what happens if when pregnet you find out the baby is breach?

Question

my mother is 37 weeks she went to go get checked and shes only dialated 1 centemetr but tehn again her last kid was 12 years ago its just me and my sister im 16 umm should she be worried she has "fibers" or something and should that interfere if she gets a c-section we saw the doctor toda adn we got an emergency ultrasound tomorrow to see if the baby is in position if it's not the doctor is gonna try and turn it i wanna know if that is gonna be painful (to turn it) thanx =}

Answer 1

How Baby’s Position Affects You (and Your Delivery)!

By Dr. Gerard M. DiLeo, M.D.
Your unborn baby bounces around in a variety of positions, but where he or she ends up immediately before childbirth is important. Decipher the different birth presentations with our handy guide.

Your baby’s head is the largest part of her body, so when a baby delivers head-first, it usually goes without saying that the rest of the baby follows. But there are many variations from this standard head-first position, such as breech presentation, transverse lie, and shoulder-first. And even if your baby presents head-first, her face can be pointing down, up, or even face-first. These little surprises keep obstetricians and midwives on alert with each seemingly routine delivery.

So what do these various positions mean to you? Here's a primer on baby presentation basics.

Head-First
In the head-first category, the shape of the mother’s pelvis can determine which way the head is placed. The most common way is face-down, allowing the easiest measurement to clear the pelvis. This position is especially helpful because the head can pivot up against the pubic bone, allowing the chin’s appearance to finish the delivery of the full head.

Face-up or occipital posterior (back of the head down) is a more difficult delivery because the baby can’t flex the head on exit. It’s like delivering a baby that weights a full pound more. It’s not impossible, but it’s more difficult to effectively push, and the pushing stage of labor can last longer than usual.

If your baby's head is sideways, this is called transverse position. Usually the head can be gently rotated by the obstetrician to face-down for a normal delivery.

Asynclitism, or a head-first position wherein the head is tilted to the right or left from the midline, is yet another birth presentation. Many people feel that an epidural given before the head has descended well into the pelvis causes the maternal muscles that normally guide the head down correctly to become relaxed, resulting in a sloppy, unguided descent. It’s a hard positioning to work with and can lead to a C-section.

Traditional Breech Presentation
Breech refers to a feet- or buttocks-first presentation. This is a real thinking obstetrician’s dilemma, because, as mentioned above, the largest part of the baby is the head. So delivery of the feet or buttocks first creates a scenario where larger and larger parts of the baby have to clear the pelvis. In other words, if the head won’t fit out in a head-first baby, delivery can be effected via second choice–the C-section. But in a breech delivery, if the head won’t fit out, the rest of the baby already has. The cord is out as well and is compressed in the birth canal on it’s way up to the placenta. This is an emergency with such a bad outcome that most obstetricians feel that a breech presentation necessitates a C-section.
So why do some babies come out head first and others breech? Babies tend to seek the most comfortable position in their mothers’ wombs. If the largest part of the baby is the head, then the baby will fidget and maneuver until the head gravitates to the largest space in the uterus. The most generous space is usually the lower uterus; and usually at 32 weeks this position will stick.
A breech usually occurs when there’s a problem and the lower uterus is not the biggest space. For instance, a low-lying placenta can occupy enough space so that the there is more space higher in the uterus. Also, congenital abnormalities can make other parts of the baby the biggest body part, meaning that part will become the lowermost presenting part. In fact, in my training it was always a warning to check for abnormalities when there was a breech presentation.
Other Breech Presentations
In a frank breech, the buttocks are first. In a footling breech, one or both feet are first–the single-footling breech or the double-footling breech. The difference depends on whether the knees are bent or not. In both situations, the hips are flexed, but if the knees are straight, then the lower legs, along with the thighs, are bent over the baby’s abdomen, resulting in the frank breech. If the knees are bent, then the feet are positioned back toward the cervix and the outside world.
Thankfully, most breeches are in that position for unknown reasons. Mostly normal breech babies are delivered by C-section, putting to rest the fear of congenital problems. Some brave obstetricians (I’m not one of them) deliver these babies, but this isn’t acceptable unless the baby is estimated to be at least a pound less than the mother’s previous largest baby, the baby is a frank breech, and the maternal pelvic measurements are generous.
Any breech that is a first baby should still be born by C-section, because it’s easier to explain a possibly unnecessary C-section than to explain a baby that was traumatized by the too large after-coming head. Plus, many OBs believe that even successful vaginal deliveries of breech babies result in what are called soft neurological signs (not brain damage, but Attention Deficit Disorder, dyslexia, hyperactivity, and the like).
Every Which Way But . . .
Occasionally I’ll encounter a baby that’s in a crazy position, such as transverse (whole body sideways) or shoulder-first. C-section is the safest way to address this malpresentation. It is just common sense: the forces of labor will crunch a baby that’s not pointing straight down.
And Then There's Twins!
If you think the placenta can crowd out an adequate space, imagine what an extra baby does! Twins will compete for the most comfortable space, but usually there’s a membrane that will separate them and favor one to be lower. The big risk here, though, is a breech baby that’s first, compared to the head-first second twin. In this positioning, the head of Baby One (the breech) may sit just above the head of Baby Two (the higher of the babies).
When labor ensues for a vaginal delivery, it’s possible to have the horror of interlocking heads. Needless to say, a breech/head-first presentation of twins necessitates a C-section. But head-first/head-first twins can deliver vaginally, as can head-first/breech. (Except, once again, when an OB just doesn't feel comfortable with this type of delivery; as is the case, once again, with me.)
There can be a considerable wait sometimes for Baby Two to descend, and with this there’s the possibility of a prolapsed cord, which could cut off oxygen to this twin. Because of this, although not always, doctors will opt to deliver twins via C-sections.
The Happy, Healthy Delivery
Delivery of a baby (or babies) requires knowledge of the baby’s position. With third- and fourth-generation antibiotics and advanced surgical technique, the risk to the mother from a C-section is now outweighed by the benefit to the baby when there’s positioning that would make vaginal delivery hazardous.
In contrast to the dangerous times of just a generation ago, we no longer need to seek heroic vaginal deliveries for these babies. And even using this way out, the C-section rate can still be kept low by waiting for proper descent of the baby’s head into the maternal pelvis before administration of an epidural.

Breech presentation
When babies are aligned in the uterus to come out buttocks first, as opposed to head first--the way most babies come out of the uterus--it is called a breech presentation. The head is the largest part of a full term baby's body. Therefore, delivery of the buttocks first may not adequately open up the birth canal enough for the head to pass through. The head may then get stuck in the birth canal, leaving the infant and mother in a precarious situation. Most babies with a breech presentation are delivered by cesarean section. On occasion the infant can be turned around so that he is lined up to come out head first.

Breech Presentation
Head Over Heels Is Better Than Heels Over Head
By Dr. Gerard M. DiLeo, M.D.
Complications that may arise with a breech fetal position.
Breech position means that the unborn baby is not head-first. The most common type of breech position is "frank" breech, in which the infant's buttocks are the first to descend into the birth canal. His or her legs are flexed at the hip, pointing the legs, straight at the knees, up toward the head. In contrast, a footling breech has the knee or knees flexed, such that the feet join the buttocks as the presenting part. This type of delivery can't be done vaginally--the laws of physics will not allow it to go smoothly. A frank breech, on the other hand, can deliver vaginally, the buttocks alone acting as an efficient dilating wedge much like the head would. But the statistics on delivering breech babies vaginally are a concern. Assuming of course the delivery was frank breech, the statistics say there is still an increase in the number of babies born who may suffer from "soft" neurological complications. This is even when everything seems to have gone well. Besides an increased risk of obvious trauma, soft neurological complications often go unnoticed but haunt parents later as hyperactivity, attention deficit disorder, dyslexia, and a host of other problems. The studies on the legitimacy of this theory have been at times inconclusive, prompting different experts to alternately advise vaginal versus Cesarean delivery for frank breech presentations.
Cesarean delivery is currently the most popular approach to seeking the best outcome for these babies. We must consider, however, the increased risks to the mother that come with cesarean section. It's true that the complication rate in private practice is low, but it's still higher than with vaginal delivery. So the answer seems to lie with talking these little babies into assuming a head-first presentation. That sort of diplomacy is called External Cephalic Version, a technique in which the baby is actually turned to the head-first position. We used to do this blindly at Charity Hospital, a forceful procedure involving two physicians, one pushing against the mother's abdomen, the other doing a pelvic exam to exert pressure there. This fell into disfavor because mothers really weren't crazy about the technique, and there seemed to be a feeling that there was probably a pretty good reason for the baby to be breech in the first place. Dr. Steve Fortunata, a perinatologist, espouses the newer thinking on the subject. The reason why version in the past failed often was that the patients who were scheduled for version weren't selected very well. Now, criteria such as how low the breech baby is and where the back is placed in the womb have made version safe and frequently successful. Ultrasonographic guidance and gentle manipulation, while a drug that relaxes the womb is used, have made the procedure desirable once again. Add to that the need to bring down C-section rates and suddenly it begins to make a lot of sense.
What has happened is that the old procedure using blind force against any breech baby has been replaced with a gentle maneuver done with a relaxed uterus under ultrasound in well-selected patients. It's called look before you leap, and it's an advance in that it's an improved rediscovery of an older procedure. It won't be the last time doctors fall head-over-heels for a safer outcome.

Ask BabyZone
Obstetrics and Gynecology
Dr. Gerard M. DiLeo is a board certified obstetrician-gynecologist who has been in private practice since 1981 and has served as Chief of the Medical Staff at Lakeview Regional Medical Center in greater New Orleans. Dr. DiLeo's new book The Anxious Parents' Guide to Pregnancy is now available.

Should I Wait Or Schedule A C-Section For Breech Baby?

My doctor has scheduled a C-section because my baby is breech. She tried to turn the baby but this failed. Is it unreasonable for me to want to wait until I actually go into labor to see if the baby might turn?

This is a problem, but it's not a tough problem, thank goodness, because after all we're talking about a healthy baby either way (assuming all else is well).

Still it's important for you to feel comfortable with the way that your pregnancy is handled. In assuming that your baby probably won't flip, your doctor is merely following a protocol of the practice. She's probably right.

No, it's not unreasonable to wait--as long as you understand and are willing to accept certain risks. For instance, a breech baby is more likely to suffer a cord accident if you have a sudden rupture of membranes, since the head is not there to prevent prolapse of the cord. The longer you wait, the more there's a chance that something like this could happen unexpectedly. Although this is unlikely, it's just as unlikely as are your baby's chances to flip to a head-first position at this stage. It's a matter of there being less room available for these types of acrobatics. I've seen it happen, but it is the stuff tall tales are made of in the OR dressing rooms. (I've even had a breech baby convert to vertex while in labor at term!)
In obstetrics your particular predicament has two equally legitimate options--waiting for the unlikely to happen, or not waiting and doing a C-section "cold" at or near term. If labor begins in the middle of the night, then you're subject to the slightly higher risk of infection and complications that attend anything done at night, when all but the largest hospitals have scaled-down crews. But that is not to scare you--it's not really a deal-breaker if it's important to you to place all possible chances on your side for a vaginal delivery.
If it looks like you're going to need a C-section, then a patient does better if it's scheduled and done during
controlled circumstances. Your doctor's discouragement is based on the dismal track record of babies spontaneously converting to vertex this late in pregnancy. You can wait to see what happens, but the odds of that happening are slim, especially since your doctor already tried a "version" and was unable to turn the baby. But waiting doesn't add so much risk that you shouldn't even consider it if it's that important to you.
In my practice, I too will electively schedule a C-section at or near term for breech babies that have not turned to head-first. Breech babies are high risk babies, and this approach gives me the greatest comfort level. I feel your doctor's pain. But I also understand your wish to avoid the pain of a C-section, so if a patient insists on waiting, I allow it as long as she understands the risks, and agrees to go to the hospital when labor begins. (We don't want to deal with a breech at full dilatation!)
Keep in mind that your doctor is responsible for the health of your baby. If you trust her with managing the other aspects of your pregnancy, it's not unreasonable for her to expect you to trust her with this decision.
Good luck. Either way, make sure you're straight with your doctor in making your concerns clear.

Dr. DiLeo

Has she tried all the ways to try to turn a breech baby? Here's a list:
1.Laying on her back on a board or using pillows so that her head is about 40 degrees lower than her feet.
2.Play music, preferably with headphones, placing them low down on her uterus.
3.Shine a very bright light low down on her uterus, or even between her legs.
4.Have someone (preferably the father) talk loudly but soothingly to the baby, low on the belly, close to the skin, telling the baby to turn around, to come towards the voice (have also heard that commanding works).
5.If all else fails, how about external version? This is where the mother is given drugs to relax her uterus, then the dr uses his hands externally to turn the baby around. This, of course, has it's pros and cons, which should be weighed. It also can be very painful for the mother (but not as much pain as she'll have after a c-section, I would think!).

Breech Labor: What To Expect




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The breech labor is in itself different from the vertex labor, and deserves discussion. In knowing what is to be expected, the midwife may free herself and her client from unnecessary concern, and be more ready to recognize and assess abnormal progress, should it occur.
1. It is not unusual for the waters to break prematurely, especially in footling breeches. It is important to check for fetal heart tones (FHTs) immediately, in the event the cord is compressed or prolapsed.

2. It is common for the mother to go into labor any time after 37 weeks gestation.

3. A fairly long prodomal period (early labor) may be expected due to the lack of application of the presenting part to the cervix.

4. The mother usually experiences a backache greater than the intensity of abdominal pain, but less severe or persistant than with a posterior (face up) presentation.

5. Multiparous breech mothers may exhibit little or no discomfort in early labor, and are often more than 4 centimeters dilated before they are aware of labor.

6. The mother may feel "breathless" during or after contractions due to pressure from the baby's head against the diaphragm.

7. Labor may escalate abruptly, after the onset of active labor. This is often a surprise to the mother who thinks that this labor will be a "snap".

8. The mother often has an early desire to push, again, markedly more so with a footling breech.

9. There may be a latent phase between complete dilation and the expulsive phase of labor, the mother may even take a little nap when complete, which is to everyone's advantage.

10. Multiparous mothers need lots of reassurance because breech descent feels very differently from the vertex.

11. Meconium show is to be expected in second stage, particularly with "buttlings", and although this is normal, continue to assess heart tones continuously to rule out cord compromise.

12. Second stage contractions are often less in frequency, duration and strength than first stage.

13. The presenting part is often discolored, and may appear swollen. This is no cause for alarm as discoloration and swelling will disappear rapidly after birth.

14. It is normal for the baby to need a minute's rest before "coming around". He has not had the scalp stimulation that occurs with the vertex delivery.

Breech Baby
What is a Breech Presentation?
The most common position for a baby to be in during labor is called the vertex, or head down position. A breech baby is not head down, but rather feet or buttocks down. There are three different breech positions a baby can be in:

Frank Breech – buttocks are down and legs go straight up.
Complete Breech – baby is sitting cross-legged.
Footling Breech – either one or two feet down.
In any breech position, the baby will exit the uterus feet or buttocks first, the head being the last part to be born. Approximately 7% of babies are breech at 38 weeks of pregnancy, only 4% are breech at 40 weeks pregnancy.

Why is a breech baby a labor challenge?
Having the head come out last increases the risk that the umbilical cord will be compressed or prolapsed. A compressed cord is not able to provide oxygen to the baby. Additionally, because the head is coming out neck first, it is less likely to mold increasing the risk for the head to get stuck. The death rate for breech babies is 4 times higher than for head first or vertex presentation babies.

Because of the increased risk of death, many doctors and midwives have stopped attending vaginal breech births. Instead, the standard treatment is to schedule a cesarean section at the earliest possible date. As fewer doctors and midwives participate in vaginal breech births, the skills necessary to safely attend the mother are lost.

Coaching Solutions
Try techniques to turn the baby before labor begins. If the baby will not turn, find a caregiver who is experienced in assisting at a breech labor.

Things to discuss with your caregiver:
As you near the end of your pregnancy, you may want to discuss ways to encourage your baby to move into a head down position. Some women have success with chiropractors familiar with techniques for encouraging proper positioning. Other women spend time with their hips higher than their head by either lying upside down on an inclined ironing board or by placing pillows under their hips. If your doctor feels your health is good, you may want to try one or both of these techniques.

Some women try placing a flashlight or headphones near their pubic bone, in an attempt to encourage the baby to move head down. Some experts recommend talking to the baby and telling him it is time to turn. Although no studies support the success of either of these methods, they seem to be harmless and your caregiver may encourage you to try them.

A medical method for turning the baby is called an external cephalic version. In this procedure, you will be given a medication that relaxes the uterus (tocolytic) and some doctors also use an epidural to minimize discomfort. Your caregiver will push and press your baby into a head down position. A Cochrane Review of the studies of external version has found that use of the tocolytic improves the success of turning the baby. You may want to discuss with your caregiver when external cephalic version may be recommended for you.

A Cochrane Review of the literature found that cesarean section did decrease the rate of death for breech infants. However, it did cause an increase in problems for the mother after the baby was born. If you know that your only option will be a cesarean (either because of lack of professionals who can attend a vaginal breech or because of other concerns for health), you may be able to delay the surgery until early labor begins. This would give your baby every opportunity to turn into the head down position.

Breech Birth is definitely a challenge for which it pays to shop around. Different caregivers have different skills and experiences, so will treat the breech birth according to what they feel is safe. If your caregiver does not feel comfortable with the way you want to handle things, interview others. You may find a caregiver familiar with the techniques you want to try. Some questions to ask:
Is there any problem with my trying alternative methods for turning my baby (such as moxibustion, pelvic adjustment with a chiropractor, hypnosis or positioning to turn the baby)?
When do you consider it time to try an external cephalic version? (Note: research indicates that early ECV is more successful)
Under what circumstances will you recommend a cesarean surgery?
Will I be disqualified from attempting a vaginal breech if this is my first baby?

The Term Breech Trial
The term breech trial (TBT) (Hannah, et al. 2000) was designed to conclusively determine if vaginal or cesarean section was the best mode of delivery for breech presentation. Previous studies suffered from small sample size, lack of randomization, and unclear inclusion protocols and outcome measures. The term breech trial was a randomized multi-center trial that included 2083 women from 121 centers in 26 countries. Inclusion criteria were singleton live fetus in frank or complete presentation at term (>=37 weeks). Exclusion criteria included fetopelvic disproportion, fetal macrosomia (or estimated weight >= 4000 grams), hyperextension of fetal head (undefined), clinician determined fetal anomaly or other mechanical condition, or a condition contraindicating vaginal delivery (e.g. placenta previa).
Planned cesarean sections were scheduled for 38 weeks gestation or more. Approved intervention included induction of labor, amniotomy or augmentation of labor for standard obstetrical indications, fetal heart monitoring intermittently or continuously, cervical dilation at least 0.5 cm/hour after the onset of active labor, descent of breech to the pelvic floor within two hours of full dilatation during second stage of labor, and delivery within one hour of active pushing. If there were fetal heart rate abnormalities or lack of progress, a cesarean was performed. If the baby were birthed vaginally, the baby was allowed to birth spontaneously up to the umbilicus, then controlled delivery of the after-coming head either with forceps or Mauriceau-Smellie-Veit maneuver occurred. Total breech extraction was not permitted.
The primary outcome was perinatal or neonatal mortality before 28 days or neonatal morbidity (birth trauma, seizures, Apgar score <4 at five minutes; cord-blood base deficit at least 15, hypotonia two hours, stupor, decreased response to pain, coma, intubation and ventilation, tube feeding, and admission to neonatal intensive care unit). The secondary outcome was maternal mortality or morbidity during six weeks post-partum. The study found planned cesarean section produced lower infant mortality and morbidity for babies in industrialized countries. There was no difference in maternal mortality or morbidity between vaginal and cesarean groups.
While this study is accepted as the gold standard in breech delivery outcome research, it is limited in several ways: 1) Inherent biases of the study design, 2) Recruitment of participants, 3) Categorical data analysis, 4) Use of non-parametric tests, 5) Presentation of initial findings, and 6) Presentation of follow-up findings.
Biases of study design
To participate in this randomized controlled clinical trial women had to agree to be randomly assigned to either the cesarean or to the vaginal birth group. This introduces a monumental bias into the study that cannot be overcome in the analysis section. If a woman is neutral about mode of delivery, she is not committed to a vaginal birth and may not be psychologically prepared for the demands thereof. This biases the study toward a Type I error (rejecting the null-hypothesis although it is true). A more appropriate design would be a cohort study where women self-select intervention. This is effectually a naturalistic experiment. While the cohort study is not randomized, the authors of the TBT found randomization did not afford the anticipated benefits since the trial was analyzed by intent to treat, but “women randomized to the planned vaginal birth group had a high rate of cesarean delivery, which would have reduced our ability of finding an association between cesarean delivery and adverse outcomes, if one existed” (Hannah, et al. 2002:1830)
Recruitment
Hewson et al. (2002) review the methodology of the TBT and note a disproportionate number of centers (61) in the English-speaking industrialized world versus the non-industrialized third world (27). However, over half (1161) of the individuals participating in the study come from the developing world. This suggests the English speaking countries had difficulty recruiting participants and needed additional sites to increase their numbers. The difficulty in recruiting participants in English speaking countries suggests the participants may not be representative of the target population, therefore results must be interpreted with caution.
Categorical data analysis
Categorical data analysis was used to analyze continuous data in this study. The basic problem with categorical data analysis applied to continuous data is that an emic perspective is imposed upon the data. For instance. WHO identifies a low perinatal mortality rate as <=20/1000 while a high perinatal mortality rate is >20/1000. One death per 1000 switches a nation from one status to the other. It is better to first conduct a multiple linear-regression analysis to determine natural categories within the data rather than just using categorical analysis with continuous data.
Use of non-parametric tests
The TBT was stopped early due to disproportionate adverse outcomes between groups. The study was originally designed as a single tailed test, but the intermediate analysis was designed as a two tailed test. Upon termination of the study, the data did not conform to the assumptions of parametric tests (normalcy, variance, and linearity) and therefore had to be analyzed with non-parametric tests. While non-parametric tests are valid and do offer statistically significant findings, they are less generalizable since the sample does not conform to the population profile.
Presentation of initial findings
The study’s initial conclusions read “Planned caesarean section is better than planned vaginal birth for the term fetus in the breech presentation; serious maternal complications are similar between the groups” (Hannah, et al. 2000:1375) However, when the data were analyzed comparing outcomes for countries with low perinatal mortality rates and high perinatal mortality rates this finding held only for countries with low mortality rates (i.e. the industrialized world). For the developing world (perinatal mortality rate >20/1000) there is no statistical difference between morbidity and mortality outcomes for cesarean babies and vaginally delivered babies (RR=0.66, 95% CI 0.35-1.24, p=0.13).
Thus, there are two competing findings in this study although this is glossed over. The reasons for the difference in response to delivery methods in the developed world and in the developing world are not hypothesized. Are clinicians in the developing world inexpert at cesarean sections? Are clinicians in the developed world insufficiently competent at vaginal breech deliveries? Why is there a difference?
Presentation of follow-up findings
At the three month follow up of maternal morbidity for the Term Breech Trial (Hannah, et al. 2002) 1596 or 1940 women from 110 centers were surveyed. The first page summary conclusion reads “Planned cesarean delivery for pregnancies with breech presentation at term may result in a lower risk of incontinence and is not associated with an increased risk of other problems for women at 3 months post partum, although the effect on longer-term outcomes is uncertain” (Hannah, et al. 2002:1822) . While this conclusion seems to advocate cesarean section, buried within the text of the article are additional differences between the two groups, not least of which was that women in the cesarean section group reported they did not like being in the trial because they did not like the method of delivery to which they were assigned (RR=2.0; 95% CI 1.31-3.04; P=.001). Additionally, fewer cesarean sectioned women breastfed their baby within a few hours of birth (RR=0.94; 95% CI, 0.89-1.00; P=.05), women in the cesarean group had more pain on the outside of the abdomen (RR=1.76; 95% CI, 1.24-2.50; P=.002) or deep in the abdomen (RR=1.89; 95% CI, 1.29-2.79; P<.001) than did vaginal birth women, and fewer c-sectioned women had pain in the bottom or genital area (RR=0.32; 95% CI, 0.18-0.58, P<.001).
Conclusion
The Term Breech Trial offers an opportunity to critically interpret cultural assumptions about birth and about “good” birth outcomes such as long term v. short term outcomes, maternal v. infant outcomes, and the assumed benefits of a “controlled” environment over a naturalistic environment. Although the controlled randomized clinical trial is posited to be an objective measure of reality, clearly it is still subject to personal and cultural biases in design and interpretation. I suggest the major contribution of this study is not validation of superior birth outcomes for the cesarean group as the article concludes, but rather reinforcement of the importance of reading all journal articles with a critical eye.
References
Hannah, Mary E., et al.
•2000 Planned Caesarean Section Versus Planned Vaginal Birth for Breech Presentation at Term: A Randomised Multicentre Trial. The Lancet 356:1375-1383.
•2002 Outcomes at 3 Months after Planned Cesarean vs. Planned Vaginal Delivery for Breech Presentation at Term. Journal of American Medical Association 287:1822-1831.
Hewson, Sheila A., Julie Weston, and Mary E. Hannah
2002 Crossing International Boundaries: Implications for the Term Breech Trial Data Coordinating Centre. Controlled Clinical Trials 23:67-73.

Heads up!
Breech is a commonly used word to refer to a baby who is not in a head down or vertex presentation. Usually this means a baby who is bottom down. About 3% of babies at 37+ weeks gestations are breech.
It is more common to have a breech baby if:
•If you've had several babies before.
•You have excessive amounts of amniotic fluid (polyhydramnios).
•Your uterus has growths or anomalies.
•Your baby has anomalies.
•Your placenta is low lying or you have placenta previa.
Babies will usually begin turning head down between weeks 28 and 32, and continue to turn on their own even during labor. There are ways to increase the chances of your baby turning to a head down position.
Non-medical Methods
• Tilt Positions. These are probably the most frequently heard about. You can do it the easy way and use an ironing board lying on the couch. Place your feet up and your head down. The theory behind these is that your baby's head, the heaviest part of his or her body, will disengage from the pelvis and baby will turn head down. It's generally recommended to do this 20 minutes a day until baby turns. Some women report dizziness from being in this position. Always discuss this or any other exercise with your midwife or doctor.
• Light/Music. The use of light or music directly at your pubic bone is to encourage the baby to come towards the light or sound. Many women report success with this and this has no side effects. For a nice touch to this you can have your partner talk towards your pubic bone, again to encourage baby to move towards the sound. Do this as often as you like until baby turns head down.
• Water. Some claims state that diving into a pool or simply being in a pool will encourage baby to turn. Again, no real problems noted from being in a pool. Double check about the diving.
• Acupuncture. This has been used along with moxibustion for success in turning breech babies. The biggest difficulty here may be finding someone who practices these techniques.
• Chiropractic Care. Chiropractors skilled in certain techniques may be able to help turn the baby. Check with your local practitioner for more information.
Medical Methods
• Homeopathy. Homeopathics, generally pusatilla, have been used for centuries in assistance in turning a breech baby. However, speaking to a knowledge practitioner is a must when trying to use this to help turn the baby.
• External Cephalic Version (ECV). External version is generally done around 37 weeks. To be a candidate one must have adequate amounts of amniotic fluid to cushion the baby. The most common way to see this performed is in a hospital with fetal monitoring, ultrasound, and many times IV medications to relax the uterus. Performed prior to 37 weeks and you run the risk of preterm labor and many babies may have turned on their own. The biggest risk to the ECV is separation of the placenta which rarely occurs mostly due to the guidance of the ultrasound. There are also potential complications with cord involvement. Recent studies show that epidural anesthesia may actually increase the success rates of external version, which are stated to be between 65-70% in an experienced practitioner.
Still Breech?
Say you've tried all of these and your baby is still breech. What does this mean?
There is actually a lot of misinformation about the mode of birth for breech babies. Many people will tell you that the only method of delivery that is safe is an elective cesarean. This is absolutely not true. Many of the problems that were once thought to be caused by the vaginal breech birth where not actually caused by the birth but by something prior to the birth. About 50% of all breech babies are currently being born vaginally (though this statistic varies drastically from practice to practice). Many criteria have to be met prior to considering a vaginal birth for a breech baby, though even the experts disagree on what they should all be. Generally speaking your chances of delivering a healthy breech baby vaginally increase with the following:
•Baby is frank breech (feet straight up).
•You've had baby(ies) vaginally prior to this birth.
•Baby is not thought to be excessively large.
•You have no pelvic or uterine anomalies.
Some breech babies are generally better off being born by cesarean. Only your practitioner can help you determine if your baby is one of them. This would also not mean that all of your subsequent babies would be breech or necessarily be born via cesarean section.

Q. At this very moment she is in the hospital where her OB is going to try and reposition the baby. How effective is this and can you give me some insight as to how that is going to affect the baby, her, and what her chances are of having a vaginal birth now. I'm in the dark and very worried.
A. The procedure is known as an external version, and the OB is performing it relatively early enough that it will likely be successful. External version usually will not affect her or the baby, though sometimes women have sore abdomens afterwards. During the procedure the baby's heart is monitored to make sure he is handling the version well. (when babies aren't happy, their heart rates react--this is why practitioners listen all the time) If the baby seems distressed during the version, the procedure will be abandoned. In essence, the OB monitors the baby's heart rate and the position of the placenta by ultrasound, as he applies pressure to the baby's head and butt to encourage him to turn.
There are some other ways to help turn a baby who is breech:
•Lying on a slant board with your hips higher than your head twice a day for 15 minutes.
•Lie on your back with your hips propped on three or four pillows and massage your belly gently, telling the baby to turn.
•In the breech tilt exercise, the mom takes an ironing board, pads it well, props one end up on the couch, and lays on it head down. She relaxes and gently starts trying to push the baby into proper position, by placing one hand on the baby's head, and one on it's breech. The key here is gentle encouragement---you do not force the baby to turn in any way. If the baby does flip, mom quickly gets up, squats and takes a walk, to try and settle the baby further into the pelvis. It has been reported that often by the fourth day of this exercise, baby will turn in anticipation of the exercise.
Having a breech baby vaginally is wholly dependent on the practitioner's experience. If your daughter wants to have her baby vaginally if it is breech and her OB does not do vaginal breech deliveries, she might need to call around to find a doctor or midwife skilled in delivering breeches. A term breech baby is less likely to have complications than a premature breech baby, but the very mechanics of the birth require an experienced practitioner who knows how to be patient. Mismanagement of a breech is often the cause of complications of the newborn, so trying to convince your practitioner to deliver a breech vaginally when they are not comfortable with it is foolhardy. Better to find a practitioner who is experienced and willing to assist a breech.
If the baby turns head down, there is no reason why she should not be able to have a vaginal birth.

Breech Delivery

The diagnosis of breech is the third most common reason for cesarean section in our country. Any strategy to bring down overall cesarean section must deal with this issue. Somewhere between 2 and 4% of all babies are born in the breech position (butt first). At the present time virtually 100% of these babies are delivered by cesarean section in the outdated belief that it is the safest way for the baby; none will say cesarean is the safest way for the mother.

However, recent studies have called this entrenched idea into question. Many experts in the field now recognize that vaginal delivery is as safe as cesarean section for the baby as well as safer for the mother. In fact, our current strategy eliminates cesarean 75% of the time when the diagnosis of breech is made. . .

Here’s how we do it. If by our physical examination, any time past 36 weeks, we believe that the baby is breech, we order a sonogram. This helps us decide if this baby is a good candidate for external cephalic version . Opinions vary as to what makes a good candidate, but the amount of fluid around the baby, the position of the limbs, the general size of the baby as well as the mother, and location of the placenta all help us decide who to offer version. If the mother accepts our offer we schedule a birthing room at the hospital approximately three weeks before the due date. We generally administer an asthma medicine that relaxes the uterine muscles just as it relaxes bronchial muscle. Then after we apply some body oil (it cuts down on the chafing from my hands), I simply turn the baby head over heals. Sound elegantly simple? It is. I just catch the baby by the back of the head (by pressing on the mom's tummy) and the butt and do what is called a "forward roll maneuver". And that is why it is successful 50% of the time.

Once verted the baby seldom returns to the former breech position. Babies that aren’t breech don’t carry the high risk for cesarean- neat! But what if it’s still butt first? Some say that the vaginal delivery of a breech is a dead art and/ or foolish in this day and age. I am reasonably sure I’m not dead and I hope Iam not foolish, but I was trained by OB’s in the mid 1970’s who believed that vaginal breech delivery was at the highest level of their expertise. They took great pride in those skills and I still do. Here again it is almost unbelievably simple.

We let the patient labor. If the butt appears we catch the baby, if it doesn’t we do a cesarean. Honestly when we do it this way, 50% of the time the baby jumps right out. So there you have it, using our management we reduce section for breech by about 75%. Any questions ? E-mail us or give us a call. Some times simple really is best.

Answer 2

If the baby is breech, it will have to be delivered by c-section unless it turns itself around. Some babies have been known to do this at the last minute.

Her doctor turning the baby from the outside is known as an "external version." I've never had this done, but I understand it is incredibly uncomfortable...almost painful, and doesn't always work. If her doctor doesn't know what he's doing or isn't very experienced at doing versions, he could seriously hurt the baby.

How far does your mom have to go until her due date? if she has weeks or months, like I said...the baby has plenty of time to move/flip itself to the correct position for delivery.

Answer 3

that doesnt really mean anything is wrong, it just means that the baby is positioned to come out feet first rather than head first. usually the doctor will have to perform a c section when it comes time to giving birth. but some babies find their way into the right position by that time, it depends how far along in the pregnancy the woman is.

Answer 4

IT DOESN'T NECESSARILY MEAN ANYTHING IS WRONG, MOST OF THE TIME, THE BABY WILL TURN ON IT'S OWN BEFORE THE DUE DATE, BUT THEN AGAIN MY SISTER'S LITTLE BOY WAS BREACH AND HAD TO HAVE A SCHEDULED C-SECTION BUT WAS BORN PERFECTLY HEALTHY HE WAS A TEN POUND BABY! I WOULD SAY THERE WILL BE AT LEAST IN MODERATION, SOME DISCOMFORT, BEFORE THE DOCTOR ATTEMPTS TO TURN THE BABY ASK IF THERE'S GOING TO BE PAIN INVOLVED SO SHE WILL AT LEAST KNOW WHAT'S COMING....HOPE ALL GOES WELL

Answer 5

It is not painful as labor or contractions, but you do feel an immense pressure on your stomach because they need to try to turn the baby and the risk of that is that you may have to go into labor that same day as your water may break.. Mine did not break when they attempted to turn my baby around, and at the same time, the baby did not turn around either. When I went into labor they attempted to take her out vaginally, butt first, but that was not successful and therefore, I had no choice to have a c-section.

Answer 6

When I was pregnant with my daughter she was breach all the way up until 2 weeks before she was born and she flipped. I was worried sick but the doctor told me that it is not uncommon for this to happen. So don't worry until you know for sure the baby is gonna stay this way. GOOD LUCK

Answer 7

Some doctors can turn a baby that is breech and sometimes a baby will turn on it's on.

They tryed to turn my lil sister when mom was pregnant with her but they couldn't and she had a c-section.

I had to have a c-section cause my son was breeched.

Answer 8

the kid is backing out...doctor may perform a c-section

Answer 9

breach blonde