Considerations for Labor when your Baby is Breech

During most of your pregnancy, your baby is completely free to move around within your uterus.  Around week 32 or so, your baby will become so large that it cannot move around as much.  It becomes much more difficult for your baby to turn over, so whatever position it is in by this point is likely to be the position it is in for delivery.  Most babies settle into a head-down position.  If a baby is positioned such that the buttocks lead the way out of the uterus, it is called a "frank breech."  This is the most common type of breech birth. 

The head-down position is the safest position for delivery.  This is because the biggest part of your baby's body is usually its head.  If the head fits through your pelvis, then the rest of the its body should slip out fairly easily.  If the fetus is born bottom first, it is possible that the body will fit through the mother's pelvis, but the baby's head will get stuck at the level of the chin. This condition, known as a trapped head, is very dangerous.  If the baby's head gets trapped, the possibility of injury is high. Once the baby's body is born, the umbilical cord usually stops pulsating (just as it would during a normal delivery). This cuts off the oxygen supply from the mother to the baby. If the baby's head is still inside the uterus the baby cannot yet breathe on its own. Therefore, it is essential to deliver the baby as quickly as possible.

Sometimes a breech baby may be turned.  The best time to attempt this is between weeks 32 and 37 of pregnancy.  There are several methods you can discuss with your physician that may turn the baby, including external Version, chiropractic care, the "breech tilt", using music at the lower part of the abdomen, or homeopathic remedies such as moxibustion or pulsatilla.

Most doctors do not believe a vaginal delivery is possible for a breech birth, although some will wait to make that decision until a woman is in labor. You are more likely to be able to deliver your breech baby vaginally if:

-  The baby is full-term and in the frank breech presentation.
-  The baby does not show signs of distress as its heart rate is closely monitored.
-  The process of labor is smooth and steady; the cervix is widening and the baby is moving down.
-  The doctor estimates that the baby is not too big or the mother's pelvis too narrow for the baby to pass safely through the birth canal.
-  Anesthesia is available and a cesarean delivery can be performed on short notice.

There are risks involved in attempting a vaginal breech delivery.  If a vaginal delivery is attempted, electronic fetal monitoring will be used to monitor the baby's heartbeat throughout labor. A cesarean delivery may be considered if there are any signs that the baby may be in distress.  You should discuss these concerns thoroughly with your physician.

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