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Breech Baby: What Causes it and What to Expect

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Are you wondering what it means to have a breech baby and what it means for your delivery?

From very early in the pregnancy, your tiny acrobat is twisting, turning, kicking, and tumbling about, suspended in the amniotic fluid in your uterus. As they grow, it gets harder to turn around—you’ll feel lots of somersaults and karate kicks!

By the time you’re at week 36, the position your baby is in begins to matter for delivery. Most babies will have turned so their heads are down toward the birth canal, but some have not—they are in the breech position. A breech baby presents with their buttocks and/or feet first instead of their head, which is a higher risk position for vaginal birth.

But just because your baby is in a breech position doesn’t mean they will stay that way. The closer the baby gets to full term, however, the harder it is to turn around on their own.

The Importance of Fetal Position Before Delivery

The position of the baby’s head matters for delivery. During birth, the baby’s head pushes through the vaginal canal, widening it and making it possible for the rest of the body to follow more easily. If the baby’s buttocks or feet lead the way, labor can become more difficult and dangerous.

Dangers of a vaginal breech birth include cord prolapse (a rare emergency when the umbilical cord exits the cervical opening first), traumatic injury such as a dislocated shoulder, or reduced oxygen if the head cannot pass through the canal after the rest of the body quickly enough. To avoid these risks, your OBGYN may recommend turning the baby to the head down position with an external, manual manipulation called external cephalic version (ECV). If that doesn’t work or your baby remains in the breech position at week 39 gestation, your OBGYN will recommend a C-section as the safest birth option.

Breech Positions

Your baby’s position will be assessed at your 36 week visit with a small ultrasound. By this time, most babies will be positioned with their head down toward the birth canal. However, about 3-4% of them will not.

There are three types of breech baby positions:

  • Frank Breech Position

The baby is in a pike position, with both feet up near the baby’s head.

  • Incomplete Breech Position

One leg is up by the baby’s head.

  • Complete Breech Position

Both knees are bent and the baby’s feet and bottom are closest to the birth canal.

Causes of Breech Baby

Most of the time, the position of the baby is a chance occurrence with no clear cause. In about 15% of breech cases, a uterine abnormality is the cause. Other reported risk factors include:

  • A previous sibling or either parent who was in breech presentation
  • Uterine abnormality (bicornuate or septate uterus, fibroid)
  • Placental location (placenta previa, cornual placenta)
  • Extremes of amniotic fluid volume (polyhydramnios, oligohydramnios)
  • Fetal anomaly (anencephaly, hydrocephaly, sacrococcygeal teratoma, neck mass)
  • Crowding from multiple gestation
  • Fetal neurologic impairment
  • Maternal hypothyroidism
  • Female sex
  • Older maternal age

How to Fix Breech Position Naturally

In many situations, babies move out of the breech position on their own.

Some natural solutions women use to encourage a breech baby to turn over before the 39th week include:

  • Moxibustion
  • Acupuncture
  • Chiropractic care

While these methods do not have sufficient evidence to prove they are effective, they are not harmful if performed by a licensed professional.

Yoga and swimming are other activities that could encourage the baby to turn around by creating a sense of more space as your posture changes.

OBGYNs can perform an external cephalic version (ECV) if a baby has not shifted positions after 37 weeks gestation. To perform this procedure, the OBGYN will place their hands on the mother’s stomach and apply pressure to physically turn the baby. This can be painful and does carry some risk, which is why it is performed in the hospital. In many circumstances, a spinal anesthetic (epidural) can be offered.

Chances of C-Section with Breech Baby

If a baby is still presenting as breech by week 39 and interventions have not encouraged the baby to turn around, a C-Section will be recommended nearly 100% of the time.

In the case of twins, if the first baby is born head first and the second is in breech position, the second baby can be born breech with a vaginal delivery under certain circumstances.

Breech Births and Birth Defects

In most cases, babies who are born breech do not experience lasting harm. The most common problem associated with breech babies is hip dysplasia due to their reduced movement and position in the uterus.

Conclusion

All the reasons babies can end up topsy-turvy by the final weeks of pregnancy aren’t fully understood. But with regular check-ins, you and your OBGYN can be prepared for a safer, smoother delivery.

 

Dr. Sarah Yanke, M.D. of Madison Women's HealthDr. Sarah Yanke has been providing healthcare to women in Madison since 2010, specializing in high and low-risk obstetrics, contraception, management of abnormal uterine bleeding, and minimally invasive surgical techniques. She is a Board Certified Fellow of the American College of Obstetrics and Gynecology.

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C-section vs Vaginal Birth: What are the Risks and Benefits?

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Just as every pregnancy is unique, every birth is, too. Some women use pain medications, others do not. Some women labor for a couple of hours, and others for 24 hours or more. Some women deliver vaginally, while others deliver by C-section. For some women, a C-section is their choice. For others, it is medically necessary for their health or the health of their baby. In the U.S., the C-section rate is about 30%. In Wisconsin in 2019, the rate of C-sections was 26%.

One of the topics that will come up in your prenatal appointments with your OBGYN is a C-section versus vaginal delivery (also sometimes called a “natural birth”). Your doctor will ask if you have a preference and if one or the other may be medically necessary.

When we talk about delivery options, some women are skeptical or afraid. It’s OK to feel those emotions and to ask questions. In fact, we’re glad to answer your questions — that’s why we’ve created this article. We hope that our candid answers can help alleviate your fears.

Why Do Women Receive C-Sections?

Women receive a C-section for one of two reasons: 1) it’s their preference 2) it’s medically necessary for either them or the baby.

That’s it.

OBGYNs don’t have a hidden agenda or a quota of C-sections to perform. They don’t get to go home sooner if a baby is born via C-section. In fact, our preference is that every birth could be a vaginal delivery. But sometimes, C-sections are simply the best, safest choice. We always make sure the benefits outweigh the risks before recommending it.

Ultimately, the decision is yours.

A woman may choose to have a C-section because:

  • she is afraid that vaginal delivery will be too painful
  • she doesn’t want to worry about the baby experiencing stress during labor
  • she doesn’t want to have vaginal tears
  • she knows when she will meet her baby
  • she had a C-section before

Other times, women receive a C-section because it becomes medically necessary. Sometimes, it will be an emergency decision. As often as possible, we want to give you time to discuss the situation so you understand why we may recommend it. That way, it is truly a joint decision with you and your OBGYN.

The most common medical reasons a woman receives a C-section are:

  • If labor is not progressing on schedule:
    Called “failure to progress,” this means that either the cervix isn’t dilating or the baby is not descending into the birth canal after a significant amount of time. Usually, this is because of fit—the baby is simply too large for the birth canal.
  • If the baby is breech:
    When a baby is in breech position, his or her bottom or feet are down instead of their head. A breech baby birth presents more risks, such as injury to the baby’s hip and thigh during delivery. The umbilical cord could flatten during a breech birth, which could reduce oxygen to the baby and cause brain or nerve damage.
  • If the baby is showing signs of stress during labor:
    A fetal heart rate monitor will help your OBGYN see how your baby is handling delivery and if intervention is needed.
  • If the placenta is covering her cervix (placenta previa):
    This could cause bleeding during pregnancy and unsafe, severe bleeding during labor.
  • If she previously had surgery on her uterus.
  • If she previously had C-sections.

A woman can receive a C-section at any point in the labor or delivery process, whether she is at 0 cm dilated or 10 cm.

Which is safer, C-section or vaginal birth?

Both forms of delivery can be safe, and both can carry different types of risk.

C-Section Benefits

There is no injury to the pelvic floor with C-section delivery. A C-section can prevent vaginal tears. And a C-section can speed up delivery when the baby is showing signs of stress, if the baby is not progressing down the birth canal or if the baby is in a dangerous position for delivery.

The C-section itself is not painful. If the C-section was planned, the woman would get a spinal injection before the surgery to numb the area. If the woman labored first, she would receive an epidural catheter. During the C-section, she would feel tugs and pressure, but would not feel pain.

C-Section Risks

Even though C-sections are one of the most common surgical procedures in the U.S., the fact that they require surgery means they do carry some risk. The biggest risks include blood loss (twice as much as vaginal delivery) and the risk of infection at the incision site. Each C-section also increases the risk of scar tissue build-up, which can increase the risk of the placenta attaching to a scar in the uterus instead of the uterine wall.

Vaginal Birth Benefits

As the baby progresses down the birth canal, amniotic fluid in their lungs gets squeezed out. This helps the baby breathe more readily on their own after birth. As the baby passes through the vagina, they are also exposed to good bacteria, which can improve their microbiome and boost their immunity.

Vaginal delivery is best for a woman who wants to have several children.

Pain relief during vaginal delivery is possible by using medications or non-medicated methods.

Vaginal Birth Risks

Vaginal birth also carries some risk, such as blood loss and risk of infection. Other risks include the baby being unable to fit in the birth canal, pelvic floor injury, vaginal tearing, and umbilical cord accidents.

A vaginal birth after a C-section (VBAC) is possible, even after two or three C-sections, but it also carries some additional risks with labor. Uterine rupture, which is where the scar from the C-section breaks open, is one of the risks of VBAC. While it is rare, occurring in less than 1% of women, it is dangerous. Your OBGYN will monitor you closely during labor.

Whether you can have a VBAC depends on the reason(s) for your previous C-section, where the incision was made, whether you had other surgery on your uterus, how many C-sections you’ve had, when you last gave birth, and other reasons. Your OBGYN will discuss these factors with you to determine the safety of a VBAC in your situation.

Which form of delivery has the best recovery?

Just like nearly everything about pregnancy, the answer to this question is “it depends.” Some women recover faster from C-section than from a vaginal delivery, and other women recover more quickly from a vaginal delivery than from a C-section.

Here are some points to consider:

C-Section Recovery

Because a C-section is a surgery, more pain medications are usually needed during recovery. Usually, women receive ibuprofen, Tylenol, or even narcotics for the first 3-7 days. (Any pain medications prescribed would still be safe for breastfeeding.)

Activity after a C-section is more limited. A woman who has a C-section shouldn’t lift anything heavier than her baby for about six weeks. She should receive help around the house and caring for any other young children. She shouldn’t drive for about two weeks or while taking narcotics.

Women who labored before receiving a C-section generally have the longest recovery time. Not only do they need to recover from the surgery, but they also need to recover from the labor itself.

C-sections themselves don’t affect weight loss after birth, however a longer time of remaining less active will make weight loss more challenging.

Vaginal Birth Recovery

Because surgery isn’t involved, recovery is generally shorter. Soreness and discomfort usually last for a few weeks but can be treated with over-the-counter pain medication, such as ibuprofen. Your OBGYN typically will recommend that you do not exercise strenuously for six weeks. Taking it easy for six weeks after delivery helps to support your pelvic floor muscles while they heal.

Talk to your OBGYN about C-Sections and Vaginal Births

At Madison Women’s Health, we want you to feel comfortable and well-informed about your decisions.

During your prenatal check-ups, we will talk to you about vaginal birth (which some people call “natural birth”) and C-sections. We will give you our recommendation based on your health history. And we will support the decision that you make.

If it becomes medically necessary to change from your original birth plan, we strive to explain the reasons behind our recommendation so you can continue to feel supported throughout the birth of your child. Our goal is always to have a safe and healthy delivery, resulting in a healthy and thriving mom and baby.

Dr. Ashley Durward, MD of Madison Women's HealthDr. Ashley Durward has been providing healthcare to women in Madison since 2015 and joined Madison Women’s Health in 2019, specializing in high and low risk obstetrics, contraception and preconception counseling, management of abnormal uterine bleeding, pelvic floor disorders, and minimally invasive gynecologic surgery.

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Epidurals for Labor: Risks, Benefits and Other FAQs

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It’s no secret that giving birth is painful! But every woman finds a way to manage the pain of childbirth — whether that’s through breathing exercises, position changes, or an epidural.

During your third trimester, your OBGYN will ask you about your preference for pain management during labor. Whatever your decision, you can change your mind even during labor (up until a certain point). Our goal is to support you so that you can have a positive birthing experience, whatever that looks like for you.

About 70% of women in our practice choose to receive an epidural during labor. And all of them have had very similar questions, fears and concerns about the process.

What is an epidural?

An epidural is a common type of anesthetic used in labor for pain relief. Epidurals are the best option available for relieving labor pain. An epidural can be given at any time during the labor process.

While you are sitting up an anesthesiologist will first numb your skin and then insert a needle and a tiny tube (called a catheter) into the lower part of your back. The needle is removed and the catheter is left in place so that medication can be delivered through the tube. The medication typically runs continuously until delivery, with more medication given through the tube as needed.

The process takes about 15 minutes to complete. As long as you’re able to get into the right position and stay still for the time it takes to place the catheter, you can receive the epidural at any point during labor. That means that you can still receive an epidural even if you initially thought you didn’t want one!

Is the epidural needle painful?

Before the epidural is placed, you’ll be given a numbing injection. The first injection will feel like a short bee sting. This lasts only for a moment. Once that area is numb from the injection, the anesthesiologist will place the catheter to deliver the pain relieving medication. It takes about 20 minutes for contraction pain to subside.

An epidural creates a feeling of numbness from your belly to your toes. You may still feel pressure during labor, but the pain will be drastically reduced. If you are still uncomfortable even after having the epidural placed, the anesthesiologist may give you additional medication through the catheter or place the catheter in a slightly different position.

Because you will feel numb, it will be hard to move your legs. You won’t be able to walk around with an epidural in place. You may not feel as great of an urge to push, but you will still be able to push. Your team will help you know when and how to push through your contractions.

You also won’t feel the need to urinate, so we will place a foley catheter in your bladder.

Will an epidural harm my baby?

Medication from an epidural does NOT harm your baby. Because the anesthesia from the epidural doesn’t enter your bloodstream, it will not transfer to your baby through the placenta.

How long does the epidural last?

The epidural is intended to last for the duration of your labor and will be removed after you deliver your baby. It will take a couple of hours for the numbness to completely go away. You will be able to walk around after the epidural wears off.

To manage pain after delivery, you’ll be given ibuprofen. Ice packs can also be applied to help with discomfort after labor.

What are the side effects from an epidural?

Epidurals are very safe. Serious complications are rare. The most common side effect we see is a decrease in blood pressure. To prevent this, you will be given extra IV fluid before having an epidural placed. If needed, the anesthesiologist may also give you medication to bring your blood pressure up.

Who shouldn’t get an epidural?

Occasionally there are circumstances where women can’t get an epidural. Occasionally we see this in women who have a low platelet count. Additionally, women who are taking blood thinners (such as heparin) to prevent a blood clot during pregnancy should not receive an epidural within 12 hours of taking that medication.

Will an epidural slow down delivery or cause me to need a C-section?

Some women are actually able to deliver more quickly after receiving an epidural because they feel more relaxed. They can push through the stronger contractions because they are in less pain. Other women may be in labor a little longer because they do not feel the urge to push to the same extent.

Your labor and delivery team will monitor you and your baby to be sure that you are progressing through labor at a safe rate.

There is no evidence that receiving an epidural makes you more likely to require a C-section. In fact, if you do need a C-section, having an epidural in place can help you be prepared for the C-section more quickly.

Other Ways to Manage Pain During Childbirth

An epidural is not the only way to manage pain during childbirth. You have several options available to you. You are also able to make changes to your birth plan while you are in labor.

Non-medicated pain control options

There are several non-medicated (or non-pharmacologic) pain control options. Read about other methods of pain relief during childbirth.

Intravenous (IV) and Intramuscular pain relief:

Pain relieving medication (opioids) can be given to help take the edge off of labor pain to make it more tolerable. This medication is either given to you through an IV or as an injection.

Opioids given through an IV catheter do enter your bloodstream, therefore they do transfer to your baby. Side effects include grogginess or sleepiness for both you and your baby.

Conclusion

We don’t judge your reasons for or against receiving an epidural.  Some of our patients choose not to receive any pain medications during labor while others request an epidural as soon as possible. (You may be surprised by how many women change their minds during labor!) There isn’t a right or wrong way of giving birth, and you aren’t more or less of a mom or a woman based on your pain management decision.

Whether you want a less painful labor or a medication-free labor, we are here to support you. Our goal is that you and your baby are safe and healthy!

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