Breech Births: What You Need to Know to Have a Breech Delivery

When my midwife told me that my daughter was breech, I was given three options: plan a c-section, turn the baby with an ECV, or flip my baby naturally. A breech delivery was not even on the table.

A vaginal breech delivery is somewhat of a taboo term, especially in the US.  There are several misconceptions about this procedure, causing many women to lose their choice in the matter. Mama,  you deserve to be fully informed about your delivery options.

This post discusses delivering a breech baby and everything that entails. We’ll talk about the different breech delivery methods, risks, and common complications. The goal of this post is to inform and empower you to make the best decision for you and your child.

About the Breech Baby Series

I’m Erin and my passion is helping moms-to-be and new moms overcome their baby blunders. This topic, breech babies, is very close to my heart.

I found out that my baby was when I was 36 weeks pregnant.

This discovery started a frantic race to turn my breech baby before 39 weeks or face a planned c-section. During this time, I was confused, disappointed, and a little scared. The research and articles on breech pregnancies is vast, but overwhelming. But at the end of the day, I found the techniques that worked and turned my breech baby at 39 weeks.

That’s why I created this Breech Baby Series. I hope here you’ll find all of the answers you need to cope with your breech pregnancy.

Here are the other posts in the Breech Baby Series:

This post may contain affiliate links. If you make a purchase from one of the links I will make a small commission at no charge to you. I only recommend what I trust. Blunders in Babyland does not diagnose, treat, or give out any professional advice for any medical conditions. 

 

What is Breech Delivery?

In this article, you’re going to see two main terms, a breech birth, and a breech delivery. While these terms are used interchangeably, it’s very important that you understand the difference.

Breech Birth

A breech birth is a very hands-off, natural approach to giving birth to a breech baby.

Mary Cronk, a world-famous midwife, spearheaded the “Hands-Off-That-Breech” concept that many providers still adhere to today. This approach states that the best way to birth a breech baby is with minimal medical intervention. In fact, with this methodology, many of the complications associated with a breech baby stem from the injuries caused by inexperienced doctors.

For example, when a doctor attempts to pull or twist the baby to help her leave the womb, he may unwittingly cause damage to her body.

Instead, Mary suggests that providers should remain hands-off as long as the labor is progressing. If it doesn’t progress (say, the baby’s head gets stuck in the pelvis), it’s time for a c-section.

If you’ve always dreamed about a completely natural labor, this is probably the technique that you’ll gravitate towards.

 

Breech Delivery

If you manage to find a provider that will agree to assist with a vaginal breech labor, this is probably the method that he will feel most comfortable with.  A vaginal breech delivery is a step-by-step process, that requires constant supervision.

There are actually three types of vaginal breech deliveries:

  • Spontaneous: where the baby is expelled with no manipulation (similar to Mary Cronk’s hands-off approach)
  • Assisted: The baby progresses to the head and shoulders when the provider intervenes. The provider might use gentle maneuvers to help the baby clear the pelvis or rotate, like the shoulder press or Frank’s Nudge.
  • Total Breech Extraction: Basically, grab the feet and pull. Obviously, this type of delivery isn’t ideal and is only used for second twin situations.

The actual procedure depends largely on your doctor’s experience, training, and preferences. Some doctors will administer oxytocin at the beginning of the labor to ensure that the cervix dilates properly before expulsion. Other doctors may refrain from oxytocin due to the associated complication. In most cases, you and your baby will be monitored very closely.

Some mothers will feel more comfortable with a breech delivery than a breech birth, simply because it’s highly managed. However, there are a few disadvantages, such as the controversy behind using oxytocin and the possibility of injuries due from an intervention.


What are the Requirements for a Breech Delivery?

Not every woman can have a breech delivery. It depends on your baby’s position in the womb, your gestation, and physical details.

With the exception of a second twin, most doctors will not even attempt to vaginally deliver a footling breech. And for good reason. With a frank or complete breech, your baby’s butt may stretch the birth canal adequately, allowing his head to pass through. There are just too many complications associated with a footling breech, including hyper-extension (if your baby’s head gets stuck) and cord prolapse.

In addition to your breech baby’s position, there are several other requirements:

  1. Doctor that is willing to do it. Canada, the UK, and Australia are much more open to vaginal breech deliveries. It can be difficult to find a provider to agree to a breech delivery in the US.  (If you’re a Canadian mommy, here’s an excellent article on breech deliveries just for you).
  2. Baby must be full-term. Preemies are typically too fragile for a breech delivery.
  3. Can safely pass through the birth canal. Sometimes a baby will just be too big to pass through through your pelvis in a breech presentation. If you have a planned vaginal breech delivery, your doctor or midwife may request x-rays to confirm your dimensions. During labor, your doctor will try to estimate.
  4. Anesthesia and an emergency c-section must be readily available. This doesn’t mean that you can’t have a home breech delivery, but you need to have a quick backup plan in place.

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Breech Births: What You Need to Know to Have a Safe Breech Delivery

Risks of a Breech Delivery

Before deciding on a vaginal breech delivery, you need to know the risks associated. This section isn’t meant to sway you from pursuing a breech delivery (obviously, there are risks associated with a vaginal cephalic delivery and c-sections…), but to give you the information you need to make the right decision for your family.

Maternal Complications of a Breech Delivery

  • Risk of perinatal injury
  • Cervical tear
  • Approximately 40% of breech deliveries end up with an emergency c-section
  • Labor can start and stop. This can cause exhaustion and further risks.

Fetal Complications for a Breech Delivery

  • Fetal Death. One study suggests that the morbidity of breech baby births is 9/1000, while another suggested only  2/1000.
  • Risk associated with using forceps
  • Risk of irregular head shape
  • Cord prolapse. This is especially the case with a footling breech.
  • Genetic abnormalities . There’s some chicken or the egg controversy here.
  • Head entrapment
  • Shoulder dystocia complications
  • Internal organ damage (rare, but it can happen if your provider doesn’t know what he’s doing)
  • Umbilical Cord can become wrapped around the baby’s neck

Breech Complications After Birth

  • Low AGBAR scores
  • Shoulder dystocia complications
  • Cervical spine injury (because of the hyperextension from a entrapped head)

Related Post: Delivering a Breech Baby: The Pros and Cons of an External Cephalic Version vs a C-Section


5 Tips for a Successful Breech Delivery

Find a Doctor or Midwife that Specializes in a Breech Delivery

Since studies in the 1950s found that breech deliveries are linked to increased fetal injury and deaths, many physicians are no longer trained in this practice. The ones that are may not be able to assist due to hospital regulations or insurance restrictions.

However, even if your doctor agrees assist with a vaginal breech delivery, it’s absolutely paramount that she knows exactly what she’s doing. If your doctor is not trained to handle the unique situations that arise with breech deliveries, she can cause more injury than good. 

Many moms are finding providers that actually specialize in breech births. For example, some midwifery groups are trained for breech home deliveries, like in Katie’s story.

 

Consider Hiring a Doula

A breech delivery is quite the commitment. If you’d rather have an experienced doctor to oversee your labor, consider hiring a doula to help you out. A doula’s expertise and encouragement can make all the difference during this process.

 

Prepare for Labor

You should always prepare your body for labor, but this is especially the case for a vaginal breech delivery. With the vast power of the interwebz, it’s super easy to do so. In addition to the resources below, Pulling Curls offers an awesome free Beginning Prenatal Course for new moms just like you!

There are several ways you can prepare yourself:

  • Kegels. Multiple times a day. As a mom that didn’t do her kegels, I am begging you to! If a breech pregnancy doesn’t inspire you to do your kegels, then maybe the idea of peeing your pants postpartum will.
  • Take a labor class. One of the best investments you can make during pregnancy is attending a labor class. Earlier I mentioned the free Beginning Prenatal Course, which is great for getting your feet wet. The Online Prenatal Course for Couples is on another level. While it’s not created for breech births, the course will teach you and your partner the most effective techniques for laboring and explain every scary aspect about the delivery process in a super simple format.
  • Practice your Zen time. A relaxed body can make a world of difference during a breech delivery. You can take up prenatal yoga (if you’re able to) or practice breathing exercises and meditation in a quite place, like the bathtub.

 

Practice Breech Labor Positions

Whether you opt for a  hands-off breech birth or an assisted breech delivery, you need to know your labor positions. Research indicates that upright positions tend to produce more successful labors, fewer perineal and fetal injuries, and a lower likelihood of interventions.

Mary Cronk recommends several breech-specific positions that will be useful even if you decide to have a monitored breech delivery.

Also note that your labor positions will most likely change as your labor progresses. For example, in the beginning you may favor the forward leaning, then move to what Mary calls the Christian position (hands and knees), and then the Muslim prayer (hands and knees but forward leaning).

 

Consider the Pros and Cons of Anesthesia Before Labor

Once you’re in labor, everything can change. I went into labor knowing that I didn’t want an epidural. 19 hours and a posterior baby later, I was injected with the most lovely epidural an exhausted pregnant lady could ever ask for.

There are pros and cons to an epidural, especially in a breech situation. An epidural slows the birthing process down, which can increase the chances of augmentation and malformations due to delivery tools. Having said that, an epidural can finally allow your body to relax, which can progress your labor. In addition, some studies suggest that an epidural may prevent you from pushing prematurely.

 

Is a Breech Delivery Right for You?

The fact is, there are additional risks with a breech delivery and only you can decide if it’s the best option for your family. Aside from the desire for a natural birth, there are several other conditions that inspire women to choose a vaginal breech delivery, such as the risks associated with ECVs, planned c-sections, or a repeat c-sections. On the other hand, the risks associated with a breech delivery can drive many women to these same procedures.

It’s a difficult decision, Mama.

Don’t feel bad if you’re still feeling torn. If you’d like to read more information about breech births, ECVs, or turning your breech baby, I hope you’ll check out more posts in this series. You can also follow my Pinterest for additional breech resources and pregnancy tips.

Now, my request to you: If this post helped you gain some clarity, please share it! There are so many women that are facing the same decisions as you. Let’s help each other!

Good luck, Mama. You’re almost there!

 

 

Medical Disclaimer: While I can give you advice based on my experience, none of this post should be substituted for actual medical advice.

Delivering a Breech Baby - Is a Breech Delivery Safe? Complications, Risks, and Facts About a Breech Delivery

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