Early in pregnancy your baby can lie in many positions in your uterus. Most babies get in to a head-down position in the uterus by the time you go into labour. About 4% of babies stay in a bottom down or breech position at term (37-42 weeks). You are more likely to have a breech baby if your pregnancy is pre-term (before 37 weeks) and about 25% of babies are in a breech position at 28 weeks gestation.
When babies are in a breech position most of them have their legs straight out, extended at the knee, in a “pike-dive” position. This is called a frank breech or extended breech. Some babies have their legs bent at the knee and this is known as a complete breech or flexed breech. Less common still is a footling presentation.
If your baby is still in a breech position at 36 weeks gestation we will discuss some options with you for the rest of your pregnancy and your delivery:
- Some women will choose to have their baby delivered by planned caesarean section as this has been shown, overall, to be the safest method to deliver breech babies.
- Some women will want to know if a vaginal delivery of a breech baby is possible.
- Some women may choose to have a procedure called External Cephalic Version (ECV) which involves gentle manipulation of your abdomen to get the baby to do a forward roll inside your uterus so that it ends up facing head down.
Dr Etherington is skilled at delivering breech babies vaginally in selected cases. If you want to be considered for a vaginal breech delivery we need to check that the baby is not too big and that your pelvis is not too small for such a delivery. Dr Etherington does not induce labour when the baby is in a breech position. The delivery itself is essentially a “hands-off” approach with minor assistance being given to deliver the baby’s legs, body and arms. The baby’s head is then gently cradled out.
Dr Etherington also regularly performs ECV procedures. These procedures are performed in the delivery suite so that your baby can be monitored before and after the manipulation. You will be given an injection under your skin of a medication that is commonly used in asthmatic patients which causes smooth muscle to relax (preventing a uterine contraction during the procedure). A scan is then performed to find out the exact position the baby is lying in. By gently lifting the baby’s buttocks out of the entrance to your pelvis, then applying pressure to the baby’s hip and shoulder, the baby is encouraged into a forward roll. It sounds very easy but often the baby will not make the forward roll and stays breech. However if the baby does do a forward roll then it will usually stay in a head-down position for the remainder of the pregnancy.