This information leaflet has been produced by Gateshead Health NHS Foundation Trust Maternity Unit to provide information to pregnant women whose baby is breech near the end of their pregnancy.
What is breech?
Breech means that your baby is lying bottom first or feet first in the womb (uterus) instead of in the usual head first position. In early pregnancy, breech is very common. As pregnancy continues, a baby usually turns naturally into the head first position. Between 37 and 42 weeks (term), most babies are lying head first ready to be born. However, 3 in every 100 (3%) babies are breech at the end of pregnancy.
- Extended or frank breech –the baby is bottom first, with the thighs against the chest and feet up by the ears. Most breech babies are in this position.
- Flexed breech – the baby is bottom first, with the thighs against the chest and the knees bent.
- Footling breech – the baby’s foot or feet are below the bottom.
Why some babies are breech?
Sometimes it is just a matter of chance that a baby does not turn and remains in the breech position. At other times certain factors make it difficult for a baby to turn during pregnancy. These might include the shape of the womb, the amount of fluid in the womb (either too much or too little), the position of the placenta or if there is more than one baby in the womb. The vast majority of breech babies are born healthy. For a few babies, breech may be a sign of a problem with the baby. All babies have a newborn examination, and breech babies will have a scan of the hips at 6 weeks old.
What can be done?
If you are 36 weeks pregnant and the baby is in a breech position, your obstetrician or midwife should discuss external cephalic version (ECV) – see Patient Information Turning a breech baby in the womb (external cephalic version).
What are my choices for birth?
Depending on your situation, your choices may include a:
- Caesarean delivery – this is a surgical operation where a cut is made in your abdomen and your baby is delivered through that cut
- Vaginal breech birth.
There are benefits and risks associated with both caesarean delivery and vaginal breech birth and these should be discussed between you and your obstetrician and / or midwife, so that you can choose the best plan for you and your baby.
Caesarean delivery
The Royal College of Obstetricians and Gynaecologists (RCOG) and the National Institute for Health and Clinical Excellence (NICE) recommend that caesarean delivery is the safest method of delivery for a breech baby around the time of birth, particularly for first time mums. Caesarean delivery carries a slightly higher risk for you, compared with the risk of having a vaginal breech birth. Caesarean delivery does not carry any long-term risks to your health outside of pregnancy. However, there may be long-term effects in future pregnancies for either you and/or your babies. These effects are not yet fully understood.
If you choose a caesarean delivery and then go into labour before the operation, your obstetrician should assess whether it is safe to proceed with the caesarean delivery. If the baby is close to being born, it may be safer for you to have a vaginal breech birth
Vaginal breech birth
A vaginal breech birth is a choice for some women and their baby. However, it may not be
recommended as safe in all circumstances. It is a more complicated birth, as the largest part of the baby is last to be delivered and in some cases this may be difficult.
Before choosing vaginal breech birth, it is advised that you and your baby are assessed. Your obstetrician may strongly advise you against a vaginal birth if:
- your baby is a footling breech
- your baby is in a certain position: for example, if the neck is very tilted back (hyper-extended)
- you have had a caesarean delivery in a previous pregnancy
- you have a narrow pelvis (as there is less room for the baby to pass safely through the birth canal)
- you have a low-lying placenta
- you have pre-eclampsia
What can I expect in labour with a breech baby?
You can have the same choice of pain relief choices as with a baby who is head first.
If you have a vaginal breech birth, your baby’s heart rate will be monitored continuously. In some circumstances, you may need an emergency caesarean delivery during labour. Forceps may be used to assist the baby to be born because the baby’s head is the last part to emerge and may need to be helped through the birth canal. A paediatrician will attend the birth to check the baby.
What if my baby is coming early?
If your baby is born before 37 weeks, the balance of benefits and risks of having a caesarean delivery or vaginal birth changes and these will be discussed with you.
What if I’m having more than one baby and one of them is breech?
If you are having twins and the first baby is breech, your obstetrician will usually recommend a caesarean delivery. The position of the second twin before labour is less important at this stage because this baby can change position as soon as the first twin is born. The second baby then has lots more room to move.
If you would like any further information on any aspects of breech, speak with your obstetrician or midwife.
How can I find out more information?
Please discuss any queries or concerns with your midwife or consultant during your appointment; alternatively if you need any more information please do not hesitate to contact the Maternity Pregnancy Assessment Unit to speak to a midwife.
Visit – National Institute for Health and Care Excellence
References
RCOG (2008) A breech baby at the end of pregnancy. Royal College of Obstetricians and
Gynaecologists.
Data Protection
Any personal information is kept confidential. There may be occasions where your information needs to be shared with other care professionals to ensure you receive the best care possible. In order to assist us improve the services available your information may be used for clinical audit, research, teaching and anonymised for National NHS Reviews. Further information is available in the leaflet Disclosure of Confidential Information IL137, via Gateshead Health NHS Foundation Trust website or the PALS Service.
This leaflet can be made available in other languages and formats
upon request.