How Risky Is It to Birth My Breech Baby Vaginally? Antenatal Care Insights.

As you approach the final stages of pregnancy, there may be some unexpected challenges that arise, one of which is the position of your baby. For most pregnancies, babies naturally move into a head-down position in preparation for birth, known as the cephalic position. However, approximately 3-4% of babies remain in a breech position by the time labour begins, with their bottom or feet positioned to come out first. This situation often raises concerns about the safest method of delivery, especially if you’re hoping for a vaginal birth and want to avoid a C-section. The question many expectant mothers ask is, “How risky is it to birth my breech baby vaginally?” The answer to this depends on several factors. In this article, we’ll explore the potential risks and benefits of a vaginal breech delivery, the considerations your antenatal care team will take into account, and how antenatal support can help you make informed decisions.

Understanding Breech Birth: What Does It Mean?

Types of Breech Presentation

Before diving into the risks of vaginal breech birth, it’s important to understand what breech position entails. There are three main types of breech presentations, and the type of breech can influence your options for delivery:

• Frank Breech: The baby’s bottom is down, with legs extended upwards towards the head. This is the most common breech position.
• Complete Breech: The baby’s bottom is down, with legs crossed and bent at the knees.
• Footling Breech: One or both feet are positioned to come out first. This is less common but considered more challenging for a vaginal delivery. Knowing your baby’s exact breech position can help you and your antenatal clinic determine the safest course of action.

Why Do Some Babies End Up Breech?

Most babies move into a head-down position between 32-36 weeks of pregnancy. However, some babies remain in a breech position due to a variety of factors, including:

• Uterine Shape: Some women have a uterus with a unique shape that makes it difficult for the baby to turn.
• Multiple Pregnancies: If you’re expecting twins or more, space may be limited, making it harder for one or more babies to turn.
• Placental Positioning: If the placenta is low-lying (placenta previa), it can prevent the baby from turning.
• Amniotic Fluid Levels: Too much or too little amniotic fluid can hinder a baby’s ability to move freely in the womb. If your baby is breech, your pregnancy care team will likely monitor their position closely through antenatal checkups and antenatal scans as your due date approaches.

Vaginal Breech Delivery: Is It Possible?

The Case for Vaginal Breech Birth

Historically, vaginal breech deliveries were more common, but with advancements in medical care and a greater understanding of the risks, C-sections are now often the preferred method for delivering breech babies. However, vaginal breech birth is still an option in certain cases, provided the right conditions are met. For a vaginal breech delivery to be considered, your healthcare team will assess the following:

• Baby’s Size and Position: If the baby is of average size, and in a frank breech position (with legs extended upwards), vaginal birth may be more feasible.
• Pelvic Measurements: Your antenatal clinic may conduct a pelvic exam or scan to ensure your pelvis is large enough for the baby to pass through safely.
• Progress of Labour: A breech vaginal delivery requires labour to progress smoothly and without complications. If there are any signs of distress in the baby, an emergency C-section may be necessary.

The Case for a Planned C-Section

While vaginal breech birth can be possible in some cases, the Royal College of Obstetricians and Gynaecologists (RCOG) and the National Institute for Health and Care Excellence (NICE) often recommend planned C-sections for breech babies due to the potential risks involved in vaginal delivery. These risks include:

• Head Entrapment: One of the greatest concerns with breech vaginal delivery is that the baby’s head may become stuck after the body is delivered, leading to complications.
• Cord Prolapse: In some breech deliveries, the umbilical cord can slip into the birth canal before the baby, cutting off the baby’s oxygen supply.
• Birth Injuries: Vaginal breech deliveries can result in trauma to the baby, including fractures or dislocation of limbs. While the idea of a C-section may be daunting, it’s essential to prioritise the safest delivery method for both you and your baby. Your antenatal appointments are the ideal time to discuss your preferences and concerns with your healthcare provider.

Alternatives to C-Section: Can My Baby Be Turned?

External Cephalic Version (ECV)

If you’re keen to avoid a C-section and have a vaginal birth, one option is to try an external cephalic version (ECV). This procedure involves a trained healthcare provider manually turning the baby from the outside of your abdomen into a head-down position. An ECV is usually performed between 36-38 weeks of pregnancy and has a success rate of about 50%. It is done under antenatal care supervision in a hospital setting, where the baby’s heart rate can be monitored throughout the procedure. While ECVs are generally considered safe, they can be uncomfortable, and in some cases, the baby may return to the breech position after the procedure. If your healthcare provider suggests an ECV, it’s important to weigh the risks and benefits and ask any questions you have during your pregnancy clinic visits.

Antenatal Yoga and Exercises

Some women try natural methods to encourage their breech baby to turn, such as antenatal yoga or specific exercises designed to create more space in the pelvis. Certain yoga positions, like the breech tilt or child’s pose, may help create optimal conditions for the baby to turn head-down. While there is limited scientific evidence to prove the effectiveness of these methods, they are considered safe, and many women find them helpful for reducing stress and maintaining flexibility during pregnancy. Yoga during pregnancy also promotes relaxation, which can be beneficial as you prepare for labour.

Making an Informed Decision: Weighing the Risks and Benefits

Risks of Vaginal Breech Birth

The risks associated with vaginal breech birth should not be underestimated. While some women successfully deliver breech babies vaginally, it requires a well-trained and experienced medical team. Possible risks include:

• Higher Risk of Complications: Compared to head-down (cephalic) births, breech births have a higher risk of complications, such as prolonged labour, fetal distress, or injury.
• Emergency C-Section: Even if a vaginal breech delivery is attempted, there is a higher likelihood of needing an emergency C-section if labour does not progress as expected. These risks make it crucial to have open discussions with your healthcare provider about the safest delivery option for you and your baby.

Benefits of Vaginal Breech Birth

For those who are candidates for vaginal breech birth, the benefits can include:

• Avoiding Major Surgery: Vaginal delivery avoids the risks associated with C-section surgery, such as infection, longer recovery time, and complications in future pregnancies.
• Quicker Recovery: Recovery after vaginal birth tends to be faster, allowing you to care for your newborn and return to normal activities sooner.
• A More Natural Birth Experience: Some women prefer to experience a natural birth without the medical interventions required in a C-section. If vaginal birth is important to you, this is a discussion to have early on with your antenatal care team.

The Role of Antenatal Care and Education

Whether you’re planning for a vaginal breech birth or a C-section, proper antenatal support and education are crucial. Attending antenatal classes near me can help you prepare for both delivery scenarios, offering practical tips on breathing techniques, relaxation, and postpartum recovery. Your antenatal education will also cover the importance of staying active and healthy during pregnancy, which can contribute to a smoother labour. Consider incorporating prenatal yoga or antenatal massage into your routine for relaxation and stress management as you approach your due date.

Discussing Your Options

The decision to deliver a breech baby vaginally or via C-section is one that should be made in consultation with your antenatal care team. Each pregnancy is unique, and the best option will depend on factors such as your baby’s position, your health, and your personal preferences. While vaginal breech birth can be risky, it is possible under the right circumstances. The key is to stay informed, ask questions during your antenatal checkups, and trust in the support of your medical team. If you’re unsure about the safest delivery method for your breech baby, don’t hesitate to seek second opinions, attend pregnancy clinic visits, and participate in antenatal classes for further education. Whatever your choice, prioritising the health and safety of both you and your baby is paramount.

Sources for Breech Birth:

1. American College of Obstetricians and Gynecologists (ACOG)
   • ACOG provides detailed guidelines and recommendations about breech presentation and vaginal birth after breech. Their guidelines help inform medical practice and expectations for managing breech pregnancies.
   • ACOG - Breech Birth
2. National Health Service (NHS)
   • The NHS provides comprehensive advice on breech birth, including the risks, options for delivery, and when a C-section may be recommended.
   • NHS - Breech Birth
3. The Royal College of Obstetricians and Gynaecologists (RCOG)
   • RCOG offers evidence-based information regarding breech presentation and the safety of vaginal delivery in these cases, along with expert recommendations for obstetric management.
   • RCOG - Breech Birth
4. Breech Birth Network
   • A support and advocacy group for women with breech babies. It offers valuable information about birth options, including vaginal breech birth and how to navigate a breech pregnancy.
   • Breech Birth Network
5. Mayo Clinic
   • The Mayo Clinic provides an overview of breech pregnancies, including the risks, methods of turning a breech baby (like external cephalic version), and potential delivery options.
   • Mayo Clinic - Breech Birth
6. The Cochrane Library
   • Cochrane provides systematic reviews of research studies on vaginal breech birth and cesarean delivery, offering a comprehensive understanding of the risks and benefits based on research evidence.
   • Cochrane - Breech Birth
7. PubMed Central
   • PubMed offers research articles and studies about breech pregnancies, vaginal birth, and C-sections, which can provide insight into the clinical risks and safety protocols for breech deliveries.
   • PubMed - Breech Birth Research