Until as recently as the 1970s, babies presenting bottom first or ‘breech’ were considered unusual but still normal in the UK and many were born at home with a midwife in attendance. With the increasing hospitalisation of birthing women and the increased medicalisation and development of obstetrics in the latter half of the 20th century, babies in the breech position in late pregnancy came to be seen as ‘abnormal’. Unfortunately this lead to a rapid loss of the skills traditionally used in helping women to give birth to breech babies vaginally. It is not uncommon for babies to be in a breech position until late in pregnancy and there are things you can do to encourage them to turn spontaneously such as adopting particular positions, hypnosis, moxibustionand homeopathy to name a few.
Women whose babies are in a breech position at 37-39 weeks may be offered External Cephalic Version (ECV) which is an attempt by a doctor to manually turn the baby using pressure on the abdomen. The ECV procedure is not without risk which you should research and talk to your midwife and doctor about. It is worth asking what success rate your doctor has as results are not guaranteed and can vary between practitioners. Most babies will turn head down by 38-42 weeks but 3-4% will remain in a breech position.
There are 4 main birthing options for women who carry their babies in the breech position:
- Planned Caesarean section before the spontaneous inset of labour around 38-39 weeks.
- Caesarean section after the spontaneous onset of labour, either planned or ‘emergency’.
- Vaginal Breech Extraction or Delivery.
- Vaginal Breech Birth.
When deciding which option is the best for you as an individual, possibly one of the most important factors to consider is the experience of the practitioner who will support you. It is also important to note that there is a significant difference between a breech vaginal ‘extraction’ or ‘delivery’ and a breech ‘birth’. Research the risks and benefits of each technique in detail.
A detailed, well referenced publication is available from AIMS entitled ‘Breech Birth: What are my options?’ from which much of the infomation on the page has been taken.
While NHS midwives are expected to keep their knowledge and skills up to date as undiagnosed breech does occur occasionally, Independent midwives often have more actual experience in breech ‘birth’ at home or in hospital. Most women with a breech baby being cared for by the NHS will opt for a caesarean section, however there may be confident and experienced NHS practitioners in your area so take your time to research your options in detail.
RCOG Green Top Guidelines: The Management of Breech Presentation
Royal College of Midwives: Campaign for normal birth – Normal Breech Birth
Surprise breech home birth (story to accompany the pictures on this page)