Breech baby at the end of pregnancy

fetal-presentation

Babies lying bottom first or feet first in the uterus (womb) instead of in the usual head-first position are called breech babies.
Breech is very common in early pregnancy, and by 36–37 weeks of pregnancy, most babies turn naturally into the head-first position. Towards the end of pregnancy, only 3–4 in every 100 (3–4%) babies are in the breech position.
A breech baby may be lying in one of the following positions:
The baby is bottom first, with the thighs against its chest and feet up by its ears. Most breech babies are in this position. Flexed breech

Extended or frank breech
The Baby is bottom first with its right next to its bottom. The thighs are against its chest and the knees are bent. Footling breech

Flexed-breech
When one or both of the baby’s feet are below its bottom.

Footling breech

It may just be a matter of chance that your baby has not turned into the head-first position. However, there are certain factors that make it more difficult for your baby to turn during pregnancy and therefore more likely to stay in the breech position. These include:
- If this is your first pregnancy.
- If your placenta is in a low-lying position (also known as placenta praevia).
- If you have too much or too little fluid (amniotic fluid) around your baby
- If you are having more than one baby.
Very rarely, breech may be a sign of a problem with the baby. If this is the case, such problems may be picked up during the scan you are offered at around 20 weeks of pregnancy at our Saavi Women's Hospital.

Depending on your situation, your choices are:
- If it’s a first pregnancy or you have previous caesarean section:- Plan caesarean section is advisable.
- If you have previous normal delivery then you can opt for vaginal birth.
There are benefits and risks associated with both caesarean section and vaginal breech birth, you should discuss with your doctor, what is best for you and your baby.

A)Caesarean section

If your baby remains breech towards the end of pregnancy, you should be given the option of a caesarean section. Research has shown that planned caesarean section is safer for your baby than a vaginal breech birth. Caesarean section carries slightly more risk for you than a vaginal birth.
Caesarean section can increase your chances of problems in future pregnancies. These may include placental problems, difficulty with repeat caesarean section surgery.

Only for patient who have previous vaginal delivery.

Vaginal-breech-birth

You should plan a hospital birth where you can have an emergency caesarean section if needed, as 4 in 10 (40%) women planning a vaginal breech birth do need a caesarean section. Induction of labour is not usually recommended.
While a successful vaginal birth carries the least risks for you, it carries a small increased risk of your baby dying around the time of delivery. A vaginal breech birth may also cause serious short-term complications for your baby. However, these complications do not seem to have any long-term effects on your baby.
Before choosing a vaginal breech birth, it is advised that you and your baby are assessed by your doctor to check :
- Your baby is a footling breech (one or both of the baby’s feet are below its bottom)
- Your baby is larger or smaller than average (your doctor will discuss this with you)
- Your baby is in a certain position, for example, if its neck is very tilted back (hyper extended)
- You have a low-lying placenta (placenta praevia).
- You have pre-eclampsia or any other pregnancy problems.

If you have a vaginal breech birth, your baby’s heart rate will usually be monitored continuously as this has been shown to improve your baby’s chance of a good outcome.
In some circumstances, for example, if there are concerns about your baby’s heart rate or if your labour is not progressing, you may need an emergency caesarean section during labour. A paediatrician (a doctor who specialises in the care of babies, children and teenagers) will attend the birth to check your baby is doing well.

If you are having twins and the first baby is breech, your doctor will usually recommend a planned caesarean section.
If, however, the first baby is head-first, the position of the second baby is less important. This is because, after the birth of the first baby, the second baby has lots more room to move. It may turn naturally into a head-first position or a doctor may be able to help the baby to turn.

Breech is very common in early pregnancy.
There is no scientific evidence that lying down or sitting in a particular position can help your baby to turn.
By 36–37 weeks of pregnancy most babies will turn into the head-first position.
If your baby remains breech, It does not usually mean that you or your baby have any problems.

This information aims to helps you make the best decision regarding your care. It is not meant to replace advice from a doctor about your own situation.