by Kathryn Kelly – NCT Practitioner and Tutor; Freelance writer
About 4% of babies present by the breech (bottom first, instead of head first) at the end of pregnancy. This is enough for it to be a normal variation of pregnancy, and before scans were routine many babies were not found to be breech until they were born. Babies move around a lot during pregnancy, and there are some reasons why babies might still be breech at the end of pregnancy. Some of these may have been picked up during a scan, while for others it might just run in the family. Not all breech presentations are discovered before labour starts, so all midwives are trained in how to support a breech labour.
If a breech presentation is discovered towards the end of pregnancy but before labour has started, your partner will be offered an ECV (External Cephalic Version), which is a procedure where an obstetrician attempts to massage the baby around into a head down position. Other options include moxibustion, a form of acupuncture using herbs, or adopting positions to encourage the baby to move.
Planning how to birth your breech baby is a balance of risks for mother and baby, and your decision may follow a discussion of any other complications, as well as a scan to confirm the exact position the baby is in. A planned caesarean birth may be recommended as research suggests it carries a slightly reduced risk for the baby. However, that can have implications for future pregnancies, as well as having significant implications for the mother’s wellbeing. Induction of labour is not recommended with a breech presentation. If it is known before labour starts that your baby is breech then you should be given unbiased information to enable you to make an informed personal decision about the birth. If a breech position is discovered in labour, and labour is progressing, then the Royal College of Obstetricians and Gynaecologists (RCOG) state that caesarean is not routine.
A vaginal breech birth need not be more difficult or painful than a headfirst birth. RCOG offers a leaflet on what happens if your baby is breech at the end of pregnancy, which states that there are the same options for pain relief. However, your carers are likely to ask the mother to step out of the water for the birth if she is using water during labour, and may suggest she avoid an epidural because it is linked to further interventions. During labour, continuous monitoring of your baby’s heartbeat will be recommended. The woman should adopt positions that are comfortable for her during labour, and the limited evidence suggests that the woman should be on all fours for the birth. If labour does not progress, then your carers will suggest calmly moving to caesarean birth.
Skilled support is essential for a vaginal breech birth, and all midwives and NHS doctors are updated in how to support breech birth as part of their regular training. Some women labour too fast for a caesarean and sometimes a breech position is not discovered until late in labour, so bottom-first births continue. However, if staff don’t get much experience with women then individuals may feel less confident. This is something you can discuss with them, and ask for staff who are confident, or referral to a unit where staff are confident.
If you would prefer to look for an alternative to NHS care, then independent midwifes usually have experience of natural breech births, and you would pay them directly for their services. If you use an Independent Midwife you can still use NHS services at any point in pregnancy or labour if you wish.
Babies who are breech at the end of pregnancy are more likely to have developmental hip dysplasia (DDH), and so you may be offered a scan a few weeks after your baby’s birth.