Breech Baby: Techniques in Preparation for Delivery

Writing about parenthood is thrilling, but my pregnancies were a mix of excitement and surprises. During my second pregnancy, everything seemed fine—until my doctor casually mentioned the term ‘breech baby.’ Instead of settling head down, my baby was positioned feet first, disrupting my birthing plans and leaving me both worried and confused.

With some guidance and a few tried-and-tested techniques, I discovered ways to help my baby move into the optimal delivery position. If you’re navigating the same uncertainty, you’re not alone. This is my attempt to explain everything about breech babies, along with safe techniques to prepare for delivery. Let’s walk this path together.

As the due date gets closer, a baby is normally positioned head down and is ready for delivery. In a breech position, the baby’s feet or bottom face downward. Don't worry - this is not a very common occurrence as you may think, but it is always good to be prepared. While your baby may be in a breech position at some point during the pregnancy, it usually resolves on its own as the fetus moves around. However, about 3 to 4 per cent of babies remain in a breech position even at the end of pregnancy,  making it a little more complicated.

Types of Breech Positions

Some babies settle into a ‘breech’ position, which isn’t ideal for delivery—but it doesn't always mean they’re upside down. While this can sound concerning, understanding the different types of breech positions can offer clarity and reassurance.

Frank Breech: The most common breech position is for the baby's bottom to face the birth canal (with the legs straight up toward the head).

Complete Breech: In this fetal position, the baby’s buttocks are pointed toward the birth canal, with both knees bent and legs folded close to the body, resembling a sitting position.
                  
Footling Breech: A footling breech occurs when one or both of the baby’s feet are positioned downward and closest to the birth canal, making the feet the first part to emerge during delivery.            

Diagnosis for Determining Breech Presentation

The diagnosis of the breech presentation is usually made based on a physical examination, fetal heartbeat location, ultrasound examination, and pelvic examination. Doctors use these methods to determine exactly where the fetus is and whether it is in complete breech, frank breech, or footling breech position.

Changes in maternal abdominal shape, palpation findings and abnormal ultrasound results are some of the signs of a breech baby in the womb.

If you’ve just found out that your baby is in a breech position, I know how overwhelming it can feel. I remember the moment my doctor told me the same during my second pregnancy—my mind was flooded with questions and concerns.

But here’s the good news: you’re not alone in this, and there are ways to handle it with the right information and support. Let’s explore the different types of breech positions together, starting with the footling breech, and see what it means for you and your baby.

Risks to the Baby

While there are a few risks to the baby to be aware of when it comes to a breech delivery, knowing them can help you feel more prepared and supported:

• The primary concern with a breech position in the womb is cord prolapse, where the umbilical cord gets compressed, potentially reducing the baby's oxygen supply.
• Another challenge is head entrapment, since delivering the baby's head can be the most difficult part and may take longer than expected.
• There’s also a small risk of physical injuries, such as minor fractures or nerve stress, due to the baby’s position.

Risks to the Mother

I understand that the idea of a breech delivery can be concerning—I’ve been through it myself. It can sometimes be more challenging for the mother, involving longer and potentially more uncomfortable labour. In some cases, assisted delivery methods like forceps or an emergency cesarean might be needed to ensure a safe birth.

Breech delivery can also require extra medical attention since it increases the risk of vaginal tearing or bleeding. It’s normal to feel a range of emotions—fear, uncertainty, or even disappointment. I felt the same way. But remember, your healthcare team is fully prepared for these situations, and their priority is to support you and your baby every step of the way.

Your pregnancy is a very vulnerable time. I would know, because a few months ago, I was waiting for a picture-perfect day filled with easy labour, lots of love and emotions. It was still a beautiful day, but my labour was far from easy because my baby boy had plans of his own!

If your baby is still in breech towards the end of your pregnancy, you'll need to look into some natural or assisted methods to encourage the baby to turn as a last Hail Mary! These are some strategies I was recommended:

External Cephalic Version (ECV)

It's a procedure where doctors try to turn a baby from a breech (feet or bottom first) position to a head-down position for delivery. The procedure is usually performed between the 36th to 38th week of pregnancy.

The doctor will put their hand on your belly and push, so hopefully, the fetus goes into a better position for delivery. It takes place in a hospital so they can watch the heartbeat of your fetus and monitor its progress with an ultrasound. It's normal to feel a little pressure, but if you feel any more discomfort, always let your doctor know.

While ECV works for many women, it does not produce guaranteed results. The baby may sometimes return to breech or not turn at all. The procedure is carefully monitored because there are small risks, like early labour or changes in the baby’s heart rate.

Natural Methods for Encouraging the Baby to Turn

Babies in a breech position are often considered high risk, but there are gentle, natural ways to encourage them to turn their head down before delivery. While these techniques aren’t always successful, they can be safe and noninvasive methods that allow your baby more room to move.

However, it’s essential to discuss any of these techniques with your doctor first. If you decide to try them, do so under your doctor’s supervision or with their approval to ensure they are both safe and effective.

You might look a little comical, attempting these exercises (I sure was). In the moment, it seemed hard and complicated, but looking back, it allowed me to move my body and relax.

• Crawling Exercises: Crawling on your hands and knees can create more space in your pelvis, potentially encouraging your baby to turn. Try this exercise on a soft surface like a mattress to promote gentle movement.
• Pelvic Tilts: Sit on the floor with your knees bent, then lift your hips off the floor in a gentle tilt. This movement can help open up the pelvic area, giving the baby more room to shift position.
• Forward-Leaning Inversion: Kneel on a couch or bed and slowly lower your hips, keeping them higher than your head as your upper body moves toward the floor. This position may help lift the baby slightly out of the pelvis, allowing for a potential turn.
• Swimming: The buoyancy of water helps relax your muscles, creating more space for the baby to move. Try gentle swimming strokes, as they may aid in repositioning the baby naturally.

I completely understand how daunting a breech delivery can be, but being prepared and organised goes a long way! When you have a high-risk pregnancy, it's very easy to get lost amid medical jargon, but sit your doctor down and ask them all the questions you may have.  

There are two options when it comes to a breech delivery:

• Trying for a vaginal breech birth
• Planning an elective C-section

Vaginal Breech Delivery Techniques

If your baby is in a breech position, it’s still possible to have a vaginal delivery, but it does require extra care and preparation.

Your position during labour can make a significant difference. Using upright positions, such as standing, squatting, or kneeling, can help you use gravity to create more space, making it easier for your baby to descend.

If you’re planning for a vaginal breech delivery, it’s important to do so in a hospital, where you’ll have medical supervision to ensure both your safety and your baby’s. It’s also good to be prepared for the possibility of an emergency cesarean section, as complications can arise despite the best efforts and planning.

Caesarean Section for Breech Babies

Cesarean sections (C-sections) for breech babies can be split into two categories; planned or unplanned :

Planning an Elective Cesarean Birth: This is a scheduled procedure in which the baby is delivered through cesarean section. Since it's pre-planned, it is relatively low-risk as most breech babies are born without any major complications.

Emergency Cesarean Section: These are usually attempted if you choose you try a vaginal birth first. If complications occur, then you change course and go for an emergency C-section, like I did. While this option is rather stressful and scary, it helps to remember that it is only done when absolutely necessary. 

Immediate post-delivery care is crucial to ensure the stability of both the mother and the baby.

Once the baby is born, the doctor will first ensure the baby is breathing properly. This may involve clearing any fluid from the baby’s mouth and nose, or providing gentle breathing assistance if needed. If the baby shows signs of distress, such as difficulty breathing, real-time monitoring of heart rate and oxygen levels will be conducted to address any concerns swiftly.

Simultaneously, the mother’s health will also be carefully monitored. This includes checking for signs of excessive bleeding, managing pain, and monitoring for any complications, especially if a cesarean section was performed. Support for initiating breastfeeding and skin-to-skin contact will also be encouraged as part of early bonding and recovery.

The combined post-delivery care helps create a safer and more supportive environment for both the mother and the baby during this critical phase.

Looking back at my pregnancies, I see how much strength it truly takes to remain calm and get through the ordeal, while worrying about your baby and yourself. The journey, for me, and most likely, for you also, will be marked by several unforeseen challenges.

However, these are final words of advice to you: if you have a breech baby, remember to trust your instincts, and trust the journey, because you are doing a good job. Your body knows what to do, so let it guide you!