Are there any other options available?

An acupuncture technique called moxibustion is sometimes used between the 33rd and the 40th week of pregnancy to encourage a breech baby to turn around. Your Lead Maternity Carer may recommend specific exercises called maternal positioning exercises to help your baby turn around. There is little evidence to indicate that these interventions are effective but they do not appear to present any risk to you or your baby. Pacific traditional healers sometimes use massaging to help turn your baby around. It is not clear whether massaging techniques are effective in turning your baby. Deliberate attempts to turn the baby should be done by a trained health professional (specialist obstetrician). Gentle massaging can be good for relieving pain but heavy, vigorous or painful massaging is not recommended and can harm your baby by causing premature labour or dislodging your placenta.

The next step is to discuss breech presentation with both your Lead Maternity Carer and specialist obstetrician who, together with you, will work out what is best for your situation.

MINISTRY OF

HEALTH
MANATu HAUORA

Further information
Ask your Lead Maternity Carer, GP or specialist what is available for you to read. General advice about maternity services is available from the Ministry of Healths 0800 MUM 2 BE free telephone line (0800 686 223).

This pamphlet is based on:

Care of Women with Breech Presentation and Previous Caesarean Birth. New Zealand Guidelines Group. 2004. Also available at http://www.nzgg.org.nz

The following publications provide helpful information:

Your Pregnancy To Hapu tanga: A guide to pregnancy and childbirth in New Zealand. Ministry of Health. 2003. Also available at http://www.healthed.govt.nz A Guide to Effective Care in Pregnancy and Childbirth. 3rd Edition. Murray Enkin, Marc Keirse, James Neilson et al (Oxford University Press 2000). Also available at http://www.maternitywise.org/guide/index.html

What to do if your baby remains breech

Caesarean has been shown to be a safer option than vaginal breech birth and all women with breech are offered a caesarean. Some women may choose to have a vaginal breech birth and if so there should be immediate access to an obstetrician and a setting where a caesarean can be performed.

Breech Birth

Information for pregnant women

Where to go for more information

This leaflet provides basic information about breech presentation to women, their partners and wha nau. Most pregnancies and labour and birth are uncomplicated. However, if your baby is presenting in the breech position you will need to discuss the risks and benefits of different types of birth (vaginal or caesarean section) with your Lead Maternity Carer. If you reach 36 weeks of pregnancy and your baby is still in the breech position, your Lead Maternity Carer will discuss with you a referral to a specialist obstetrician for a consultation.

The following websites also contain useful information for pregnant women:
The Ministry of Healths health education website http://www.healthed.govt.nz The Cochrane Library website http://www.update-software.com/cochrane/ http://www.cochrane.org/cochrane/revabstr/g010index.htm New Zealand Parents Centre website http://www.parentscentre.org.nz

Published in July 2004 by the Ministry of Health PO Box 5013, Wellington, New Zealand HP 3860

Breech birth
For most of your pregnancy, your baby is able to move freely in a roomy bag in the amniotic sac (your womb), which is filled with amniotic fluid (the waters). By the eighth month of pregnancy, when your baby is about 50 centimetres long and weighs just over three kilograms, there is less room to move.

Different types of breech position

Your baby is more likely to be in the breech position if he or she is premature (that is, born before 37 weeks of pregnancy). If your baby is in a frank breech position (bottom down and legs bent or extended up toward his or her face) it may be possible to have a vaginal birth; you will need to discuss this with your Lead Maternity Carer. You can also ask for an opinion from another doctor or midwife if the one you have been seeing does not feel comfortable about vaginal breech births. You may also need to find a Lead Maternity Carer who is experienced in vaginal breech births to assist you with the birth of your baby. If one or both of your babys knees or legs are closest to your vagina (footling breech) or your baby is sitting cross-legged (complete breech), a vaginal birth is more risky for your baby and he or she will probably need to be born by a caesarean section. A caesarean section is the surgical delivery of the baby. During this procedure, a specialist obstetrician cuts through your lower abdomen and uterus (or womb) in order to surgically remove your baby and placenta.

Can my baby be turned around so that I can have a vaginal birth?

A head-first birth is better for you and your baby. Trying to turn the baby is therefore a good thing to do. The process most likely to turn your baby successfully is called external cephalic version (ECV) and can be carried out from 37 weeks until the onset of labour. You will need to discuss with your Lead Maternity Carer and specialist obstetrician the risks and benefits of ECV and whether it is a good option for you. If you want to try ECV, then you will need to see a specialist obstetrician who is experienced in ECV and who will attempt to change your babys position to headfirst by applying external pressure to your abdomen to turn the baby in either a forward or backward somersault. With ECV, there is a 67 percent likelihood that a baby can be successfully turned around. Sometimes, however, the baby refuses to budge or less frequently rotates back into the breech position after he or she has been successfully turned around. Drugs to relax the uterus (tocolysis) may be offered to increase the success of ECV. The ECV procedure should be monitored continuously by ultrasound and the foetal heart rate should be listened to. It should be carried out in hospital with facilities and staff available for an emergency caesarean section should any complications arise.

Frank Breech

At this stage, most babies settle into a vertical, head down position called the cephalic or vertex position. This allows the baby to be born head-first by a vaginal birth. When labour begins, most babies are in this position, but a few (up to four out of 100) will settle into a bottom-first, or breech position. Some variations of the breech position are shown on the right. Vaginal breech birth is associated with increased harm to the baby. On average this occurs in one in every 28 vaginal breech births. For this reason, if your baby remains in a breech position after 36 weeks, the offer may be made to have the baby turned. If the baby remains breech, you may choose to have a caesarean.

Footling Breech

Complete Breech