A breech presentation means that your baby is not head down but sitting with his or her buttocks closest to your cervix. This means if you deliver vaginally, your baby’s buttocks or feet will come out first. This happens in 3–4% of all full-term births.
Your baby’s position in your womb is first evaluated during an ultrasound taken in your second trimester. If your baby is found to be breech, you will be asked to return for an ultrasound in the third trimester to reassess your baby’s position. In addition, a few weeks before your due date, your baby’s position will be checked again during a physical exam. If it appears that the baby might still be in a breech position, or if your baby has moved into a breech position, you will receive an updated ultrasound.
No. There are different breech positions that a baby could assume in your womb. They are as follows:
Complete breech: Your baby’s buttocks are first. This usually means the legs are folded at the hips and knees. Sometimes the feet are below the buttocks (also called footling breech) and sometimes the baby is in a crossed legs position with the feet level with the buttocks.
Frank breech: In this position, the baby’s buttocks are aimed at the birth canal with your baby’s legs sticking straight up in front of his or her body with the feet near the head.
Kneeling breech: In this position, your baby is extended at the hips with the legs bent at the knees and the feet up behind the baby’s back. This type of breech is not common.
Even though most breech babies are born healthy, there is a slightly higher rate of chromosomal abnormalities like Down’s syndrome, seen in breech babies. For this reason, it is recommended for mothers with breech babies to undergo genetic testing before their baby is born. However, other things can cause a breech presentation such as an abnormally shaped uterus, having a short umbilical cord, having a low-lying placenta or placenta previa (where the placenta covers the
cervical opening), or having the nuchal cord around the baby’s neck. It is not always easy to know why a baby is breech.
Yes! Sometimes, babies turn upside down on their own so that their head in facing down before the mother goes into labor. This is why a repeat ultrasound is performed for babies who were found to be breech early in the pregnancy.
Although there is nothing you can do yourself to help your baby turn, if your baby is still breech at your 36 or 37 weeks of pregnancy, many doctors are able to manually rotate your baby to a head down position. This is called an External Cephalic Version (EVC).
An ECV is performed either at the hospital with spinal anesthesia or at a Birth Center, based on your preference. During this procedure, the mother is given a medication to help relax the uterus. This medication is safe for you and your baby. The doctor will then turn your baby by externally pushing on your abdomen. The goal is to rotate your baby into a head down position. This procedure can take up to an hour, but you and your baby will require an additional hour of monitoring after the procedure to make sure he or she is happy in this new position. Dr. Shehata’s ECV success rate is about 65-70%.
Not every doctor performs a EVC. Furthermore, not every mother qualifies to have the procedure done.
An ECV will not be performed if:
You are carrying more than one baby
Your amniotic fluid levels are low
Your amniotic sac is ruptured and you are leaking fluid
You are having vaginal bleeding
You have uncontrolled high blood pressure or preeclampsia
Your uterus is abnormally shaped
There is something wrong with the pregnancy that prevents you from qualifying for a vaginal delivery
There are concerns about the health of your baby, such as fetal anomalies or your baby being abnormally small (growth restricted)
Your baby is in kneeling breech presentation
Most physicians do not believe in attempting a vaginal delivery for a breech position even if you and your baby are otherwise healthy. This means you will have to undergo a C-section. Although medical guidelines allow either a breech delivery or a c-section, most doctors have not been trained on how to properly perform them. Dr. Shehata has undergone additional medical training to deliver breech babies. If you are interested in an alternative to a c-section, Dr. Shehata can review your medical file to determine if you would qualify for a breech vaginal birth. She will take the time to educate you on the risks and benefits of both a breech vaginal birth and a c-section so you have the information to determine which mode of delivery is best for you and your baby.
Yes, if it is done by a trained medical provider experienced with breech vaginal births, a breech delivery is safe and the mother suffers less trauma than undergoing a c-section.
Although there are some short-term risks during and immediately after delivery, breech births have here have not been shown to have any long-term risks to you and your baby. There are also significant long- term complications that can occur if you undergo a c-section. This is why Dr. Shehata will go over both the risks and benefits of a breech vaginal birth vs. a c-section delivery with you as part of her consultation on your delivery options. Dr. Shehata will work with you to develop your ideal birth plan.
It was previously thought that breech vaginal births caused hip dysplasia. Hip dysplasia is the medical term for when a hip socket doesn't properly develop. The hip socket is supposed to fully cover the ball portion of the thighbone so that it can’t dislocate when the legs move. When the hip joints are not developed properly, it can cause pain, a limp when walking, a “popping” sensation with certain movements, and/pr arthritis in the joint if it wears out too quickly. Babies who are born with hip
dysplasia usually require special braces, physical therapy, and sometimes surgery.
However, it is now understood that hip dysplasia is actually caused by the breech position in the womb, and it is NOT from delivering a baby in a breech position.
Having a c-section will decrease the risk of your baby having hip dysplasia, but it does not eliminate the risk. In addition, long-term outcomes for babies delivered vaginally in a breech position are not significantly different than those delivered by c-section. Therefore, having a breech vaginal delivery is a reasonable alternative for a woman with a baby who is breech and who does not want to undergo a major abdominal surgery.
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