With my second pregnancy, he was in the breech position until 30 weeks. I knew It – I had wicked heartburn and I could feel his head under my ribs. After each ultrasound, my OB and I chatted about my options for delivery with a breech baby. He was also very reassuring that the majority of babies will turn head down by 30 weeks. Luckily my son listened and at my 30-week ultrasound, he was head (cephalic position) down.
Did you know that only 3% of babies are breech at birth? If you have an atypical structure of your uterus or pelvis, twins or triplets, and low amniotic fluid you are at an increased chance of having a breech baby at 40 weeks. There is a growing trend to deliver breech babies via caesarean section in both Canada and the United States. The decision regarding how your baby is delivered should take into consideration your wishes and the experience of your health care provider. Let’s talk about what options you have.
External Cephalic Version (ECV)
You may have heard of an ECV from your healthcare provider or read about it while doing your research. An ECV is a procedure used to turn a baby from a breech or side-lying position into a head-down position. It is successful 58% of the time. This happens before labour begins, typically around 37 weeks. ECV is performed by a qualified Obstetrician in your birthing unit. If you are followed by a midwife they will be with you for the procedure to support you but not preforming the version.
Once you arrive on the birthing unit your nurse will listen to your baby with a NST (Non-stress test), start an IV and the OB will explain the risks and benefits of the procedure and have you sign consent. The OB will also do a bedside ultrasound to confirm the position of the baby. With both hands on the surface of your abdomen—one by the fetus’s head and the other by the bum—the doctor pushes and rolls your baby to a head-down position. You will feel discomfort during a version procedure, especially if it causes the uterus to contract.
The amount of discomfort depends on how sensitive your abdomen is and how hard the doctor presses on your abdomen during the version. If at any time your baby does not tolerate the ECV (drop in heart rate, or distress) the procedure is stopped and you may be taken for an emergency caesarian section if needed. Once the ECV is completed you will stay for a short time for another NST to make sure baby is still happy.
Dr. Larry Webster, a Chiropractor, developed this technique which focuses on the intrauterine constraint. By reducing the stresses being applied to the uterus, the baby would have more room to move into the head-down position on its own. The Webster technique involves a chiropractic evaluation of the sacrum (lower back) and it’s alignment within the pelvis. Adjustments are performed to put the sacrum back into the correct alignment. Massage and stretching of the attachment points of the uterine ligaments on the abdominal wall are also performed. This specific combination of adjustments and soft tissue work to normalize the tension of the uterine ligaments on the uterus itself and result in the reduction of intrauterine constraint.
Breech Vaginal Delivery
The head is the widest part of the baby’s body. During normal vaginal childbirth, it would come out first. However, in a breech vaginal birth, the head comes out last. During vaginal breech childbirth, your OB will ask you to push your baby out to the point where the legs and lower belly are delivered. Once the baby’s lower belly is out, your OB will support the baby’s body and, with the help of an assistant (such as a nurse or midwife), will perform a rotational manoeuvre to deliver the arms and head. This manoeuvre, accompanied by your pushing efforts, will help your baby’s head pass through your pelvis. In some cases, your OB may use other manoeuvres or forceps to help deliver your baby’s head. Even if you and your doctor decide to try vaginal childbirth, a caesarian section may be necessary for you and your baby’s well-being if the labour is not progressing properly. For this reason, a breech delivery should happen in a hospital, where a caesarean section is available if you need it.
Society of Obstetricians & Gynecologists of Canada (SOGC) Guidelines
They recommend an external cephalic version if appropriate for a full-term breech baby. After that, if baby is not head down, and the candidate is a good candidate for vaginal breech birth, the provider should counsel the patient on the benefits and risks of both vaginal breech birth and planned cesarean and encourage shared decision making and support of the patient’s decision.
Long-term neurological infant outcomes including cerebral palsy do not differ by planned mode of delivery, even in the presence of serious short-term neonatal morbidity.
American College of Obstetricians & Gynecologists (ACOG) Recommends
Obstetrician – gynecologists and other obstetric care providers should offer an external cephalic version as an alternative to planned caesarean for a woman who has a term singleton (1 baby) breech fetus, desires a planned vaginal delivery of a vertex presenting fetus, and has no contraindication. Planned vaginal delivery of a term singleton breech fetus may be reasonable under hospital-specific protocol guidelines for both eligibility and labour management.
Whichever option you feel is right for you, including a caesarean section, it is important to sit down with your health care provider and discuss your pregnancy and what options are best for your specific situation. The policy and procedures of your hospital and your health care provider’s expertise also plays a role. Keeping an open mind with flexibility and remembering the most important goal at the end of all of this – a healthy baby and a healthy mom!