Breech baby

At some time before birth, usually by 36 weeks’ gestation, most babies move themselves so they are head down, ready to come out of the birth canal the ‘right way’. If that doesn’t happen and the baby’s head is still up, and its bottom or feet are facing the birth canal, then this is called a breech presentation. This occurs in around 3 to 4 per cent of births.

Why is breech a concern?

Firstly, there is a higher rate of problems with babies who are breech. We’re not sure why that is, but all babies who are breech are given a pretty thorough checking to make sure they’re healthy.

Then there’s the birth itself.

In a normal delivery, the head, which is the biggest part of baby’s body, comes out first and the rest of the body is guided through afterwards. But when the body comes out first, it may be hard to guide the baby’s head out because the body may not stretch the birth canal quite enough for the baby’s head to come out easily.

As a result, birth does tend to be more traumatic and there is also more chance of a prolapsed cord, where the umbilical cord slips through the cervix into the birth canal first and is pushed against the baby’s body, which can stop the flow of blood through the cord.

But having said that, the vast majority of breech births are safe, with good outcomes for both the mum and baby.

Can you prevent a breech?

No, it just happens and you have no control over it.

Can you turn the baby?

Using a technique called external cephalic version (ECV) a very experienced obstetrician can manipulate your abdomen in an attempt to turn the baby into the preferred head-down position. This technique has a pretty successful hit rate, working for around 40 per cent of first-time mums and about 60 per cent of mums who have already had one or more babies.

Will you need a caesarean?

A caesarean is definitely safer, but that doesn’t mean it’s automatically done in every situation. In the largest trial of low-risk breech births, the risk of mum dying or baby becoming seriously sick was much lower in the planned caesarean group than for the planned vaginal birth group (1.6 per cent versus 5 per cent).

However, the risk of mum getting sick was around the same for both.

There is no doubt that planned caesareans for breech presentations have made huge improvements in health outcomes for both mums and babies. However, if you have a single, low-risk breech baby, you should be offered a natural birth rather than a caesarean straight off the bat.

High-risk breech, such as a footling breech, head extension, estimated foetal weight of more than 4kg, a suspected foetal anomaly or foeto-pelvic disproportion, would rule out a vaginal delivery in the majority of circumstances.