Breech delivery: Your questions answered

Breech delivery: Your questions answered 

 - Breech delivery: Your questions answered
Birth can be a daunting process and when something goes wrong unexpectedly it can be quite traumatic.

Chances are that if your baby is breech you will know about it before the birth. But even so, it helps to be prepared and know what to expect.

Breech birth can seem like a nightmare to most expectant mothers but most of time it won't pose any problem for your baby and the hospital staff will be on hand to help you through every step.

What is breech? 
This is where your baby is lying in the opposite position to what it should be.

Usually this means that your baby is lying bottom or feet first rather than the desired head-first position.

How common is breech birth? 
Breech birth itself happens to only 3 in every 100 pregnant women, but many babies are in the breech position in the first few weeks of pregnancy.

Your baby will usually naturally turn itself the right way round so there is no reason to be alarmed early on.

Is it dangerous for my baby? 
In the early stages of pregnancy your baby being in the breech position won't cause much alarm.

Problems can arise in breech birth if the umbilical cord gets caught around the baby's neck and interrupts the oxygen supply. Other problems can also arise in vaginal breech birth. That's why caesarean is the recommended option.

What happens if my baby is breech? 
Breech positions in babies is very common, dealing with this situation is pretty much a standard procedure for health specialists.

Problems start to arise if the baby has still not turned into the head first position by weeks 36-42. Your health advisor or midwife will assess you if this is the case and usually suggest an external cephalic version (EVC) as the first option.

What is EVC? 
This is when your midwife or health professional will put pressure on your tummy to try and turn the baby into the usual head-down position.

Your babies heart beat will be monitored closely throughout the procedure so that any distress can be countered.

This is not a particularly comfortable or painless procedure but it is much less painful than vaginal breech birth or the after effects of caesarean. This procedure normally works for 50 percent of breech babies but if it fails there are two options.

When should it not be used? 
This procedure should not be used in the following circumstances:
  • If caesarean is the only safe option for mother and child.
  • If you've experienced vaginal bleeding within the last 7 days
  • If there's abnormal cardiotocography
  • If there's a major uterine anomaly
  • If there are ruptured membranes
  • If it is a multiple pregnancy (except delivery of second twin).
What are the choices for birth? 
For the 3 percent of women that will have to have a breech birth there are only two options - either caesarean delivery or vaginal breech.

Caesarean delivery is recommended by the Royal College of Obstetricians and Gynaecologists (RCOG) and the National Institute for Health and Clinical Excellence (NICE) as the safest method for the baby around the time of birth.

As the main risk from breech delivery is the umbilical cord getting caught around the baby's neck preventing breathing, caesarean is the best way to combat this risk. Despite the decreased risk for your child, there will be a higher risk of complications for you due to anaesthetics.

However there are no major long term risks for your health but it will extend the recovery period after the birth.

Vaginal breech birth is a more complicated option but it can be an option. However this should only be performed by doctor or surgeon particularly trained in this type of birth and this can be quite hard to find.

You will be advised not to go ahead with a vaginal breech birth if:
  • Your baby's feet are below its bottom (this is known as a footling breech).
  • Your baby is very small or premature (under 2kg).
  • You have pre-eclampsia.
  • Your baby is large (over 3.8kg).
  • If you've had a caesarean delivery before.
  • You have a narrow pelvis.
If I'm having a home birth will I need to go to hospital? 
It will be better for the safety of mother and baby to go to hospital if the baby is breech.

Before you opt for a home birth your health advisor will assess you and if your baby is breech you will not be allowed a home birth as the safest option for yourself and your baby.

What if my baby is premature? 
Your health advisor will advise you on which is the best course to take if you are under 37 weeks pregnant and your baby is breech.


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