Breech baby at the end of pregnancy
The Royal College of Obstetricians and Gynaecologists has published updated patient information to help women and their partners understand what it means if your baby remains in breech position after 36 weeks of pregnancy, and the options available to deliver your baby.
What is breech?
Babies lying bottom first or feet first in the womb instead of in the usual head-first position are called breech babies. It is very common in early pregnancy. By 36–37 weeks of pregnancy, most babies turn naturally into the head-first position. Only 3–4 in every 100 (3–4%) babies remain in the breech position towards the end pregnancy.
Why is my baby breech?
It may just be a matter of chance that your baby has not turned into the head-first position. But there are certain factors that make it more difficult for your baby to turn. These include whether this is your first pregnancy, your placenta is low-lying, and you have more than one baby.
Very rarely breech may be a sign of a problem with the baby. If this is the case, such problems may be picked up during the scan at 20 weeks.
What if my baby is breech towards the end of my pregnancy?
If your baby is breech at 36 weeks, your options will be discussed with you. These include trying to turn your baby into the head-first position by external cephalic version (ECV), a planned caesarean birth, or a planned vaginal breech birth.
What does ECV involve?
ECV involves applying gentle but firm pressure on your abdomen to help your baby turn to lie head first. It is usually performed after 36 or 37 weeks of pregnancy. ECV is carried out in hospital, by a doctor or a midwife who have been trained in ECV. Medication is given by injection before the ECV to relax the muscle of your womb. An ultrasound scan will see whether your baby has turned.
ECV is successful for about 50% of women. There is a small chance that your baby will turn back to the breech position.
If the ECV is unsuccessful, your healthcare professional may try again on another day, or discuss your options for birth.
If ECV is successful, you are more likely to have a vaginal birth.
Is ECV safe for me and my baby?
ECV is generally safe with a very low complication rate.
Some risks following an ECV include a slighter higher chance needing an emergency caesarean, forceps or vacuum birth during labour.
Immediately after ECV, there is a 1 in 200 chance of you needing an emergency caesarean birth because of bleeding and/or changes in your baby’s heart beat.
There are some situations when ECV shouldn’t be carried out, such as if you have had recent vaginal bleeding or your waters have broken early. Your doctor or midwife will discuss with you if ECV isn’t suitable for you and explain why.
Is there anything else I can do to help my baby turn?
No scientific evidence supports that lying down or sitting in a particular position can help. Some evidence suggests burning a Chinese herb called Mugwort at 33–35 weeks of pregnancy may help your baby to turn. This should be performed under the direction of a registered healthcare practitioner.
What are my options for birth if my baby remains breech?
“Depending on your situation, your choices are planned caesarean birth or planned vaginal breech birth. There are benefits and risks associated with each option,” explained Dr Geeta Kumar.
Research shows that planned caesarean birth is safer for your baby than a vaginal breech birth. Caesarean birth carries slightly more risk for you than a vaginal birth and can increase your chances of problems in future pregnancies.
For a vaginal breech delivery, you will need to be cared for by a specialist team. You should plan a hospital birth where you can have an emergency caesarean birth if needed, as 4 in 10 (40%) of women planning a vaginal breech birth do need a caesarean section. Induction of labour is not usually recommended. While a successful vaginal birth carries the least risks for you, it carries a small increased risk of your baby dying around the time of delivery or serious short-term complications.
What can I expect in labour with a breech baby?
You have the same choices for pain relief as with a baby who is in the head-first position. If you need an epidural, there is an increased chance of a caesarean birth. Your baby’s heart rate will usually be monitored continuously. If there are concerns or your labour is not progressing, you may need an emergency caesarean birth.
What if I go into labour early?
If you go into labour before 37 weeks of pregnancy, the benefits and risks of having a caesarean birth or vaginal birth changes and these will be discussed with you.
What if I am having more than one baby and one of them is breech?
If you are having twins and the first baby is breech, a planned caesarean birth is usually recommended. But if the first baby is head first, after it is born, the second baby will have more room to move and it may naturally turn or a doctor may be able to help the baby to turn.
“If you have a breech baby, you may feel anxious and have concerns. If you do, speak to your midwife or GP – they will be happy to give you advice and support you,” said Dr Geeta Kumar.
The RCOG patient information on “Breech baby at the end of pregnancy” can be found here: www.rcog.org.uk/en/patients/patient-leaflets/breech-baby-at-the-end-of-pregnancy/
This information has been developed by the RCOG Patient Information Committee and is based on current guidelines. For more information about RCOG’s Patient Information, please visit: www.rcog.org.uk/en/patients/patient-leaflets/