Breech Position And Breech Birth: Treatment Overview

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Treatment Overview

By the 36th week of most pregnancies, the fetus naturally turns head-down (vertex). In this position, the fetus is ready for a head-first delivery through the birth canal. If your fetus is bottom-down (breech position) as your due date approaches, your health professional will recommend a scheduled cesarean delivery (C-section), which is safer than a vaginal breech delivery.⁴ However, if your fetus can be turned before labor starts, you can try for a vaginal labor and delivery.

See illustrations of different breech positions .

Turning a breech fetus

Trying a version procedure to turn your fetus increases your chances of being able to deliver vaginally.^8,¹ You may also try at-home postural management; though not well studied or proven, it is considered safe, with potential to be effective.⁹

External cephalic version (or version) is done in a medical setting with constant fetal heart rate monitoring. You will have an ultrasound before and after the version attempt. Your health professional may first give you a medicine to relax your uterine muscles. To turn the fetus, your health professional will press on specific areas of your abdomen. Version can be repeated several times if the first attempts to turn the fetus are unsuccessful.
Postural management is something you do at home. You carefully position yourself with your hips raised above your head several times a day for several weeks.

If a version is successful, your fetus' position will be checked regularly until labor begins. If your fetus stays head-down, a planned cesarean is not needed, and you can expect to go through labor. You may deliver vaginally or by cesarean, depending on how the birthing process goes, as during any non-breech birth. In one study, women who had given birth before had a lower cesarean rate after a successful version procedure than did women delivering for the first time.²

Delivering a breech infant

Most breech infants are delivered by planned cesarean section (C-section) to prevent harm to the mother and infant. If your fetus remains in or returns to breech position near your due date, your doctor will likely schedule a cesarean. The American College of Obstetricians and Gynecologists recommends againstvaginal birth of breech infants when cesarean delivery is possible.⁴ For more information, see the topic Cesarean Section.

During the 1990s, some experts recommended vaginal breech delivery by experienced doctors, reasoning that avoiding a cesarean can benefit the mother. However, a major study has since found that 5 of every 100 breech infants delivered vaginally suffer serious complications such as organ and neurological damage. (This means that 95 of every 100 newborns have no serious problems from vaginal breech birth.) To compare, less than 1 of every 100 breech infants have serious problems when delivered by cesarean. All mothers in the study had a similarly low level of complications, regardless of how they delivered.⁵

On occasion, a cesarean breech birth is neither possible nor recommended. When a breech labor progresses too quickly, a vaginal birth may be the only delivery option. During a twin birth, a second twin who is breech may best be delivered vaginally.⁴ Risks are lowest for the newborn when a doctor has a lot of experience doing this kind of delivery.⁷

A fetus in a breech position can be delivered by:

A perinatologist.
A family medicine doctor with training in cesarean deliveries.
An obstetrician.

If you have a certified nurse-midwife or certified professional midwife for obstetric care, she will refer you to a doctor for a cesarean delivery.

Your pediatrician or family medicine doctor may be present during the delivery in case your newborn needs care after birth.

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Last updated:	May 05, 2006
Author:	Kathe Gallagher, MSW
Reviewed By:	Joy Melnikow, MD, MPH - Family Medicine, William Gilbert, MD - Perinatology
Editors:	Kathleen M. Ariss, MS, Pat Truman

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