According to the American Journal of Perinatology, approximately 3-4% of births in the UK are breech. Here we ask Dr Christina Yu, Consultant in Obstetrics and Fetal Medicine at The Portland Hospital, to explain how being breech can affect a baby’s delivery and how expectant mothers can encourage their baby to change position in the womb.
What is breech birth and how common is it?
A breech birth occurs when a baby’s head has not engaged and it exits the pelvis with either the feet or buttocks first. Approximately 20% of pregnancies will be in the breech position at 28 weeks gestation but this decreases to just 3-4% of births at full term, according to the Royal College of Obstetricians and Gynaecologists.
How will I know if my baby is breech?
A good indication that your baby is in the breech position is if you feel kicks low down in the pelvis. Additionally, your midwife or doctor may become suspicious of a breech position upon abdominal palpation.
The good news is that the Royal College of Gynaecology estimate that 60% of babies in the breech position at 32 weeks of gestation will change position spontaneously to the expected head-down position. After 36 weeks of gestation the likelihood of the baby spontaneously changing position is decreased but, according to the Royal College of Obstetricians and Gynaecologists, the possibility is still 25%.
If a baby is in the breech position how might it affect their delivery?
Babies in the breech position are commonly delivered by a Caesarean section and studies have confirmed that elective Caesarean sections will have a lower risk to the fetus than a vaginal delivery if the child is in the breech position.
Women expecting a child in the breech position should be assessed carefully before selecting a vaginal breech birth and advised of the increased risk to them and their babies if attempting vaginal breech birth.
Unfavourable clinical features can also affect whether a woman expecting a baby in the breech position is suitable for vaginal birth. These factors include:
-If they have had contraindications to vaginal birth (e.g. placenta praevia, compromised fetal condition)
-If they have a clinically inadequate pelvis
-If they have footling or kneeling breech presentation
-If they are expecting a large baby
-If they are expecting a growth-restricted baby
-If their baby has been found to have a hyperextended fetal neck on the ultrasound
-If the woman has had a previous Caesarean section
How can I encourage the baby to change position?
A good way to encourage your baby to change position is by letting gravity help and lying flat on your back and raising your pelvis off the floor. Support your hips with a pillow and try to stay in this position for five to ten minutes.
Alternatively, get on all fours on your knees, with your forearms on the floor in front of you and your bottom up in the air for five to ten minutes. Other alternative methods include moxibustion, which is an ancient Chinese technique where burning herbs can stimulate key acupressure points.
Is there any way that my consultant can encourage the baby to move position?
If your baby is still bottom down at 37 weeks and there are no contraindications, your doctor should offer to try to turn your baby to the more favourable head-down position.
This procedure is known as an external cephalic version (ECV). It's done by applying pressure to your abdomen and manually manipulating the baby into a head-down position.
According to the Journal Clinical and Experimental Obstetrics and Gynaecology, an ECV has about a 58% success rate in turning breech babies but having a version is not entirely risk free and some women find it very uncomfortable.
For more information on breech births or to book an appointment with Dr Yu please contact The Portland Hospital’s maternity enquiry line on 020 7390 6068 or alternatively email firstname.lastname@example.org