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Maternity Unit

Babies in the breech position

Breech means that your baby is lying bottom or feet first in the uterus (womb) instead of in the usual head first position. In early pregnancy, breech is very common; at 28 weeks 30 in every 100 babies are breech.

Later your baby usually turns naturally into the head first position so only three in every 100 babies remain breech by the end of pregnancy.

Why are some babies in breech?

Sometimes it is just a matter of chance at other times certain factors make it difficult for a baby to turn during pregnancy. These might include the amount of fluid in the womb (either too much or too little), the position of the placenta or if there is more than one baby in the womb. Most breech babies are healthy but for a few babies being breech may be a sign of a problem. All babies will have a newborn examination.

What can be done?

After 37 weeks of pregnancy, if your baby is in the breech position we recommend an External Cephalic Version (ECV) which aims to turn the baby to a headfirst position while still in the womb. This then allows you to attempt a normal vaginal delivery and the difficult decisions about breech delivery can be avoided. An ECV reduces the risk of a caesarean section without any increased risk to the baby.

You can find out more about ECV.

Who can have ECV?

An ECV is not recommended if you have:

  • A low lying placenta (placenta praevia)
  • Vaginal bleeding
  • A low level of amniotic fluid in the sac that surrounds and protects the baby
  • A particularly small baby 
  • Any fetal heart rate concerns.

You will have an ultrasound scan to check for these conditions before the ECV.

How successful is ECV?

45 in every 100 women will have the baby turned to the head down position. Very occasionally the baby will turn back to breech.

The risks of ECV are very small:

  • Rarely, the baby can be distressed. If this happens we can immediately perform a caesarean section (less than one in 100 of cases)
  • Labour may start (one in 100 cases)
  • The waters may break (one in 100 cases)
  • There may be a small blood loss from either the mother or baby.

What happens at ECV?

You will be given a two hour appointment at the Maternity Assessment Unit (MAU). On the day of ECV you must not eat or drink for six hours beforehand. On arrival you will be scanned to confirm the breech presentation. Just before the ECV you will be given an injection under your skin (Terbutaline), which relaxes your uterus and makes it easier to turn the baby. You will also be given a tablet (Ranitidine) that reduces the acid in your stomach. We will then try to turn the baby. The procedure is uncomfortable but not painful (and will be stopped if it is). Ultrasound is used to monitor the baby’s heartbeat and the success of the procedure. The operator’s hands are used to lift the baby and turn the baby into the head down position. After the procedure the baby’s heart rate is monitored again.

What if ECV fails?

If the ECV is unsuccessful we will arrange an antenatal clinic appointment with your consultant or a senior member of their team. At  this appointment you will be able to discuss the best way to deliver and plan for the remainder of your pregnancy.

What are my choices for birth?

If you decide not to have an ECV or if it we are unable to turn the baby then there are two choices for birth, either a planned caesarean delivery or a vaginal breech birth.

Caesarean delivery

Along with the Royal College of Obstetricians and Gynaecologists (RCOG) and National Institute for Health and Clinical Excellence (NICE) we recommend that caesarean delivery is safer for a baby that remains in the breech position.

Caesarean delivery carries a slightly higher risk for you, compared with the risk of having a vaginal breech birth. Caesarean delivery does not carry long-term risks to your health,  however, a caesarean section influences your care in future pregnancies which you may wish to discuss.

Sometimes labour may start before your planned caesarean delivery. Your obstetrician will assess whether it is safer to proceed with the caesarean delivery or if the baby is close to being born, it may be safer for you to opt for a vaginal breech birth.

Vaginal breech birth

A vaginal breech birth remains a choice for some women, however, it is not be recommended as safe in all circumstances. This is because it is a more complicated birth as the head is the widest part of the baby and is last to be delivered - occasionally this may be difficult.

Where a vaginal breech birth is being considered, we can support this on the Delivery Suite. We are able to offer this service as we have experienced obstetricians trained to deliver a breech baby vaginally along with facilities for an emergency caesarean delivery should this be necessary.

Before choosing vaginal breech birth, it is advised that you and your baby are assessed. We advise against a vaginal birth if:

  • your baby is a footling breech (feet below the bottom)
  • your baby is large (estimated weight over 3,800 grams)
  • your baby is particularly small (estimated weight less than 2,000 grams)
  • your baby is in a certain position: for example, if the neck is very tilted back
  • you have had a caesarean delivery 
  • you have a narrow pelvis
  • you have a low-lying placenta
  • you have pre-eclampsia.

What can I expect in labour with a breech baby?

Apart fro a water birth you have the same choice of pain relief as with a baby who is head first. An epidural has many benefits in these circumstances. We advise that your baby’s heart rate is be monitored continuously. As with any labour, you may need an emergency caesarean delivery. Forceps may be used to assist the baby to be born. This is because the baby’s head is the last part to emerge and may need to be helped through the birth canal. A paediatrician will attend the birth to check the baby.

What if my baby is coming early?

If your labour starts before 37 weeks, the benefits versus the risks of a caesarean delivery or vaginal birth changes and will be discussed with you.

What if I’m having more than one baby and one of them is breech?

If you are having twins and the first baby is breech, your obstetrician will usually recommend a caesarean delivery. The position of the second twin before labour is less important at this stage because this baby can change position as soon as the first twin is born. The second baby then has lots more room to move.

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