Breech birth

 A breech presentation is defined as the condition in which the baby is in longitudinal lie and the podalic pole presenting at the pelvic brim with the head occupying upper pole of uterus. A breech birth is the birth of a baby from a breech presentation. In the breech presentation the baby enters the birth canal with the buttocks or feet first as opposed to the normal head first presentation. In breech presentation, fetal heart sounds are heard just above the umbilicus.

A breech position means that your baby is in a bottom-down position inside your womb. Usually your baby will settle into a head-down position in your pelvis around the eighth month of pregnancy. A head down position of the baby inside your womb is called a vertex or a cephalic position. 

When labor, nearly all (96 per cent) babies are lying head down in the uterus, but a few (about 3-4 per cent), will settle into a bottom-first, or a breech position. 

What factors would make me more likely to have a vaginal birth or a caesarean? 

• If your doctor is trained and experienced in handling breech births, she will consider you for a vaginal delivery if: 
• Given birth you've given birth vaginally before, as your vagina will be used to stretching
• There are no other features of your pregnancy that would make giving birth vaginally more risky
• An anaesthetist can be on standby to give local anesthesia in case your doctor has to do an assisted birth or emergency caesarean
• Facilities for a caesarean (if needed) will be available nearby

You may have to have a caesarean section if:

• Your baby is in a difficult position
• An ultrasound shows that your baby's head is tilted back (hyper-extended)
• Your baby's foot or feet are below its bottom or the baby is in a kneeling position - both of which are uncommon 
• Your baby is large (over 3.8 kilos) 
• Your baby is small (less than 2 kilos) 
• You have had a previous caesarean birth 
• You have a narrow pelvis 
• You have a low-lying placenta 
• You have pre-eclampsia or another condition that means either your health or that of your baby is at risk

As the number of breech vaginal births continues to fall, your doctor may not give you the choice. It may also get harder for you to find another doctor who has the requisite skills to conduct a vaginal delivery for your breech baby. Many doctors will be reluctant to treat a new patient who comes to them for the first time late in her pregnancy, at term or in labour. If you do get a caesarean section, read our article on recovery after caesareans to help you after the birth.

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