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McKesson Clinical Reference Systems: Women's Health Advisor 2002.2
Spanish version
Illustration
Vaginal Delivery of a Breech Baby
In this discussion you will learn what a breech baby is and
what the risks are for a breech delivery. You will find out
when it is considered safe to allow a vaginal delivery of a
breech baby and what your health care provider will do to
make sure the delivery goes smoothly.
What is a breech baby?
A breech baby is a baby in the breech position in the
uterus. This means that the baby is in a position where the
bottom, knees, or feet would come out before the head in a
delivery through the vagina (birth canal).
How will I know if my baby is breech?
If your baby is in the breech position, you may feel the
baby's head moving under your rib cage. Or you may feel as
if you have a hard knot up under your ribs. Your health
care provider may be able to feel the baby's head. He or
she may hear the baby's heartbeat above your navel (belly
button) rather than in your lower abdomen.
How often are babies in the breech position?
The breech position is common in early pregnancy. About one
third of all babies are breech at 24 weeks, but by the 32nd
week most babies are in the head-down position. When there
are twins, often one of them is in the breech position.
If your baby is in the breech position, your health care
provider may try to turn the baby to the head-down position
after 36 weeks. He or she may use a procedure called
external cephalic version to do this. If it is not
successful, your provider will leave your baby in the breech
position until you deliver. Most babies change position by
the time labor begins. By the time of delivery, only about
3% of babies are still breech.
What are the risks of a breech delivery?
A breech delivery is the birth of a baby bottom-first or
feet-first instead of head-first. Because your breech
baby's head will be the last part to come through the birth
canal, special problems might occur that could make vaginal
delivery unsafe. If the baby's head is not delivered
quickly after the rest of the body, there is a risk of brain
damage, suffocation, and death.
The head is the largest part of the baby that must fit
through the birth canal. During a normal head-first
delivery, there is time during labor for your baby's head to
slowly mold itself so that the diameter of the head is
smaller. The head can then pass through the birth canal
more easily.
When your baby is breech, the baby's bottom, instead of the
head, molds to the birth canal. Once the bottom has been
delivered, the abdomen, chest, arms, and head follow
quickly. This does not allow much time for your baby's head
to mold itself. It is then harder for the head to pass
through the birth canal.
Also, because your baby's head, the largest part of the
body, does not enter the birth canal first, the cervix
(opening to the birth canal) may not open as much as it
should. This may make it difficult for the baby's head to
pass through the cervix. The risk is especially high for
premature babies weighing less than 5 pounds because their
small bodies may not stretch the cervix enough for the
relatively large head.
If your pelvic bone structure is too small or the baby's
head is too big, the head may have trouble even moving into
the birth canal, making a vaginal delivery dangerous.
When is it safe to have a breech baby with a vaginal
delivery?
A breech baby can be delivered vaginally instead of with a
cesarean section if:
- The progress of labor is not slowed or abnormal in any
way.
- Your baby's head is not too large.
- Your baby weighs less than 8 pounds but more than 5
pounds.
- Your baby's feet are not hanging down below its bottom
and ready to come out first (footling breech).
- Your baby's legs are extended out straight at the knees
(frank breech) instead of bent up to the abdomen
(complete breech).
- Your baby's head is flexed with the chin tucked on the
chest.
- Your pelvic bone area is wide enough.
- You have not had a cesarean section in the past.
- Your baby's heart rate does not slow down during labor.
- Your health care provider has experience in vaginal
breech deliveries.
- Your weight before pregnancy was less than 180 pounds.
Before delivery your health care provider may order an x-ray
to measure the size of your pelvis and an ultrasound to
determine the size of the baby, the type of breech, and the
position of the head.
Will I have to do anything different during a breech
delivery?
During the delivery, you will be instructed to breathe and
push as for a normal delivery. While your baby is coming
out through the birth canal, your health care provider or an
assistant will press down firmly on your abdomen over the
top of your uterus to help the delivery.
Your health care provider will probably perform an
episiotomy to make your baby's delivery easier. An
episiotomy is a 1- to 3-inch cut made from your vagina
towards your rectum to make the opening bigger. The
episiotomy is stitched up after the delivery.
Your health care provider may use forceps to ensure a smooth
delivery while protecting your baby's head. If necessary, a
cesarean delivery will be done.
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