Breech presentation

At the end of pregnancy, 3-4% of babies are in a breech presentation. This means with the buttocks in the mother's pelvis and the head on top.

A breech baby has consequences for the course of the pregnancy and the delivery. Because there is a greater chance of complications when the baby is breech, the delivery will take place in hospital under the supervision of a gynaecologist.

WHAT TO DO IF YOUR BABY IS BREECH?

There are a few options:

  • You can wait until the baby spontaneously turns into a headfirst position. The ability of a baby to turn on its own depends on several factors, including the space in your abdomen, the type of breech presentation, the term of the pregnancy and the degree of subsidence in the pelvis. If the baby is still in a breech presentation at 36-37 weeks, the midwife will transfer the care to the gynaecologist.
  • You can opt for an external version. Specialised midwives can try to turn the baby from the outside with their hands on your belly. An external version is a safe and effective way to have the baby in the head position. The success rate depends on several factors: whether this is your first child or not, the space in your belly, the size of the baby, the skills of the midwife, etc.
  • Sometimes an attempt is made to use acupuncture to turn a baby. By treatment with Moxa, the baby is stimulated to move more and turn itself around. The effectiveness of this treatment has not been sufficiently proven. If you want to try Moxa therapy, it is recommended to start early in the pregnancy.

The midwife can advise you which of the above options seems best for you.

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GIVING BIRTH TO A BREECH BABY

Compared to a head birth, a breech birth is slightly riskier. However, a vaginal birth is possible, especially if the child is not in a full breech presentation.

In a breech birth, there is:

  • a slightly higher chance for the baby to be incubated,
  • a slightly higher chance of straining the nerve or muscles in the baby's neck or shoulder,
  • more often a slightly lower Apgar score,
  • a higher chance of a caesarean section and the possible consequences of this (see below).

This is why it is important to monitor the progress of the delivery closely during a breech birth. The gynaecologist will use CTG to monitor the baby's heartbeat and will check whether the strength of the contractions and the dilation are optimal during the birth. If this is not the case, a Caesarean section will still be performed.

WHAT ARE THE POSSIBLE CONSEQUENCES OF A CAESAREAN SECTION?

EFFECTS OF A CAESAREAN SECTION ON THE MOTHER:

  • long-term recovery
  • increased risk of infection
  • more chance of excessive blood loss
  • more chance of bladder and bowel problems
  • With a next delivery (because of the scar in the uterus) there is more chance of complications such as rupture of the uterus, excessive blood loss, ingrown placenta.

EFFECTS OF A CAESAREAN ON THE BABY:

  • Greater chance of infection
  • Sometimes cuts or other birth related conditions
  • If the uterus ruptures during a subsequent delivery, then this is very dangerous for that child (acute fetal distress).

VAGINAL OR CAESAREAN?

A large global study was conducted to see which is better: a vaginal breech birth or performing a planned C-section when the baby is breech. The study showed the following:

  • Babies born in a breech presentation by a planned Cesarean section experience fewer problems during and after birth than children born after a vaginal delivery.
  • However, two years after birth, all children from both research groups (cesarean versus vaginal birth) turned out to be equally healthy. There is no difference in development or health. In short, the difference that was present shortly after birth disappeared after two years.
  • With a Caesarean section, there is a greater risk of complications for the mother than with a natural birth.
  • After a Caesarean section, there is more risk for the baby which is born the next time. These risks are about the same as the risks of a vaginal breech birth.

In conclusion:

Considering the short-term effects, it is better for a baby in a breech presentation to be born via a planned C-section than via a vaginal delivery. But there is no difference in the long run; a planned Cesarean section and a vaginal breech birth are equally safe. Especially if you consider the consequences of a Cesarean section for the mother and any subsequent children.

YOUR CHOICE

If your baby is in a breech presentation, you can often choose whether you want to give birth naturally or by means of a planned Cesarean section. Always make this choice in consultation with your gynaecologist and ask him/her for advice. Try not to be influenced too much by what people around you or on the internet say. Make your own choice. Take the following into account when making your decision:

  • Your future desire to have children
  • The course of any previous deliveries
  • The type of breech presentation
  • The size of the baby
  • The sense of security you have during a vaginal birth or a caesarean section
  • The advice of your midwife and/or obstetrician

AFTER BIRTH

A breech presentation can have a slight influence on the baby's hip development. There is therefore a slightly higher risk of hip dysplasia. The advice is to have an ultrasound made of the baby's hips 3 months after birth. This can be requested through the doctor.