You’re 36 weeks, one day, 14 hours and two minutes pregnant — but who’s counting? As your pregnancy rounds the finish line, you’re ready to meet this little person who’s been pressing on your bladder for the last nine months. You’ve discussed your birth plan with your provider, packed your hospital bag and even have the car seat installed.
And your little one is getting their final preparations done too. Your baby will move into a final position for birth, ideally with their head moving closer to the birth canal.
Right around your 36-week appointment, your provider will check to make sure your baby has moved down for their final descent into the world. So, what happens if your baby isn’t in the right place at the right time? Instead of head down, they’re breech!
What does breech mean?
Around three to four babies in every 100 are breech at term, meaning they are bottom-first or feet-first position. This is called breech presentation.
While most breech babies are born healthy, complications can occur if not treated. As you prepare for the arrival of your baby and your 36-week appointment, read on to know more about breech births and your options for safely delivering your baby.
Why would my baby be breech?
Sometimes there’s no clear reason why your baby is breech but there are some things that make it more likely.
“Most breech pregnancies happen by chance, but some happen because of a problem with the baby, the uterus or placenta, or the amount of amniotic fluid around the baby,” Jennifer Steir, a certified nurse midwife with Banner Health Clinic in Fort Collins, CO. “Trust babies, sometimes they don't turn because they can't. But most breech babies turn head down by themselves before labor.”
What are the signs that my baby is breech?
If your baby is in a breech position, you may notice their tiny baby feet moving and kicking in your lower belly. Or you may feel pressure under your ribcage from their head.
During your third trimester, your provider will be able to tell which way your baby is positioned by feeling your belly and locating where their head, back and bottom are. If they suspect your baby is breech, they will perform an ultrasound to confirm precisely what position your baby is in.
Your baby could be in any of the following breech positions, depending on the position of their legs:
- Frank breech baby: bottom first with feet up near the head
- Complete breech baby: bottom first with the legs crossed
- Footling breech baby: either one or both feet are below their bottom in this position
- Oblique breech baby: the head is down but is pointed toward one of your hips
What are the risks with a breech presentation?
Giving birth to your baby vaginally isn’t usually any more painful than a head-down position, but it does carry a higher risk for your baby.
“Head and shoulder entrapment, when the head or shoulders gets stuck after the body has descended, can cause a hypoxic injury (no oxygen to baby) or a delivery-related trauma in an attempt to deliver the shoulder and head,” Steir said. “Umbilical cord prolapse can also occur, putting the baby at risk for hypoxic injury.”
Umbilical cord prolapse happens when the umbilical cord is squeezed as the baby moves down the birth canal. The squeezing of the cord slows down the supply of oxygen and blood to the baby.”
Is it possible to turn a breech baby?
When your baby is breech, there are a number of natural ways to try and turn them. These methods include exercises and positions. One of the most popular techniques is called an inversion position or Spinning Babies technique.
“Inversion is a technique for relaxing your pelvic muscles and uterus,” Steir said. “It also helps a breech baby flip upside down.”
If your baby doesn’t turn, an external cephalic version (ECV) can be offered. ECV is a procedure performed at or close to term where your provider attempts to turn your baby from the outside.
“To do this, pressure is applied to the belly to try and move the baby to a head down position,” Steir said. “It’s done after 36 weeks and in the hospital, so that your baby can be monitored and where you’ll be near a delivery room should any complications arise.”
An EVC is successful about half the time, and it’s more likely to work if you’ve previously had a natural, vaginal birth.
Will I need a C-section if my baby is breech?
This depends on several factors that you’ll want to discuss with your provider. Some babies can be safely delivered through the vagina, but usually, breech babies in the U.S. are delivered via cesarean section (C-section).
The key to a successful vaginal breech birth is to have a team of health care professionals who are experienced in managing this kind of birth in a facility that offers emergency surgery, if necessary.
However, it may not always be the safest option. Your medical team will make recommendations based on what is safest for you and your baby.
Important questions to ask your provider
Whether newly pregnant or nearing the finish line, here are some questions to ask your provider if you have concerns about having a breech baby:
- How can I tell if my baby is breech?
- What are the benefits and risks of ECV?
- What are my options for delivery if my baby is breech?
- What are the health risks to my baby or me if they are born breech?
Babies can be breech early in pregnancy, but most of them turn on their own to be headfirst by the time of delivery. Sometimes, in rare cases, the baby is bottom-first (or feet-first) known as a breech presentation or a breech baby.
During pregnancy, it’s natural for you to be worried about your baby’s position. It’s important to see your provider regularly through pregnancy as they will be able to suggest and advise on what is best for you and your baby.
“Prenatal care is essential for not only detecting but offering management options, including inversion exercises, ECV, counseling on the risks of breech delivery, counseling on the risks of C-section and finding a suitable management option that both patients and providers can agree upon for both mom and baby's safety,” Steir said.