Breech baby – what are your choices? Information for parents

Women’s Health – Specialist Services Division

Produced:

February 2013

Review Date: February 2016

Breech baby means that your baby is ‘bottom down’ or feet first in the womb instead of the usual ‘head down’ position. A breech birth may be a more complicated birth as the head is the largest part of a baby and is the last part to be delivered in a breech birth. In early pregnancy, breech positions are very common. A baby usually turns so that between 37 and 42 weeks (term), most babies are ‘head down’ ready to be born. However 3 in every 100 babies (3%) are still breech at the end of pregnancy. There are three different types of breech, as shown below:

Footling Breech

Flexed Breech

Extended/Frank Breech

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Why is my baby in the breech position? Often it is just a matter of chance that a baby does not turn and remains breech. Sometimes, however, certain factors can make it difficult for the baby to turn: There may be too much or too little fluid around the baby The position of the placenta (afterbirth) is close to or covering the opening (cervix) of the womb. This is called placenta praevia There may be more than one baby present in the womb

What will happen if my baby remains breech? If you are 37 weeks pregnant and your baby is breech you have 3 choices that you should discuss with your doctor or midwife: External Cephalic Version (ECV) - trying to turn your baby into a head down position Delivery by caesarean section - an operation where a cut is made in your abdomen and baby is delivered through that cut Vaginal breech birth - baby is delivered bottom first

What is ECV? External cephalic version is a technique where pressure is applied to your abdomen to help the baby turn a somersault in the womb to lie head down. This increases the likelihood of having a vaginal birth. Although you may find ECV uncomfortable, it should not be painful. Page 3

ECV is usually offered after 37 weeks of pregnancy and can be done right up until you give birth.

What are the advantages? ECV is successful for up to half (50%) of all women. Relaxing the muscles of the womb with medication improves the chance of success. The medication will not affect your baby and if your baby remains head down after the procedure you can expect a normal birth; although there is still an increased risk of caesarean section.

What are the risks? ECV is generally safe. The procedure is carried out using ultrasound scanning and your baby’s heart will be monitored before and after ECV. However like any medical procedure complications can occur. One in 200 babies need to be delivered by emergency caesarean section after an ECV because of bleeding from the placenta or changes in the baby’s heartbeat.

What happens if my baby remains in the breech position after ECV? If your baby remains in the breech position your doctor will discuss with you the options for giving birth. There are two options; a caesarean section delivery or a vaginal breech delivery.

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Caesarean Section Delivery What are the advantages? Research shows, that if ECV is unsuccessful, caesarean section around the expected time of birth may be the safest way of delivering a baby that is presenting ‘bottom first’ (breech).

What are the disadvantages? Caesarean section carries a slightly higher risk for you when compared with a vaginal breech delivery. It does not carry any long-term risks to your health outside of pregnancy, however; there may be consequences for future births. (See leaflet Caesarean section and subsequent births.)

Vaginal Breech Delivery This is also an option but it cannot always be recommended as safe in every circumstance. Your doctor may advise you against vaginal breech delivery if: Your baby’s feet are coming first (as in a footing or flexed breech) Your baby is particularly large or small You have had a previous caesarean section Your placenta is low-lying If you choose to have a vaginal breech delivery, your baby should be delivered in the Sharoe Green Unit where there is access to medical support and advice. Page 5

Your labour should start spontaneously labour and progress normally. Your baby’s heart rate will be monitored closely during your labour and if there are any concerns your baby may need to be delivered by emergency caesarean section.

What if my labour starts before 37 weeks? If your labour starts before 37 weeks, the risks and benefits of having a caesarean section or vaginal birth change and this will be discussed with you at the time.

What if I am pregnant with twins and one baby is breech? If you are having twins and the first baby is breech, your obstetrician will usually recommend a caesarean section. The position of the second twin is less important as this baby often changes position after the first twin is born.

Sources of further information: www.lancsteachinghospitals.nhs.uk www.nhsdirect.nhs.uk www.patient.co.uk Lancashire Teaching Hospitals NHS Foundation Trust is not responsible for the content of external internet sites Page 6