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It is common knowledge that babies move around while they’re still growing in the womb. The feel of the baby kicking and moving is something every parent enjoys and looks forward to. As the pregnancy progresses and the last few weeks of gestation approach, the baby prepares for delivery naturally by slowly moving towards the birth canal.

Most babies naturally move their heads towards the birth canal by the 36th week of pregnancy. In some cases, however, the baby does not naturally move and remains head-up and buttocks-down. This position is known as a breech presentation. 

A baby in breech position can still be delivered vaginally, but the risk of complications is greater and stillbirth, infant mortality and birth defects can occur. This is why many doctors prefer to perform a cesarean delivery to safely birth breech babies. 

Making the decision about vaginal delivery or cesarean delivery if the baby is breech depends on the type of breech presentation. There are three types of breech presentations - complete, footling and frank - and only those in frank position can be delivered vaginally with complete safety. For the rest, cesarean delivery is recommended.

However, in countries like India, babies with breech presentations have been traditionally delivered through vaginal delivery by experienced midwives. What’s more, large parts of rural India do not have enough medical facilities to make cesarean delivery possible. This makes the diagnosis and treatment of breech babies more difficult in India.

  1. How common is breech baby?
  2. What does a breech baby feel like?
  3. Types of breech position
  4. Causes of breech position
  5. Is breech birth bad for the baby?
  6. Are breech babies stronger and bigger?
  7. Treatment of breech presentation
  8. How can I turn my breech baby naturally?
  9. Breech birthing or delivery techniques
Doctors for Breech Position and Breech Birth

Around 3-4% of all pregnancies have a breech presentation at full term. That’s a four out of 100 chance of your baby being breech. These odds are quite low, and so there is no need to panic about it. If your baby is indeed breech, you must visit a doctor to evaluate the situation and discuss your options.

It’s very difficult to tell if your baby is not breech before 35-36 weeks of pregnancy. If you are 36 weeks pregnant or farther along in your pregnancy and can feel your baby’s head pushing high in your belly, or feel the baby kicking in the lower belly still, you should go to the doctor immediately. An obstetrician or experienced midwife will be able to place their hands on the belly to find out where the baby’s head is to know if he or she is still breech.

Ultrasounds and special X-rays can also be used to identify the position of the baby and the size of the pelvis. These methods can also help determine if vaginal delivery is at all possible for a breech baby.

There are three main breech positions:

  • Complete breech: The buttocks point downwards and the legs are folded at the knees with the feet tucked near the buttocks.
  • Frank breech: The buttocks point downwards and the legs are straight up in front of the body, with the feet near the head. This is the only breech position in which a vaginal delivery may still be safe.
  • Footling breech: The buttocks point downwards, but one or both legs stretch out below the buttocks. In this case, either or both legs will be delivered before the rest of the body. This position is also known as an incomplete breech.

The exact causes of a breech presentation are not known yet. But a few conditions are linked to the occurrence of the baby’s breech position:

  • If the woman has given birth before.
  • If the woman is pregnant with twins.
  • If the woman has a history of premature delivery.
  • If the woman’s womb has too much or too little amniotic fluid.
  • If the woman’s uterus is abnormally shaped, or has uterine growths like fibroids.
  • If the woman has placenta previa or preeclampsia.

Your baby being breech doesn’t usually mean that there is something wrong with him or her. Most breech babies are born completely healthy, especially if they’re delivered via cesarean. This is because trying to vaginally deliver a breech baby can cause the umbilical cord to be compressed in the process. This can lead to a lack of oxygen during the birthing process, and in extreme cases cause cerebral palsy or even stillbirth.

However, a few breech babies might have birth defects. It’s important to remember that these birth defects are not caused by the breech position. Quite the opposite: if your baby has a congenital condition like spina bifida, this might be the reason why your baby was unable to turn in the womb and was in a breech position.

The idea that breech babies are stronger, and being kicked by them can cure aches and pain, is a myth. Breech babies are not stronger or bigger than other babies. If they are born with birth defects or anomalies, they might, in fact, be more susceptible to comorbidities and other health issues.

It is preferable to turn a breech baby during the time when he or she should naturally turn in the womb. This time period is between the 32nd and the 37th weeks of pregnancy. There are a number of ways to turn the baby. The following are two methods that may be employed by your doctor.

External cephalic version

This is a non-surgical method of turning the baby while he or she is still in the uterus. An ultrasound is usually done to determine the position of the baby, the location of the placenta and the amount of amniotic fluid in the womb. 

In this procedure, medicine is given to relax the uterus. The lower abdomen is then gently pushed in a certain way to realign the baby in the head-down position. The heartbeat of the baby is closely monitored during this process, and if any problem shows up, the procedure is paused or stopped completely.

The external cephalic version (EVC) process has a very high rate of success, but it cannot be performed if the due date is close. ECV cannot and should not be attempted in the following conditions:

  • If the obstetrician does not have adequate experience of conducting an ECV.
  • If the woman is rhesus negative. (Read more: Rh sensitization during pregnancy)
  • If the woman has experienced bleeding during pregnancy.
  • If the placenta is located in the lower area of the uterus or if the mother has placenta previa.

Webster breech technique

This non-surgical procedure was devised by Dr Larry Webster, a member of the International Chiropractic Pediatric Association. Webster created a chiropractic procedure through which experienced chiropractors can reduce the pressure on the pregnant woman’s pelvis and help the uterus and surrounding ligaments relax. A relaxed uterus can help the baby to turn naturally in the womb. The Journal of Manipulative & Physiological Therapeutics reports that the Webster breech technique has an 82% success rate and that this technique is best used in the eighth month of pregnancy.

While it is not advisable to try strange and potentially harmful home remedies to naturally turn a breech baby, there are some safe, natural techniques that you can try at home. These techniques are risk-free and won’t cost you anything. However, there is no assurance of their success, which means that you might have to consider ECV or cesarean delivery if they don't work.

Indian version technique

Also known as the breech tilt, this method promotes conditions in which the baby can spontaneously turn. Large and firm pillows are used to create a 12 inch or 30cm high, soft platform. The pelvis is placed on the pillows, the thighs are abducted or straightened away from the pelvis. Once in this position, you should breathe normally and stay for 10-15 minutes, thrice a day. It’s best to try this on an empty stomach, and make sure your abdominal muscles aren’t tense.

Music therapy technique

Babies can hear outside sounds while they are still in the womb, and so music can be used to urge them to turn naturally. Place headphones on the lower part of the abdomen and play a recording of your own voice or soothing music. This can help the baby move from the breech position to the head-down position.

If your baby does not turn naturally using any of the above-mentioned techniques, or ECV is not an option, most doctors will ask you to steer clear of a vaginal breech delivery and choose cesarean delivery.

Vaginal delivery of a baby in breech position can be attempted only under the following circumstances:

  • The baby is full-term.
  • The baby shows a frank breech presentation.
  • The cervix is widening properly, indicating that the labour process will be smooth.
  • The doctor estimates the baby is not too big and the mom-to-be's pelvis is not too small.
  • Anesthesia is available and so is cesarean delivery on short notice in case complications show up mid-birth.

In case all these factors play in your favour, vaginal delivery might be possible. It is usually recommended that mothers with breech babies give birth on all fours.

Cesarean delivery is comparatively safer, and can ensure that the baby is delivered without any danger to himself or herself, or to the mother for that matter.

If the baby is breech and premature, the doctor will invariably choose cesarean delivery. This is because the head of premature babies is larger in proportion to their bodies, and the mom's cervix might not stretch enough to accomodate vaginal birth.

Dr. Sonam Yadav

Dr. Sonam Yadav

Obstetrics & Gynaecology
7 Years of Experience

Dr. Priyanka Gupta

Dr. Priyanka Gupta

Obstetrics & Gynaecology
10 Years of Experience

Dr. Vrinda Khemani

Dr. Vrinda Khemani

Obstetrics & Gynaecology
6 Years of Experience

Dr Megha Apsingekar

Dr Megha Apsingekar

Obstetrics & Gynaecology
4 Years of Experience

References

  1. American Pregnancy Association [Internet]. Irving, Texas, USA; Breech Births
  2. MedlinePlus Medical Encyclopedia [Internet]. US National Library of Medicine. Bethesda. Maryland. USA; Breech - series—Types of breech presentation
  3. Michigan Medicine [internet]. University of Michigan. Breech Position and Breech Birth
  4. National Health Service [Internet]. UK; What happens if your baby is breech?
  5. National Childbirth Trust [Internet]. London. United Kingdom; Breech babies: what you need to know
  6. Wildschut, Hajo I.J. et al. The art of vaginal breech birth at term on all fours. Clin Case Rep. 2017 Feb; 5(2): 182–186. PMID: 28174647
  7. Eller, D.P. and VanDorsten, J.P. Breech Presentation. Curr Opin Obstet Gynecol , 5 (5), 664-8. PMID: 8241444
  8. Singh, Abha. et al. Delivery in Breech Presentation: The Decision Making. J Obstet Gynaecol India. 2012 Aug; 62(4): 401–405. PMID: 23904698
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