Breech means that the buttocks of the baby are closest to the birth canal instead of the baby’s head. One out of every 25 full term babies will be born in the breech position. There are 3 variations of the breech position:
Footling breech, where one or both legs of the baby are folded with the footor feet close to the birth canal; the feet will be born first in this position.
Frank breech, where the legs are not folded but are straight, with the feet near the head.
Complete breech, where the legs are folded at the knees and the feet are near the buttocks.
Caeserean section (C-section) has become the preferred mode of delivering babies in breech positions but societal pressure for a natural birth has meant some women and midwives are questioning this recommendation.
So, what does the science say?
There have been several large studies conducted in the last decade or so which have compared planned C-section with vaginal delivery. In the only randomized trial, women with a frank or complete breech baby were randomly allocated to planned C-section or vaginal birth.
Outcomes were similar between the groups for the mothers but were significantly worse for the babies in the vaginal birth group: more babies died before, at, or shortly after birth or were in a bad condition once born (e.g. low Apgar score) for the group of women who had a vaginal birth, compared with women who underwent a C-section.
A recent study published in 2014 which looked at neonatal outcomes recorded on a Dutch national perinatal registry showed similar outcomes. The researchers found that as there was an increase in C-sections for breech babies, there was a decrease at the same time in infant deaths in the period before, during and after birth. In fact, it was estimated that there is a 10-fold increase in mortality for vaginal delivery of a breech baby, compared with C-section.
Of course, mothers with a breech baby should be able to have the autonomy to be able to decide what kind of birth they have, but this decision should be made with a full understanding of the risks involved. Although the overall risk of bad outcomes for a breech vaginal birth is still quite low, if something does go wrong it can have serious repercussions for the baby.
Can I manually turn my baby around before birth?
It is possible to move the baby from a breech position into a head-down (orvertex) position before labor starts. First, a medication which relaxes the uterus is given and, then, the physician will try to manually turn the baby around by putting their hands on the baby’s buttocks and head and attempting to roll he or she over.
This procedure is normally done between 37–42 weeks, as normally before this period the baby will turn around by themselves. There are risks involved with the procedure but these are generally quite low. In an analysis of 12, 955 women undergoing this procedure, the rate of serious complications (stillbirth or placental abruption) was 0.24% and water breaking occurred in 0.22% of women.
However, as with any medical procedure or process, the potential benefits should be balanced against the possible risks, even if those risks are low.
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