Birth

Babies that are breech are more than likely delivered via C-section.
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Here’s What Happens If Your Baby Is Breech

You still have some options!

by Sarah Jaffe

Several books on pregnancy, and tons of information online, have shared with expectant parents that, during the 8th month, just as you’re nearing labor, most babies should be in a head-down, bottoms-up position. But what if your baby isn’t like “most babies?” If your baby isn’t head-down and is in a breech position, does that mean you’re definitely going to need a C-section? If your baby turns to the head-down position before he’s full term, likely not. If he doesn’t, the answer is yes, you’ll most likely need a C-section, though that answer also has a few caveats.

What Does It Mean for A Baby to Be Breech?

A “breech” baby is one whose feet or rear end is down closer to their parent’s cervix and whose head is closer to the top of the uterus. (A fetus can also be “transverse,” which means that they’re essentially side to side, or “cephalic,” which means head-down.) But just because a baby is breech at some point during your pregnancy doesn’t mean that he’ll stay that way.

What To Expect noted that about a quarter of babies are breech at 28 weeks, but only three or four out of every 100 babies are breech at full-term. If you’re still early in your third trimester, or even mid-way through, there’s ample time for your baby to find their way head-down. Even if they takes their time getting to the head-down position, a breech baby who flips before 39 weeks (when schedule C-sections typically take place) can likely be delivered vaginally just the same as a baby who flipped much earlier.

If a baby hasn’t flipped by approximately 36 weeks, a procedure called an External Cephalic Version (ECV), in which a doctor tries to rotate the baby by pressing on the expectant parent’s abdomen, can help coax a reluctant baby to the head-down position. But, that doesn’t always work: The American College of Obstetricians and Gynecologist has found that ECVs are successful 58% of the time. Jenna Cecot, a registered diagnostic medical stenographer who has been in the field for 15 years, tells Romper that in her experience, some babies flip easily during the procedure, but others stay put: “Typically, babies who were going to flip cephalic did so with relatively little effort on the part of the doctor.”

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What Happens If Your Baby Stays Breech?

It is not impossible nor unheard of to have a vaginal delivery for a baby who’s still in the breech position at the time of birth — but it is rare. The site Evidence Based Birth reported that 93.8% of all breech babies were born by C-section in 2019. Lesley Alexander, a labor and delivery nurse at SSM De Paul Hospital in St. Louis, tells Romper that in her experience, breech babies are not delivered vaginally. “The risk is simply too high when a C-section is a viable option. Obviously, there are risks with a C-section as well, but those are more easily mitigated. Most providers just do not have the experience in delivering a breech baby, so they do not want to take the risk.” Breech babies who are born vaginally have the risk of their head getting stuck during labor or of experiencing cord prolapse, in which the umbilical cord becomes compressed during their birth process, both of which can decrease the baby’s oxygen supply and lead to brain damage or loss of life.

In 2000, a study called the Term Breech Trial compared outcomes for vaginal versus Caesarean deliveries of over 2,000 breech births and concluded that negatives outcomes were significantly lower for breech babies born who were born via C-section. In response to the study, The American College of Obstetricians and Gynecologists issued a statement that “planned vaginal delivery of a term singleton breech may no longer be appropriate.” In 2006, they softened that stance somewhat; current guidelines state that determining the mode of breech birth “should consider patient wishes and the experience of the healthcare provider” and that “planned vaginal delivery of a term singleton breech fetus may be reasonable under hospital-specific protocol guidelines for eligibility and labor management.”

But because vaginal breech births are rare, and have become more so during the past 20 years, finding a healthcare provider with the necessary experience and training to attempt a vaginal delivery of a breech baby is its own challenge. In a 2017 article for Elle, Courtney Doggart describes her efforts to find a provider who would deliver her breech baby; even in New York City, she could only find a handful of doctors who would do it, and the doctor she found did not take any insurance.

Planning For A C-Section Birth

Parents who were hoping to avoid a C-Section can feel disappointed when their babies stay breech. Elizabeth, an Arlington, Virginia mom, tells Romper via Facebook message that she and her partner tried “just about everything” to try to flip her breech baby, including an EVC procedure that was not successful. Her care team let her go past her due date to 41 weeks, but ultimately she had to have a C-Section when her son didn’t budge out of the breech position. Despite having hoped for a different outcome, being prepared for the possibility of a C-Section and being educated about the process helped her. “I’m really glad we had taken birthing classes and understood both vaginal births and C-sections, and we were familiar with non-medicine pain relief options, but also knew all about the different types of anesthesiology... I felt much more calm in the moment because even as things changed from our original — medicated, vaginal birth — plan, we both knew and understood the options we had.”

Experts:

Lesley Alexander, Labor and Delivery Nurse, SSM Health DePaul Hospital-St Louis,

Jenna Cecot, registered diagnostic medical stenographer

Studies:

Hannah, M. E., Hannah, W. J., Hewson, S. A., Hodnett, E. D., Saigal, S., & Willan, A. R. (2000). Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Term Breech Trial Collaborative Group. Lancet (London, England), 356(9239), 1375–1383. https://doi.org/10.1016/s0140-6736(00)02840-3

American College of Obstetricians and Gynecologists (2000, reaffirmed 2012). External cephalic version. ACOG Practice Bulletin No. 13. Obstetrics and Gynecology, 95(2): 1–7.