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Bottom first! What to expect if your baby is breech What is a breech baby? A breech baby is one that is born bottom first rather than the usual head first. Most breech babies will have straight legs going up past their ears (a “complete breech”), or bent legs in the usual foetal position (a “flexed breech”). Some will have one bent and one straight leg. Others have their legs curled up beneath them, so that their feet are born first, and even more rarely can have their legs in a kneeling position and be born knee first. In most cases there is no obvious reason why a baby is breech. Typically 3-4% of babies will be breech at full-term. This is an awkward statistic – not frequent enough for midwives and doctors to see them regularly, and frequent enough that most people know someone who has had a breech baby. Even more awkwardly, approximately 1 in 4 of all babies will be breech at 30 weeks, and most of those will turn into a head-down position by themselves with no intervention. However, the details matter. First-time babies are less likely to turn, as are babies in women who have already had a previous breech. Undiagnosed breeches Some breech babies always go undiagnosed until labour has commenced, either because the baby turns breech very late in pregnancy, or because it felt like a head-down baby to the midwife. It can be quite a difficult experience for women to be told in advanced labour that their baby is breech, and especially difficult at that stage to make a logical informed decision about the birth. Ante-natal care Usually a breech baby is first recognised by your community midwife at a regular antenatal appointment. Addenbrookes is currently running a major study of first time pregnancies, which includes regular ultrasound scans, and these will also show if a baby is breech. In my own limited experience, women with breech babies often describe a hard round “bum” digging into their ribs. Not all breeches are spotted in pregnancy, especially if the baby’s legs are straight so that the kicks are high up towards your ribs, just as they would be in a head-down baby. A suspected breech pregnancy should be referred for an ultrasound “positional” scan at 36 weeks, and anyone planning a home birth should also be offered a scan at that time. If the scan shows that the baby is breech, then the hospital midwives will explain a procedure called ECV (external cephalic version) which aims to turn the baby, and book an appointment for you straightaway. There are some cases (for example low fluid levels) where an ECV will not be offered. However, ECVs can usually be offered to women who have had previous Caesareans. If the baby remains breech, then you will have a “clinic appointment” with a hospital consultant to discuss your birth options. Turning methods The first focus in a breech pregnancy is always to try to encourage the baby to turn head-down. A turned baby is no longer breech, and the pregnancy and birth can then proceed just like any other, allowing you to have your baby at home or in the Midwife-led Birthing Unit if you wish to. There are several “alternative” turning methods, which can be started as early as 34 weeks, as well as the ECV offered by the NHS. If you try the alternative approaches it is worth checking whether or not your particular practitioner has successfully turned breech babies before. Most of the turning methods are combined with positional exercises. The formal positions are the “knee/chest” position, where you kneel with your shoulders resting on the floor (or a cushion) and your bottom in the air, or a reclining position where you lie on your back with your legs up against the wall and cushions supporting you under your bottom. The aim is to have your pelvis higher than your shoulders to encourage the baby to move out of your hips. This gives the baby room to move into a head-down position, which usually happens after the exercises rather than during them. Lots of “floor-scrubbing” is also meant to help – one breech mum I spoke to bought gardening knee pads to make this more comfortable! The alternative methods include an acupuncture technique called moxibustion, which involves burning moxa sticks over a certain acupressure point on your little toe every day for 10 days. If the first course of treatment is unsuccessful, then a second can be tried after a gap of 4-5 days. Success rates of 50-80% have been reported, although formal published studies show insufficient evidence of benefit to recommend the use of this method within the NHS. Other methods include a chiropractic method called the Webster Technique, which ensures that the mother’s pelvis is straight and aligned, a cranial osteopathy method and homeopathy using pulsatilla. ECV is offered in the NHS at 36 or 37 weeks. There is a formal study underway looking at using ECV at 33-35 weeks, but this will not become standard practice unless the study shows good results. An ECV is done by one of the Rosie consultants, several of whom regularly carry them out. The doctor uses their hands to push the baby around into a head-down position, following the same path that a baby would take if she turned by herself. Ultrasound scan is used to check the baby’s heart beat and position during the procedure. Although women often say that ECVs are “uncomfortable”, this means “uncomfortable but not so painful that I needed to ask the doctor to stop”. Roughly half of all ECVs are successful, meaning that from then on the pregnancy is treated as normal. If the first ECV is unsuccessful, then a second one can be attempted. One aspect which always worries people is that you are asked to skip breakfast before an ECV and to bring a hospital bag. This is in case the ECV triggers a labour or upsets the baby and requires you to stay in for a Caesarean. However, in reality, this happens very rarely, less than once a year at Addenbrookes, so is an example of the hospital being highly cautious. Many breech mums try several turning methods, to give themselves the greatest possible chance of turning their babies. You should always tell each practitioner if you are using other methods, to ensure that they don’t counteract each other. Article continues.... Breech%20birth%202.htmlshapeimage_1_link_0