efore birth, most babies move into a head-down position in the uterus. Some do not. When the buttocks, feet, or both are in place to come out first during birth it is called breech presentation.
If your baby is in the breech presentation when your due date is near, you should know what to expect. You then can plan with your doctor the best way to manage your labor and delivery. This pamphlet will explain:
- How breech presentation is found
- Reasons it may occur
- What can be done before birth
- Options for how the baby is born
|
| Most breech babies are
born healthy. If your baby is
still in the breech position
as your due date draws
near, talk with your doctor. |
Breech Presentation
A full-term pregnancy lasts about 40 weeks from the first day of the last menstrual period. In the first 36 weeks the baby changes position many times. In the last weeks the baby shifts less because there is less room to move around.
By 3–4 weeks before the due date, most babies move so their heads are down near the birth canal (vagina). If this does not happen, the buttocks, the feet, or both may be in place to come out first during birth. This is called breech presentation. It happens in 3–4% of full-term births and requires special planning for how the baby will be born. If your baby is in a breech position, your doctor may recommend cesarean delivery.
Most breech babies are born healthy. But they have a higher risk for certain problems than babies born head first. Your doctor will talk with you about the best plan for you and your baby.
Related Factors
It is not always known why a baby is in a breech position. Breech is more common when:
- The woman has had more than one pregnancy
- There is more than one fetus in the uterus (twins or more)
- The uterus has too much or too little amniotic fluid (the liquid around the fetus inside the uterus)
- The uterus is not normal in shape or has abnormal growths, such as fibroids
- The placenta covers all or part of the opening of the uterus (placenta previa)
- The baby is preterm
In some cases, a birth defect may be one of the reasons why a baby has not turned into the head-down position before birth.
Finding the Baby's Position
To plan for delivery of a breech baby, your doctor will find out how the baby is positioned. One way for your doctor to tell which way your baby is facing is by doing a physical exam. Placing his or her hands at certain points on your abdomen, the doctor feels the shape of the baby. By feeling where the baby's head, back, and buttocks are, he or she can tell the breech position of the baby.
An ultrasound exam may be used to confirm the position. In this test, a device is moved across the abdomen. The sound waves it produces make an image of the baby that can be seen on a screen.
The baby's position can change until the end of pregnancy. As the time of delivery nears, some babies turn on their own. Your doctor may not know for sure if your baby has settled in a breech presentation until labor starts. Sometimes a breech presentation is first found during a pelvic exam of a woman in labor.
Changing the Baby's Position
If the baby is breech, your doctor may suggest version. This is an attempt to turn the baby head down. It can improve your chance of having a vaginal birth.
To turn the baby, the doctor places his or her hands at certain points on your abdomen, then pushes or lifts. This helps the baby move. It is as if the baby rolls forward in slow motion. If this does not work, the doctor may try to get the baby to roll backward. In some cases, the doctor may have a second person help turn the baby.
Most often, version is not tried until you are at least 36 weeks pregnant. If it is done before then, the baby may still change position.
Your doctor will assess your health and the state of your pregnancy to see if version is an option for you. Certain conditions may increase the risk of version or decrease the chance of its success. If you or your baby has any of these conditions, your doctor may not recommend version.
Before your doctor tries to turn the baby, an ultrasound exam will be done. This exam shows:
- How the baby is positioned
- Where the placenta is positioned
- How much amniotic fluid is present
Ultrasound also may be used to help guide the turning.
The baby's heart rate is checked with fetal monitoring before and after version. If any problems arise with you or the baby, version will be stopped right away.
Sometimes, a drug is given to you first to relax the uterus. This may make it easier to turn the baby.
Although rare, there can be some complications with version:
- Premature rupture of membranes
- Problems with the baby's heart rate
- Placental abruption
- Preterm labor
Version usually is done near a delivery room. If problems occur, the baby then can be delivered quickly, by cesarean delivery if necessary.
More than half of attempts at version succeed. Some babies, though, move back into a breech position. If that happens, your doctor may try version again. But it tends to be harder to do as the time for birth gets closer. This is because as the baby grows bigger, there is less room for him or her to move.
Delivery
If your baby is in a breech position, your doctor will talk with you about the best type of birth for you and your baby. If the baby can be turned with version, vaginal birth may be an option. If the baby is in a breech position as the time of delivery nears, cesarean birth may be best. Your doctor will go over the risks and benefits in detail. Together you will decide on the best plan for you and your baby.
Vaginal Birth
Vaginal birth can be more difficult when a baby is breech. This is because, at birth, the head is the largest and firmest part of the baby's body. In the head-down position, the head comes out first. In most cases, it is then easy to guide the rest of the body through the birth canal. In the breech position, the body comes out first, and it may be hard to guide the baby's head out of the mother's body. This is because the baby's body may not stretch the cervix enough to allow room for the baby's head to come out easily.
The risk of harm to the baby may be increased in a vaginal breech birth. There is also more chance of a prolapsed cord. That is when the umbilical cord slips through the cervix into the birth canal before the baby does. This can cause the cord to be pinched, which can stop the flow of blood through the cord.
Cesarean Birth
Most breech babies are born by planned cesarean delivery. Like any major surgery, cesarean birth involves risks. These problems occur in a small number of women and usually are easily treated:
- Infection
- Bleeding
- Problems from pain relief medication
It is not always possible to plan for cesarean birth. The baby may move into the breech position just before labor begins. In that case, you will not know that you are going to have a cesarean delivery until you are in labor.
Finally...
Most breech babies are born healthy. If your baby is still in the breech position as your due date draws near, talk with your doctor. He or she will discuss the risks so that together you can plan the delivery that is best for you.
| Glossary
Cesarean Delivery: Birth of a baby through an incision made in the mother's abdomen and uterus.
Placenta: Tissue that provides nourishment to and takes away waste from the fetus.
Placental Abruption: A condition in which the placenta has begun to separate from the inner wall of the uterus before the baby is born.
Premature Rupture of Membranes: A condition in which the membranes that hold the amniotic fluid rupture before labor.
Preterm: Born before 37 weeks of pregnancy.
Ultrasound: A test in which sound waves are used to examine internal structures. During pregnancy, it can be used to examine the fetus.
Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.
Version: A technique, performed late in pregnancy, in which the doctor manually attempts to move a breech baby into the head-down position. |
This Patient Education Pamphlet was developed under the direction of the Committee on Patient Education of the American College of Obstetricians and Gynecologists. Designed as an aid to patients, it sets forth current information and opinions on subjects related to women's health. The average readability level of the series, based on the Fry formula, is grade 6–8. The Suitability Assessment of Materials (SAM) instrument rates the pamphlets as "superior." To ensure the information is current and accurate, the pamphlets are reviewed every 18 months. The information in this pamphlet does not dictate an exclusive course of treatment or procedure to be followed and should not be construed as excluding other acceptable methods of practice. Variations taking into account the needs of the individual patient, resources, and limitations unique to the institution or type of practice may be appropriate.
Copyright © February 2007 by the American College of Obstetricians and Gynecologists. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, posted on the Internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.
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Before birth, most babies move into a head-down position in the uterus. Some do not. When the buttocks, feet, or both are in place to come out first during birth it is called breech presentation.
If your baby is in the breech presentation when your due date is near, you should know what to expect. You then can plan with your doctor the best way to manage your labor and delivery. This pamphlet will explain:
