Special delivery: options for breech babies
Posted on 31 January 2018
If your baby is not positioned head-down in your womb by 36 weeks, he or she is considered breech. Dr Ludwig van Zyl, a gynaecologist and obstetrician practising at Mediclinic Vergelegen, explains the options for delivery in this scenario.
What is a breech baby?
Breech refers to the position of your baby in the womb. The ideal position for your baby from 36 weeks in utero, is head-down; a breech baby is positioned bottom-down. And there are three different types of breech:
- Complete breech – posterior first with knees bent
- Frank breech – posterior first with legs stretched and feet at the head
- Footling or incomplete breech – one leg is lowered over the cervix
What causes a baby to breech?
Dr van Zyl says there are many reasons for a baby to breech but the most common are:
- The size of the baby
- The position of the placenta (placenta previa)
- The shape or size of the pelvis
A breech is also more likely if you go into early labour, have too much amniotic fluid, fibroids or you’re carrying more than one baby. 
Is natural birth still possible?
Dr van Zyl says natural birth is possible but not advised because of the higher risk for damage to your baby’s brain. 
‘Preferably, especially with a first baby, you should have a caesarian section. If you deliver a breech vaginally, the baby’s bottom part of the body goes through the birth canal first, with the biggest part of the body following, so the head can get stuck which can really complicate the delivery. There is also the risk of cord prolapse, which means the umbilical cord emerges before or with your baby. If the umbilical cord is compressed during the birth, the flow of blood to your baby is restricted.’
Can a breech be prevented?
Dr van Zyl says there is nothing a mother can do to prevent her baby from breeching, but there is a way to reposition the baby once it has breeched.
He reports many patients ask about external cephalic version (ECV). This is a non-surgical technique that involves pushing on the belly to move your baby in utero while monitoring on an ultrasound. It may also involve medication to relax your uterus.
‘It can be done but you’ll have to discuss it with your gynaecologist because there are certain safety measures, and boxes that need to be ticked before you can even consider that,’ he explains. ‘ECV is ideally performed between 32 and 37 weeks of pregnancy as it becomes more difficult closer to your due date.’