Breech Babies

When Your Baby is Bottoms Up Before Delivery

By Sue Poremba
December 14, 2008

Joanne Stanway was working in the public relations department at Women and Infants Hospital
in Rhode Island when she was pregnant with her daughter. She was asked if she'd like to
participate in medical teleconferences to test new equipment. In exchange, she was offered new
ultrasound pictures of the baby.

"Early in my 8th month, I was having one of these ultrasounds when the tech casually said over
the microphone to the participating physicians, 'As you can see, the baby is breech,'" says
Stanway, now living in Chelmsford, Mass. "I didn't know that. This was frightening because I
had not experienced any problems during my pregnancy."

What Is Breech?
Many babies are breech at some time during their days in the womb, but only a small percentage
(less than 5 percent) are born breech. When a baby is breech, it means a part of the fetus's body
other than the head is in the birth position. There are different types of breech positions.

"A breech presentation is when the baby's bottom is in the birth canal," explains Dr. Randy Fink,
an OB/GYN in Miami, Fla. "Breech babies can be footling breech (foot coming first), frank
breech (when the legs are folded in the front of the baby with the feet near the face) or complete
breech (depending on how the legs are folded). Most babies arrive head first into the world
because the diameter of the head is smaller than the diameter of the hips, so therefore it passes
more easily into mom's pelvis."

Why Are Some Babies Breech?

There are a number of reasons why a baby will flip into a breech position. "It can be random,"
says Dr. John Schmitt, division head at the University of Virginia Health System's Division of
Obstetrics and Gynecology. "The baby turns all the time during the first two trimesters, and
sometimes they get trapped." This happens when the pregnancy is moving into the third trimester
and the baby has become too large to move freely.

The shape of the mother's uterus is another reason why babies end up breech. Mothers who have
a history of uterine fibroids or other uterine problems are likely to have a baby who moves into a
breech presentation. Or if the mother has had a number of pregnancies previously, it could be
that the uterus has stretched, giving the baby more room than normal to move around.

The placenta also can be a factor in breech births. If it is at the top of the uterus, it can cause the
baby to move into a breech position. Multiple births often include a breech. Whatever the reason,
the fetus seems to know instinctively its position in the womb should not be head down and
moves into a position that is more comfortable.
Helping Baby Move
If the baby is in a breech presentation, in some cases the OB/GYN may be able to manually
"flip" the baby into the proper birth position. This is done by a method called external cephalic
version. "We physically invite the baby to do a somersault to get the head down," says Dr. Fink.

To execute the external cephalic version, the doctor essentially massages the mother's abdomen,
picking up the baby as best as possible from the pelvis region. Placing the hands with one near
the baby's head and the other near the baby's bottom, the doctor gently moves the baby in a
circular motion, encouraging the fetus to roll over and get into a head-down position.

The external cephalic version is done around the 37th week of pregnancy and is done in a
hospital because of the risks involved. The mother will likely have some discomfort during the
procedure (some mothers will use an epidural, but it is not standard). There is a small chance
there will be a placental abruption, which happens when the placenta separates from the baby.
The mother is hooked up to an ultrasound during the entire procedure, so should there be a
placental abruption, the doctor will know immediately and an emergency C-section will be
performed.

In most cases, when the external cephalic version is successful, the mother will be sent home to
wait until she goes into labor naturally. But if the cervix is dilated, the doctor may decide to
induce labor right away.

The external cephalic version success rate is dependent on many variables, ranging from the
doctor's experience (some medical facilities have one doctor who handles all external cephalic
versions) to the baby's weight. And not all babies are in a fetal position that lends itself to being
flipped. If the baby remains in a breech presentation, the mother should expect to have a C-
sectioAt one time doctors were more willing to allow a mother to try and have a vaginal birth
with a breech baby, particularly one that was in a frank position. However, today doctors feel
that delivering a baby as a C-section is the safer way to go.

When a baby is breech, some women worry they are somehow responsible. "So much of it is
anatomy," says Dr. Schmitt. "There is nothing a mother can do to prevent it."

Dr. Fink agrees. "It's nobody's fault," he says. "It's not because of sex or because of stress or
because of something the mother ate. It's physics. Something in the top half of the baby is too big
to fit through the pelvis."

The ultimate goal is to take home a happy, healthy baby. But mothers who are concerned about a
breech presentation do have this one small consolation from Dr. Fink. "When a baby passes
through the birth canal, the baby gets a point head," he says. "Breech babies have beautiful
heads."

REFERENCE: http://www.pregnancytoday.com/articles/labor-delivery/breech-babies-3539/3/
 A reading on

BREECH BABIES
(Breech Presentation)

Submitted by:
Christine Joy A. Pepito
BSN-3D

Submitted to:
Ms. Louie Grace Miraflor, RN
Clinical Instructor