Which statement is most likely to be associated with a breech presentation?

Most babies settle into a head-down position, ready for birth, by about the last month of pregnancy. Health professionals call this a ‘vertex’ or ‘cephalic’ position.

When a baby is positioned bottom-down late in pregnancy, this is called the breech position.

It is fairly common for a baby to be in a breech position before 35 to 36 weeks gestation, but most gradually turn to the head-down position before the last month.

Your doctor or midwife will feel your abdomen when you have your pregnancy check-ups in second and third trimesters — this is called an 'abdominal palpation'. When they feel your abdomen at 35 to 36 weeks, they will assess whether the baby has settled into a head-down position in preparation for birth. If they suspect your baby might be in a breech position, they can confirm this with an ultrasound scan.

There are 3 main types of breech position. All of them involve the baby being in a bottom-down, head up, position. The variations of breech include:

• frank breech — the baby’s legs are straight up in front of its body in a V shape, so its feet are up near its face
• complete or flexed breech — the baby is in a sitting position with its legs crossed in front of its body and its feet near its bottom
• footling breech — one or both of the baby’s feet are hanging below its bottom, so the foot or feet are coming first

What does it mean for my baby?

While your baby is still in the womb, it is just as safe for them to be in a breech position as it is for them to be head-down. There are no long-term effects on children who were in a breech position during pregnancy. The birth process, however, is often more challenging when babies are still breech at the start of labour.

Why do some babies remain in a breech position?

Often it is unclear why a baby remains in a breech position. Some of the common reasons include:

• too much or too little amniotic fluid around the baby
• the length of the umbilical cord
• multiple pregnancy — for example, often one twin will be in a head-down position and the other in a breech position
• uterine fibroids
• an irregular size or shape of the mother’s uterus

Can my baby still turn after 36 weeks?

Some breech babies turn themselves naturally in the last month of pregnancy. If this is your first baby and they are breech at 36 weeks, the chance of the baby turning itself naturally before you go into labour is about 1 in 8. If you’ve already had a baby and this one is breech at 36 weeks, the chance of them turning naturally is about 1 in 3.

If your baby is in a breech position at 36 weeks, your doctor or midwife might suggest you think about an ECV, or external cephalic version, after 37 weeks. This will increase your chances of your baby turning to a head-down position. However, ECV is not suitable for everyone, so it’s important to discuss this option with your doctor or midwife.

Some people think that you might be able to encourage your baby to turn by holding yourself in certain positions, such as kneeling with your bottom in the air and your head and shoulders flat to the ground. Other options you might hear include acupuncture, a Chinese herb called moxibustion and chiropractic treatment. There is no good evidence that these work.

Talk to your doctor or midwife before trying any techniques to be sure they do not harm you or your baby.

What are my options if my baby is breech?

If you don’t have an ECV, or if you have it but it doesn’t work, then your options are to have an elective caesarean birth or to have a vaginal birth. Things may be different if you have had a caesarean section before — in this case, if you wish to explore the option of vaginal breech birth, you will need to discuss this with your obstetrician. You may be advised to have a caesarean section again.

Often, women are encouraged to have a caesarean birth if their baby is breech because it might be safer for the baby. But a vaginal birth is still an option in the right circumstances, such as:

• no other issues that would suggest a vaginal birth is unsafe, such as placenta praevia
• you are giving birth in facilities that can handle an emergency caesarean, if necessary
• you have an obstetrician or midwife who is skilled in vaginal breech births

What is involved in a vaginal breech birth?

When babies are in a cephalic (head-down position) ready for birth, the birth process is more straightforward because the crown of the baby’s head is born first. The head is the largest part of the baby’s body, so it makes way for the rest of the body to follow.

The birth process might be more challenging if your baby is breech. When a baby is born bottom first, the baby’s body is born before the largest part, its head. Often this doesn’t cause a problem. But there is a chance that the head, or the head and arms, may not follow easily, once the body is born. In this case, it is important that a midwife or obstetrician with skills and experience in breech births is present to assist your baby to be born.

Upright maternal positions, such as kneeling or a hands and knees position, are recommended when you give birth to a breech baby. The obstetrician or midwife will be standing by, observing closely, with a ‘hands off‘ approach, unless your baby's progress during the birthing process slows down. In such cases, there are a number of techniques that can be used to assist your breech baby to complete the birth vaginally, or it may be necessary to proceed to an emergency caesarean section.

The progress of your labour will be monitored closely. If there is any delay in the descent of your baby, a caesarean section might be recommended. This is because a delay in the baby’s descent inside may be an indication that the birth process could also be delayed, which is more risky for your baby.

In many settings where vaginal breech births are offered, it is preferred that your baby is monitored continuously with a cardiotocograph (CTG). If available, you may prefer a cordless, waterproof CTG so you can remain upright and mobile, and so you can use the bath or shower for pain management during labour.

What should I ask my doctor or midwife?

It is worth discussing whether you might benefit from an ECV, because if this is successful, you can go on to try a vaginal birth.

You should also ask if:

• a vaginal birth is safe for the type of breech position your baby is in
• the health service you are planning to use can manage a breech vaginal birth
• your doctor or midwife has training and experience in managing a breech vaginal birth

Do all hospitals offer vaginal breech birth?

Not all hospitals have obstetricians and midwives on staff with the skills and experience in assisting women with a vaginal breech birth. If it is important to you, and your doctor or midwife can’t offer you a vaginal breech birth, you can ask to be referred to another health service.

What if I am planning a home birth and my baby is breech?

If you are planning a home birth, discuss options for your care with your midwife. The Australian College of Midwives and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists recommend that you should be referred to an obstetrician if your baby is breech at the start of labour. This usually means being transferred to give birth in a hospital. In most cases, your midwife will be able to continue supporting you during your birth in hospital and also continue postnatal care at home after your baby is born.

Which of the following best describes a frank breech presentation quizlet?

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