Causes of Breech Birth

In the initial stages, your baby is small and moves in the direction of the amniotic fluid. However, she grows, the cavity around her shrinks, making it difficult to move around. She eventually moves into the vertex position.

In this case, an excessive amount of amniotic fluid in the uterus allows the baby to move around even more and could bring it to a breech position before delivery.

The head is usually heavier than the rest of the body. This makes it easy for the baby to move into the head-first delivery position.

However, sometimes the cephalic end (towards the head) of the neural tube does not close between the 23rd and 26th day of pregnancy. This causes a defect in brain development, known as anencephaly.

A major portion of the baby's brain and skull fail to develop. So the baby's head is comparatively light and moving becomes to the vertex position becomes difficult.

Another common cause of having a breech baby is an abnormally short umbilical chord.  This could prevent the baby from moving around and force her into a breech position.

If you are expecting twins, it is possible that one baby is in the vertex position and the other is in the breech position.

Risks with Breech Babies

The only risk involved with a breech baby is during the delivery. Make sure your doctor or midwife is experienced with breech baby deliveries.

In case of a vaginal delivery, there is a chance of the baby getting injured. The genitalia could also be mildly swollen but will heal in a few hours.

There is also a chance that the umbilical chord might get trapped around the neck of the baby. This will cut off the baby's blood/oxygen supply  In such cases, the baby is removed immediately with the help of a special kind of forceps. If delayed, it could cause permanent neurological damage and even death.

However, if you are a first-time breech mother, you will be advised to undergo the C-section. If you have given a vaginal birth before, it will be comparatively easier for your second baby to come out, because your vagina has experienced stretching during your last delivery. Hence, you will not have any problems with your second baby, even though she is breech.

Can I turn my baby around?

There are a few exercises that could encourage your baby to move into the vertex position.

The breech tilt involves lying down with your hips, elevated (about 12 inches). This is done thrice a day for 20 minutes.

With Elkin's manoeuvre you have to spend about 15 minutes in the knee-chest position. This is done every two hours.

These exercises are not recommended by doctors in India as there is a chance that the placenta may separate. Also, the umbilical chord may get stuck while performing these exercises, thus causing harm to your baby.

Delivery Methods

Vaginal Delivery

With experienced doctors and midwives, it is possible to have a vaginal delivery for a frank or complete breech baby.

However a vaginal delivery is advised only if;

1. You have had a normal vaginal delivery before.
2. Your pelvic region is wide enough for the child to come out easily.
3. Your baby weighs not more than 2-3 kilos.

Sometimes, doctors try to manually turn the baby around by applying pressure on your abdomen. This procedure is called External Cephalic Version (ECV) or version.

You may feel uncomfortable with this, so discuss the pros and cons with your doctor.

There is a chance that the baby may not move at or may return to original breech position, even after a successful version.

Most vaginal breech baby deliveries are treated as normal deliveries. However, an anaesthetist  is always kept on standby, because in such cases, there could be a need to manually stretch out the vagina, and you could need local anaesthesia. Also, a neo-natalogist could be required for any complications, or in case you need to have an emergency C-section.

C-section

Most women prefer a C-section to avoid any possible risks for the breech baby. If your baby is a footling breech,or if her face is tilted up (stargazing), a C-section is necessary.

In case of a C-section, a version procedure is not needed.

(With inputs from Dr. Duru Shah, MD, Consultant Obstetrician & Gynaecologist, and Dr. Reshma Rafi, Gynaecologist, Mumbai)