What to do if my baby is breech?

BREECH PRESENTATION

Breech position or “presentation” is when the baby positions itself so that the buttocks, legs, or feet are at the top of the cervix. Reasons why breech presentations occur are many. It is estimated that about 3 to 4% of all births are breech. The different types of Breech presentations are:

– Frank Breech: When the baby’s Buttocks are at the top of the cervix and her legs bent upwards towards her face.
– Complete Breech: When the baby is sitting “cross legged” as if in a yoga position
– Footling Breech: When the baby’s feet are over the cervix.

Typically baby assumes a favorable position for birth by 34th week. Sometimes, due to some factors babies are slow to reach this milestone. Why a baby presents a Breech position is not known for sure, but one of the factors can be due to excess Amniotic fluid. As the baby is not able to engage the head over the cervix, it may so happen that either the feet or buttocks land on the place. Sometimes a baby which is slow in reaching its milestones may end up being in Breech position.

However, there are no proven studies which have listed the causes for Breech positions.

Almost ALL hospitals in India do not give any option to mother with Breech babies to birth naturally. The ONLY solution to a Breech baby is to perform a cesarean operation. This is because of the “risk avoidance” mindset pervading among hospitals. While the foremost consideration is (and should be) the safety of baby and mother, the question of whether a mother should be given the option of delivering a Breech baby naturally should be at least considered.

While in the US Breech births almost always happen via cesarean operations, Midwives have routinely helped mothers with Breech babies deliver naturally. Midwives are experts in the Physiology of birth. Hence, midwives have a better skills to help mothers with Breech babies delivery naturally. Midwives have an array of techniques in their protocols that are useful in making babies turn “head down” into the cervix. Of course, there must be a facility to handle any immediate emergency when trying for Natural Breech birth. Transportation of a breech baby in full fledged labor is quite risky. In these situations, availability of skilled Obstetricians and other staff in premises becomes a very important factor for safety of mother or baby.

At The Sanctum, Dr Vijaya Krishnan has delivered breech babies naturally, using her unique skills and with active participation from mothers. However, some mothers were advised not to try for Natural birth of their Breech babies, since the risks outweighed the benefits. In all situations, the decision is taken after taking the mother, her partner and family into confidence, and appraising them of the pros and cons of any option. Each mother is advised taking into consideration her unique situation and the couple becomes a part of the decision making team.

Some of the techniques to turn Breech babies are simple enough that mothers themselves can do. These include:

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  BREECH TILT POSITION (c) SpinningBabies

  Tilt Position: In this position, the mother lies on her back, with knees bent and feet firmly on the floor. Then she lifts her pelvis up in the air about 12 inches from the floor. Mother’s partner can help her keep this position for about 30 seconds. She may keep pillows beneath her buttocks for support.

• ECV: External Cephalic Version is a medical procedure done around the 37th week if baby is still in a Breech position. The uterus is given an injection to relax it, and baby is assessed for her well being before the technique. Only if certain conditions are met does the mother and baby become safe and eligible for an ECV. The baby’s heart rate is monitored while the midwife gently pushes and guides the baby through the abdominal wall in order to encourage him to turn to a “Vertex Presentation”. While this sounds simple, it really requires a lot of skill and practice on the part of the midwife. Dr Vijaya is perhaps the only midwife in India and one of very few in the world who has consistently been successful in ECV techniques.
• Sound: Since babies can hear well by 35th week and can respond to sounds, some midwives use pleasing sounds low down near the mother’s uterus. It is said a Breech baby may turn his head down so that he can hear the sound better, thereby positioning him in the right manner. Partners can place headphones on the mother’s abdomen or even talk to the baby low down near the uterus. This is a relatively harmless technique, and in some situations has been found to be successful.

However, any “self-technique” must be discussed beforehand with your midwife, and pros and cons of any option must be clearly understood.

For more information on various other topics surrounding Pregnancy, Labor and Delivery and Post Partum or Newborn Care, please visit our FAQ Section. In case you have any other questions, please write to us for a one-on-one Skype Consultation with Dr Vijaya.

Another very helpful source of information about Breech births and delivery Breech babies naturally, is SpinningBabies website.