lying or you have placenta previa

Most babies are head-down between 32 and 36 weeks into pregnancy. The vast majority will be head-down by the time labor starts.

Non-Medical Methods of Turning a Breech Baby

There is insufficient evidence that postural changes encourage a breech baby to turn. However, if your doctor gives you the green light, there are some positions that you can try at home, including:

• Tilt positions. This is probably the most well-known method of trying to turn a breech baby. You can do it the easy way and use an ironing board lying on the couch. Place your feet up and your head down. The theory behind this is that your baby's head, the heaviest part of his or her body, will disengage from the pelvis and the baby will turn head down. It's generally recommended to do this for 20 minutes a day until the baby turns. Some people report dizziness from being in this position. Always discuss this or any other exercise with your midwife or doctor.
• Light/music. The use of light or music directly at your pubic bone is thought to encourage the baby to come towards the light or sound. For a nice touch, you can have your partner talk towards your pubic bone, again to encourage baby to move towards the sound. Do this as often as you like until baby turns head down.
• Water. Some claims state that being in a pool will encourage the baby to turn.

Medical Methods of Turning a Breech Baby

Alternatively, you can seek outside help in turning the baby into a head down position. These methods include:

• External cephalic version (ECV). External version is generally done around 37 weeks. If it's performed prior to 37 weeks, you run the risk of premature labor, plus many babies may have turned on their own. To be a candidate you must have adequate amounts of amniotic fluid to cushion the baby, be carrying only one fetus, have a placenta that is not near or overlying the cervix, and have a healthy fetus. The most common way this is performed is in a hospital with fetal monitoring, ultrasound, and often IV medications to relax the uterus. The biggest risk to the ECV is a separation of the placenta. This rarely occurs mostly due to the guidance of the ultrasound. More than half of ECV attempts are successful. A 2010 retrospective cohort study found that epidural use increased the success rate of ECV, from 56% in the non-anesthesia group to 79% in the anesthesia group.
• Acupuncture. This has been used along with an alternative therapy called moxibustion for turning breech babies. Systematic reviews from five clinical trials found that moxibustion alone or in combination with acupuncture reduced the number of non-cephalic presentations. The study’s authors caution that more rigorous, high-quality randomized, controlled trials are needed. The biggest difficulty here may be finding someone who practices these techniques.
• Chiropractic care. Chiropractors skilled in the Webster Technique may be able to help turn the baby. Thorough research on the maneuver is lacking. But an older 2002 survey of 1,047 U.S. and Canadian members of the International Chiropractic Pediatric Association (ICPA), found that chiropractors reported a success rate of 82% when using the Webster technique to turn breech babies.

Vaginal Birth May Still Be Possible

Say you've tried some or all of these and your baby is still breech. What does this mean?

Most breech babies are born via planned c-section, but a vaginal birth may be possible in some circumstances. Risks associated with a vaginal breech birth are the head or shoulders becoming stuck and umbilical cord prolapse.

Vaginal birth is contraindicated in the following circumstances:

• Cord presentation
• Fetal growth restriction
• Fetal weight greater than 4,000 g
• Footling breech
• Inadequate pelvis
• Hyperextended fetal head

Talk to your doctor to see if you might be a candidate for vaginal breech birth. Your doctor’s experience with vaginal breech birth and your hospital’s guidelines are factors that may determine whether or not vaginal birth is an option in your circumstance.  

Cesarean May Be Best

The rate of cesarean delivery for breech birth is 87%. The number of physicians that have the required skills and experience to support a vaginal breech delivery has decreased. Studies have found that cesarean birth lowers the rates of perinatal mortality, neonatal mortality, and serious neonatal morbidity when compared to vaginal breech birth.

The American College of Obstetricians and Gynecologists (ACOG) recommends ECV for breech presenting fetuses. If the breech presentation persists, ACOG suggests carefully weighing a patient’s wishes and a doctor’s experience to determine the safest delivery method. 

Some breech babies are better off being born by cesarean. Only your practitioner can help you determine if your baby is one of them. If you do have a cesarean, this doesn't mean that all of your subsequent babies would be breech or necessarily be born via cesarean section.