Positioning of breech babies
Breech babies sit in one of three positions:
- Extended or frank breech - hips flexed, with the thighs against the chest, and feet up by their ears.
- Flexed breech - hips flexed with thighs against the chest, but knees also flexed with the calves against the back of the thigh and feet just above the bottom.
- Footling breech - as above, but hips not flexed so much, and the feet lying below the bottom.
The options available to you for the birth will then be discussed.
They include the following:
- Normal breech delivery
- Attempt at turning the baby (external cephalic version or ECV) then normal breech delivery if this is unsuccessful
- ECV followed by caesarean section if unsuccessful
- Elective caesarean section
Normal Breech Delivery
Until recently, there was not enough research to guide us on what is the safest way for a breech baby to be born.
In 2000, the results of the Term Breech Study were reported. This study included 121 hospitals throughout 26 countries. Babies were randomly allocated to either planned breech delivery or planned caesarean section.
The results revealed that planned caesrean section was safer for the baby than attempt at vaginal birth, with vaginal delivery resulting in a 1% increased risk of death and 2.4% increase in risk of serious problems in the early months after birth.
There has been a lot of back and forth analysis and re-analysis of the information provided to us by the Term Breech Study, including criticisms of the study design. Also, the findings of the Term Breech Study do not apply to twin pregnancies and if the second twin is breech, this does not rule out a normal birth.
Since 2000, there has been a significant fall in the number of vaginal breech births throughout the UK, Canada and the US. The result is that even if you do not agree with the findings of the research, or if you accept them and still want a normal breech birth, finding an obstetrician who has enough experience to offer breech delivery might be difficult.
Not having an experienced obstetrician will mean that the risk for the baby will be greater than the findings of the Term Breech Study, as this was one of the study entry requirements.