Can a Breech Baby be Delivered without a Cesarean Section

Women have been having babies for millions of years. Over time medicine has increased the safety of childbirth so there are much fewer deaths, both of babies and of their mothers. Some of these babies born over the years have been breech babies and they have been delivered vaginally. So, can it still be done?

Diagnosing a Breech Baby-

A breech baby is one that has its bottom or its feet in position to be delivered first (rarely the knees will be presented first). There are four breech positions including the Frank Breech which is where the baby’s bottom is pressed against the cirvix and the legs are flexed toward the head, this is the most common breech position effecting 65-70% of all breech babies. The second most common is the complete breech position where the baby’s bottom is pressed against the cervix and its legs are bent in a cross legged position with its feet near the buttocks. The third most common is the Footling Breech where the baby has one or two feet in position to come first. The rarest is the Kneeling Breech where the baby has its legs are bent and the knees are pressed to the cervix.

A breech baby is usually diagnosed between 36 and 37 weeks. While it is still possible for the baby to turn around before delivery (even after labor has started). It is usually a sign of concern if it is in this position after 36 weeks. The diagnosis will come with an abdominal exam, an examination of the cervix, and usually an ultrasound to confirm.

Trying to Turn a Breech Baby-

Once the diagnosis has been made most doctors prefer to try and turn the baby into the correct position. If the baby ends up in the correct position before delivery a normal vaginal delivery would then take place. This is the ideal situation and there are a few options for trying to get the baby to turn. For more information on it see How to get a breech baby to turn before delivery.

Delivering a Breech Baby-

It is sometimes possible to deliver a breech baby vaginally. Ideally the baby would be full term and in a Frank Breech or Complete Breech position. These positions are such that the hips of the baby open the birth canal and vagina enough for the head to make their way through with less risk.

There are few doctors who will deliver a breech baby on purpose and it is more likely that it happens because there is no time to do otherwise. Most doctors prefer to do a Cesarean Section because it has less risk to the baby (though research shows that there is a slightly higher risk to the mother in a Cesarean Section).

The Risks-

The biggest risk for the baby during a breech vaginal delivery is that the umbilical cord will become compressed, called Umbilical Cord Prolapse. It is easier to do in a breech delivery because of the shoulders, head, and the time it takes the hips to make their way through the canal. This can lead to lower oxygen and can cause a number of problems including brain damage and death.

The next concern is head entrapment. It is possible for the head of the baby to get stuck because of the odd angle that it comes through at and also because the space isn’t large enough for the head. This is a bigger risk for pre-term babies because their hips are smaller then their heads. It is also more likely in the Footling Breech and Kneeling Breech positions because the baby’s hips are less likely to make such a large clearance for the head.

Injury to the head or brain is also possible due to the rapid passage of the head. In a normal birth it takes a lot of time for the head to make its way through and then the body comes through rapidly. In breech the bottom of the baby (usually the hips) take the longest time to get through and then the head comes through fast.

It is also possible that an inexperienced doctor could accidentally injure the baby. Most doctors have very little experience with breech babies and holding their bodies so their internal organs don’t get bruised or damaged is difficult. It is also possible to damage the spine while using forceps to try and dislodge a baby experiencing head entrapment.

Cesarean Section-

Most doctors feel that the best course of action should it come down to delivering a breech baby is through Cesarean Section. While it is possible to delivery a healthy and happy breech baby vaginally (my mom was one) the risks are often considered greater then the advantages. Therefore a Cesarean Section is recommended.

After being diagnosed with a breech baby the best thing is to get the baby to turn into the correct position. This is often possible and is the best thing for both mom and child. However, when that isn’t possible, the risks of a vaginal breech birth need to be considered. If you still would prefer to deliver without a Cesarean Section it is best to find a doctor who is knowledgeable and experienced in the area to at least assist your normal doctor. This can cut down some of the risks. If the risks are not worth it to you, then a Cesarean Section is definitely the way to go.