Just before birth, most babies are in a position with the head down into the uterus of the mother and this is the reason why the majority of babies born head first. Sometimes the baby is in breech or feet. When a baby is in that position before birth is said to be a breech birth or a baby is breech. Many babies are breech early in pregnancy but most of them turn to the position facing the end of pregnancy. Babies born early are more likely to be breech. If more than one baby in the womb at the same time one or more of the babies may be breech. Abnormal levels of amniotic fluid around the baby may result in a breech delivery. As you approach your due date, your doctor will be able to tell by physical examination, ultrasound or both, if your baby is breech.
Does the delivery of a breech baby be delivered without a cesarean?
The delivery of some breech babies can be safely through a vaginal delivery. However, more complications can occur if the baby is breech. A baby who is breech may be too small or may have birth defects because of breech delivery. When babies are born breech vaginally, they are more likely to be injured during or after birth than babies born head first. Babies born vaginally in the breech position are also likely to develop a birth defect in which the joint socket of the hip and thigh bone are separated. The complications with the umbilical cord are also more likely to happen in babies born vaginally and breech, for example, the umbilical cord is more likely to be compressed during labor, which can cause nerve damage and brain due to lack of oxygen.
Although babies are breech delivered vaginally, it is generally easier and safer vaginal deliveries in which the head comes out first. Doctors usually deliver the breech babies by cesarean section, which is also known as "C-section". Cesarean delivery also involves risks such as bleeding, infection and longer hospital stay for mother and her baby.
Anything I can do to help if my baby is breech?
It is very important to visit your doctor regularly during pregnancy. Your doctor can tell if your baby is breech and help plan what to do. Some doctors will plan to cesarean delivery. Others may give their patients exercises to do at home that can help the baby to turn head-first position. Some doctors try to turn the baby in the womb of the mother using a procedure called external cephalic version. If this procedure is successful and the baby stays head down is most likely a normal vaginal delivery.
What is ECV?
ECV is a way of trying to turn a baby from breech position to vertex (head down) while still in the womb of the mother. In other words, external cephalic version means turning the baby from outside of the abdomen so that the baby is placed in position with the head down. The doctor will use his hands on the outside of your abdomen to try to turn the baby.
When is external cephalic version done?
External cephalic version is done in late pregnancy, more or less after 37 weeks of gestation.
Who can have external cephalic version?
Many women with normal pregnancies may have external cephalic version. Women who can not be done include those with one of the following:
- Vaginal bleeding
- A placenta that is near or covering the opening of the uterus.
- A reactive nonstress test
- An abnormally small baby
- A low level of fluid in the sac that surrounds and protects the baby.
- An abnormal fetal heart rate
- Premature rupture of membranes
- Twins or other multiple pregnancy
What are the risks of external cephalic version?
External cephalic version has some risks, including the following:
- Preterm birth
- Premature rupture of membranes
- A small blood loss for either the baby or the mother.
- Fetal distress can lead to an emergency delivery by cesarean section.
- The baby might turn back to the breech position after it has ECV.
Although the risk of these complications is small, some doctors prefer not to try an external cephalic version.
What happens after the procedure?
When the procedure is completed, your doctor will perform another nonstress test. If everything is normal, you will not have to stay in the hospital. If the procedure fails, your doctor will talk to you about the possibility of having a vaginal delivery or cesarean immediately. Your doctor may also suggest repeating the external cephalic version.
What is the probability of successful external cephalic version?
The probability of successful ECV depends on several factors including:
- How close you are of your due date
- How much fluid is around your baby
- How many pregnancies have you had
- How much your baby weighs
- What position is the placenta
- What position is your baby
The average success rate is about 65%. Even if the procedure works at first, there is still a chance that the baby will turn back to breech. This also depends on the factors listed above.