About 3-4 percent of all pregnancies will result in the baby being breech. A breech pregnancy occurs when the baby (or babies!) is positioned head-up in the woman's uterus, so the feet are pointed toward the birth canal.
In a “normal” pregnancy, the baby will automatically turn inside the womb into a head-down position to get ready for birth, so a breech pregnancy presents a few different challenges for both mother and baby.
There are three different types of breech pregnancies: frank, complete, and footling breech, depending on how the baby is positioned in the uterus. With all types of breech pregnancies, the baby is positioned with its bottom toward the birth canal instead of the head.
Doctors can't say exactly why breech pregnancies occur, but according to the American Pregnancy Association, there are many different reasons why a baby might position itself the "wrong" way in the womb, including:
- if a woman has had several pregnancies
- in pregnancies with multiples
- if a woman has had a premature birth in the past
- if the uterus has too much or too little amniotic fluid, meaning the baby has extra room to move around in or not enough fluid to move around in
- if the woman has an abnormally shaped uterus or has other complications, such as fibroids in the uterus
- if a woman has placenta previa
A baby is not considered breech until around 35 or 36 weeks. In normal pregnancies, a baby usually turns head-down to get into position in preparation for birth. It's normal for babies to be head-down or even sideways before 35 weeks. After that, though, as the baby gets bigger and runs out of room, it becomes harder for the baby to turn and get into the correct position.
Your doctor will be able to tell if your baby is breech by feeling your baby's position through your stomach. They will also most likely confirm that the baby is breech using an ultrasound in the office and in the hospital before you deliver.
In general, breech pregnancies aren't dangerous until it's time for the baby to be born. With breech deliveries, there is a higher risk for the baby to get stuck in the birth canal and for the baby's oxygen supply through the umbilical cord to get cut off.
The biggest question with this situation is what is the safest method for a woman to deliver a breech baby? Historically, before cesarean deliveries were common, doctors, and more commonly midwives, were taught how to handle breech deliveries safely. However, breech deliveries do have the risk of more complications than a vaginal delivery.
A 2000 study that looked at over 2,000 women across 26 countries found that overall, planned cesareans were safer for babies than vaginal births during breech pregnancies. The rates of infant death and complications were significantly lower with planned cesareans for breech babies. However, the rate of complications for mothers was about the same in both cesarean and vaginal birth groups. A cesarean is major surgery, which could account for the rate of complications for mothers.
The British Journal of Obstetrics and Gynecology also looked at the same study and concluded that if a woman does want to have a planned vaginal delivery with a breech pregnancy, she might still have a chance to have a safe delivery with a trained provider. Overall though, most providers would prefer to take the safest route possible, so a cesarean is considered the preferred method of delivery for women with breech pregnancies.
So what should you do if you have a breech pregnancy? While you will most likely have to talk with your doctor about scheduling a cesarean, there are also ways you can try to turn your baby. Success rates for turning a breech pregnancy depend on the reason your baby is breech, but as long as you try a safe method, there's no harm.
External version (EV)
An EV is a procedure in which your doctor will try to manually turn your baby into the correct position by manipulating the baby with their hands through your stomach.
According to the American College of Obstetricians and Gynecologists, most doctors will suggest an EV between 36 and 38 weeks of pregnancy. The procedure is usually performed in the hospital. It requires two people to perform and the baby will be monitored the entire time for any complications that might require delivering the baby. The ACOG notes that EVs are successful only about half of the time.
Some mothers claim to have had success using an essential oil, like peppermint, on their stomachs to stimulate the baby to turn on its own. As always, however, check with your doctor before using essential oils, as some are not safe for pregnant women.
Another popular method for women with breech babies is inverting their bodies to encourage the baby to flip. Women use different methods, like standing on their hands in a swimming pool, propping up their hips with pillows, or even using the stairs to help elevate their pelvis.
Your doctor will probably be the one to let you know if your baby is breech. You should talk to them about your concerns for your baby's breech birth, including the risks and benefits of choosing a cesarean, what to expect from surgery, and how to prepare.