Breech Delivery

A breech birth is when a baby is born with the buttocks or the feet first. Most babies are in a head down (vertex) position when they are born. Many babies are breech early in the pregnancy but turn to headfirst position toward the end of the pregnancy. There are three types of breech babies that can pose a risk to the baby and may need delivery by cesarean delivery. These include:

  • When the baby's buttocks is showing first in the birth canal (vagina) with the legs straight up and the feet at the baby's head (frank breech).

  • When the baby's buttocks shows first with the legs bent at the knees and the feet down near the buttocks (complete breech).

  • When one or both of the baby's feet are down below the buttocks (footling breech).

RISKS WITH BREECH DELIVERIES:

  • Umbilical cord prolapse. This is when the umbilical cord is in front of the baby before or during labor.

  • Injury to the nerves in the shoulder, arm and hand (Brachial Plexus injury) when delivered.

  • Birth defects, overly large head (hydrocephalic) and neural tube defects (spina bifida) are seen more often.

  • Premature babies are seen more often. These are babies that are born too early.

  • There is an increase rate for cesarean delivery with breech babies.

CAUSE OF BREECH PREGNANCY:

  • The mother has had several babies.

  • Having twins or more.

  • The uterus is abnormal in shape and size (double uterus).

  • The baby weighs less than 5 pounds.

  • There is too much or not enough amniotic fluid.

  • There is a tumor in the uterus.

  • All or part of the placenta covers the opening of the uterus (placenta previa).

DIAGNOSIS

When you are close to your due date, your caregiver can tell if your baby is breech by an abdominal or vaginal exam, an X-ray or ultrasound, or any combination both.

TREATMENT

  • More problems are likely if the baby is breech, but some babies may be delivered safely without a cesarean delivery. A cesarean delivery also has risks such as longer hospital stays, blood clots, infection or bleeding. A breech delivery can compress the umbilical cord or cut off the blood supply to the baby. This can cause brain damage or death to the baby.

  • You and your caregiver will discuss the best way to deliver the baby, in your particular circumstance.

  • Your caregiver may try to turn the baby in your uterus. This is done towards the end of a normal pregnancy with your caregiver placing both hands on the abdomen, gently and slowly turning the baby around. This is a procedure called external cephalic version (ECV). If this procedure is successful, and the baby stays head down, a normal delivery is more likely.

  • Some doctors will plan to deliver a breech baby by cesarean delivery.

An ECV should be attempted only when:

  • The pregnancy is more than 36 weeks along.

  • The breech should be confirmed with an ultrasound.

  • ECV should only be done in a delivery/surgical room with an anesthesiologist, surgical nurses and pediatric nursery nurses and preferably a pediatrician present. All should be ready for an emergency cesarean delivery if necessary.

  • A medication is given before the ECV is attempted to relax the muscles of the uterus.

  • A nonstress test on the baby should be normal.

  • A biophysical profile on the baby should be normal.

  • The baby should have continuous monitoring during the ECV.

  • Using regional anesthesia (epidural) helps the outcome of the ECV to be more successful.

  • The baby should be monitored for 1 to 2 hours after the procedure.

The benefits of ECV are:

  • Lower risk to the baby when delivered head first.

  • Lower cost.

  • Decrease in rate of cesarean delivery.

The ECV should not be used if you have:

  • Vaginal bleeding.

  • Placenta previa.

  • A nonreactive nonstress test of the baby.

  • An abnormal biophysical profile of the baby.

  • An abnormally small baby.

  • A low level of fluid in the sac that surrounds and protects the baby.

  • An abnormal fetal heart rate.

  • Early rupture of the membranes.

  • Twins or other multiple pregnancy.

  • An abnormal shape uterus, tumor or genetic defect (double uterus).

More than half of external cephalic versions work. Even when they work, there is always a chance that the baby will turn back to the breech position.

HOME CARE INSTRUCTIONS

When you are pregnant:

  • See your caregiver regularly.

  • Take your prenatal vitamins as suggested.

  • Eat a well-balanced diet and exercise regularly unless instructed otherwise.

  • Get plenty of rest and sleep.

After you have the baby:

  • You may have a small amount of bleeding for a week or so.

  • You may have some cramping of the uterus, especially if you are nursing.

  • Do not have sexual intercourse until your caregiver says it is okay.

  • Do not use tampons or douche.

  • Do not take aspirin because it can cause bleeding.

  • If you had a cesarean delivery, you may have some pain in the cut (incision). Your caregiver will advise you or give you pain medication.

  • Do not lift anything over 5 pounds.

  • Try to have help at home for 2 to 3 weeks.

  • Keep all your post delivery appointments.

SEEK IMMEDIATE MEDICAL CARE IF:

Before you have the baby:

  • You have vaginal bleeding.

  • You are leaking fluid or have a gush of fluid from the vagina.

  • You develop uterine contractions.

  • You develop a temperature of 100° F (37.8° C) or higher.

  • You feel the baby is not moving or is moving less than normal.

After you have the baby:

  • You develop a temperature of 100° F (37.8° C) or higher.

  • You have heavy vaginal bleeding.

  • You develop abnormal vaginal discharge.

  • You have pain when you urinate.

  • You become light headed or faint.

  • You have leg pain, chest pain or shortness of breath.

  • If you had a cesarean delivery and develop redness and swelling around the incision. You see fluid (pus) coming from the incision.

Call your caregiver if you think you are developing any problems during the pregnancy or after you have the baby.