Obstetrics - My baby is breech

What is a ‘breech’ baby?

Most babies are lying with their head down at the end of pregnancy, but 3 or 4 in 100 babies are breech. This means that it is lying with its bottom down and it’s head up (near your ribs).

Your options are explained in this leaflet. These are:

• ECV (a procedure to attempt to turn baby)
• a planned vaginal breech birth or
• a planned caesarean birth

No matter what you decide, the most likely outcome is that you and your baby will be well.

ECV – External Cephalic Version (Turning the baby)

An ECV is when a doctor or midwife attempts to turn your baby using their hands on your tummy. This can be carried out after 36 weeks. 8 in 100 babies will turn head-down by themselves after 36 weeks without an ECV.

Benefits

If your baby turns, you are more likely to have a normal birth than a caesarean.

Risks

The chance of needing an urgent caesarean within 24 hours of an ECV is 0.5% (1 in 200). This is most often due to bleeding or concerns about the baby’s heart rate after the procedure. Your waters can break.

Will it work?

5 in 10 babies turn head down during an ECV. This is slightly higher if you have had a baby before (6 in 10) and slightly lower if it’s your first baby (4 in 10).

The chance of baby turning breech again after successful ECV is about 2-3 in 100.

Vaginal breech birth

Going into labour and giving birth vaginally with a breech baby is nearly as safe as giving birth to a head-down baby.

Points to note

We do not start (induce) your labour for you with a breech baby. If your baby needs to be born because there are concerns, we will advise you to have a caesarean birth.

There is no increased chance of your baby having long term problems (such as cerebral palsy) or being admitted to the neonatal unit compared to having a caesarean birth.

Benefits of vaginal breech birth

• Your baby decides the right time to be born
• You recover more quickly than after a caesarean
• Labour is sometimes quicker with a breech baby than with a head down baby
• On average, hospital stay is shorter compared to a caesarean birth
• The chance of needing forceps to deliver your baby’s head is LOWER than if your baby was born head-first

Risks of vaginal breech birth

• 2:1000 chance of baby dying around the time of birth, compared with 1:1000 for head-down vaginal birth and 0.5:1000 for planned caesarean birth.
• 4 in 10 women will need a caesarean when they plan a breech birth, either before or during labour (6 in 10 will have a normal birth)
• A caesarean during labour increases the chances of complications compared with a caesarean before labour
• There is a small chance your baby will need help with breathing in the first few minutes after birth. Most babies are well by 5 minutes
• The baby’s arms or head can get caught as it is being born – the midwife or doctor will use their hands to help the baby be born if this happens

Planned caesarean birth between 39-40 weeks

This is an operation to deliver your baby through a cut in your tummy. It is carried out between 39 and 40 weeks of pregnancy.

Benefits of planned caesarean birth

• Lower chance of complications than a caesarean carried out during labour
• Reduced risk of baby dying around the time of birth - 0.5 in 1000, compared to 1:1000 for head-down vaginal birth and 2:1000 for planned vaginal breech birth
• Reduced chance of injury to the vagina, bowel problems and pain during sex
• Reduced chance of loss of bladder control

Risks of caesarean birth

• Increased hospital stay – average is 4 days after caesarean birth and 2 days for normal birth
• Recovery time is longer than after a vaginal birth
• The normal amount of blood loss during a caesarean is about twice as much as a vaginal birth
• Damage to the bladder, bowel or kidneys requiring further surgery (this is rare)
• 2 to 3 in 100 babies have breathing problems after birth which can result in baby going to the baby unit
• Accidental cut to the baby – most heal well, with no scarring
• Increased risk in future pregnancies of stillbirth, excessive bleeding and problems with the placenta

For ways to encourage your baby to turn itself, see

https://www.spinningbabies.com/pregnancy-birth/baby-position/ breech/flip-a-breech/ or scan the QR code below