Going for Breech
If you do choose to go for a breech delivery, the following 'rules' will normally be required:
- The baby is not excessively small or large
- Your pelvis is not judged as excessively small. Previously we used to do a pelvic x-ray to check the exact measurements of the pelvis. It has since been found, however, that this is unnecessarily limiting and a judgement based on previous births and/or pelvic examination is as useful. There is also a very small but definite increased risk of childhood cancers in babies exposed to this type of x-ray.
- Baby is not a footling breech. Extended breech is the most favourable, but flexed breech is OK as long as the bottom moves down and engages into the pelvis. Footling breech babies don't fit so well onto the cervix, leading to a risk of the cord falling out during labour (cord prolapse).
- Baby is not 'stargazing'.
- Labour starts spontaneously.
When labour starts you come into hospital as usual. Some doctors advise an epidural for every woman having a breech birth, but this is not strictly necessary.
There is some evidence that epidurals increase the risk of a caesarean section being needed during labour. Many women who have a breech birth choose this type of pain relief in any case.
Labour is never excessively long and continuous monitoring of the baby's heart rate is advised. When it comes to the actual birth, some doctors use forceps to control the delivery of the baby's head, others prefer to just assist it with their hands.
An episiotomy (cut) is frequently needed for first-time mothers, but it really depends on how well the skin stretches, the progress at the time of delivery and the size of the baby.
A paediatrician will be present at the birth to check the baby over, but you will be able to have him with you straight after this.
Congenital hip problems are more common in breech babies and this explains why some are breech in the first place. The paediatrician will examine your baby more fully before you go home.
External Cephalic Version
It is possible to manoeuvre the baby from breech to a head-first position. This is done after 37 weeks and the success rate is around 50%, though some doctors are successful as often as 70% of the time.
It is useful in that it definitely reduces the number of breech and caesarean births. Around 2.5% of babies flip back to breech after a successful ECV.
The doctor places her hands on the womb, and guides the baby through a forward somersault - often the baby seems to get the idea and his kicking helps to complete the turn.
Some doctors use a drug to help the womb relax, particularly for first-time mothers. It may be quite uncomfortable during the turn, but shouldn't be excessively painful. The baby's heartbeat is monitored before and after ECV.
It is a safe procedure for the baby, but on the rare occasion the baby becomes distressed, a caesarean delivery will be necessary at that time. Because the baby is mature and facilities for surgery are close at hand, this rare occurrence is still not harmful for the baby.
If an ECV is unsuccessful, it is still possible to have a normal breech birth as discussed above.