Birthing a Breech Baby
It is estimated that one in 25 full-term births are breech births. Conventional wisdom has held that these are abnormal births and happen because something is wrong either with the mother or with the baby. In the mother’s case, there may be a physiological reason relating to the shape of her uterus that prevents a baby from being able to turn head down. On the baby’s side, it has been assumed that there is something medically wrong or undeveloped in the baby even though the vast majority of breech babies are born healthy with no medical indications for their breech position.
It should be noted that until later in the second trimester, most babies are in a breech position. When the head becomes heavy enough, the baby will normally turn head down and then settle into birth position. This change in position can occur near the end of the pregnancy, but sometimes, not until labor starts. Some babies who are born prematurely (at 37 weeks of gestation or earlier) may still be in a breech position at the onset of labor.
Let’s just review the breech positions.
Breech Birth Positions
Frank Breech (courtesy of Royal College of Obstetricians and Gynaecologists)
Extended or Frank Breech Position – The baby’s buttocks are positioned down and the legs are straight, with the feet up around the head. This is the most common breech presentation.
Flexed (Complete) Breech (courtesy of the Royal College of Obstetricians and Gynaecologists)
Complete or Flexed Breech Position – The baby’s bottom is positioned down, but the knees bent so that the feet are also facing down.
Footling Breech (courtesy of the Royal College of Obstetricians and Gynaecologists)
Footling Breech Position – The baby’s feet are positioned to come out first.
Breech Birth Options
For many generations, North American doctors have thought that the safest way to deliver a baby in the breech position is by cesarean section. The Royal College of Obstetricians and Gynaecologists recommends cesarean section for breech deliveries and most health care providers in the United States will not even consider a vaginal delivery.
In certain circumstances, cesarean section is the safest method of delivery for mother and baby.
There is an increasing level of support, however, for vaginal deliveries of breech babies. Proponents of vaginal deliveries say that it can be done safely. If the baby is full-term, does not show any sign of distress, if labor is progressing and the baby is not too big, then vaginal delivery may be an option. While some gynecologists are becoming more supportive, women who decide they want a vaginal delivery — especially if they elect for a home birth, will need to find a midwife.
Mary Cronk’s article “Hands off the breech!” led the upswing in midwives learning the skills to help moms deliver breech babies vaginally. It is a trend that is sweeping through many countries outside of North America. The key to a successful vaginal breech delivery is getting the woman off of her back. The lithotomy and even semi-sitting position, which most hospitals encourage, is not conducive to a successful vaginal delivery. Breech deliveries are better done on the hands and knees.
It is important to not induce a breech birth. This will force the baby through the pelvis before the pelvis and baby are ready. Breech babies should not be delivered with forceps or other extraction methods. In most cases, the woman’s body and baby will do what they’re made to do. In these situations, a hands off approach is the best approach. A cesarean section should be reserved for those cases when labor doesn’t progress and if in the second stage of labor, the buttocks or feet do not come down.
Conclusions about Breech Birth
There is so much information out there. So much more than even 10 or 15 years ago. Although the current obstetrical practice in North America prefers cesarean section delivery for breech babies, it is no longer the absolute. Women do have options available to them. It is impossible to get all the facts and explore all the options and then choose which is the best option based on each woman’s individual circumstances.
In researching for the past series of articles on midwives and breech births, I found these three amazing videos of breech home births. It is important to remember that even under the best of circumstances, this may not be possible for all women, but I thought it was important to see.
Darlene Oakley is a freelance writer for EmpowHER.com.
Sources:
Breech Babies. Women’s Health. Web. May 1, 2012.
http://www.womens-health.co.uk/breech.asp
A breech baby at the end of pregnancy – information for you. Royal College of Obstetricians and Gynaecologists. Web. May 1, 2012.
http://www.rcog.org.uk/womens-health/clinical-guidance/breech-baby-end-pregnancy
“Hands off the breech!” Cronk, Mary. AIMS Journal, 2005, Vol 17 No 1. Web. May 1, 2012.
http://www.aims.org.uk/Journal/Vol17No1/handsOff.htm
Breech Births. American Pregnancy Association. Web. May 1, 2012.
http://www.americanpregnancy.org/labornbirth/breechpresentation.html
Frank Breech Birth Video. Homebirth: A Midwife Mutiny. Web. May 1, 2012.
http://www.homebirth.net.au/2010/01/frank-breech-video.html
Birth Video of a Breech Baby. Homebirth: A Midwife Mutiny. Web. May 1, 2012.
http://www.homebirth.net.au/2008/04/breech-birth.html
Frank breech home birth. SpinningBabies. Web. May 1, 2012.
http://spinningbabies.blogspot.ca/2010/06/baby-june-home-breech-birth-june-2010.html
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