Throughout your pregnancy, your baby will be moving around and flip-flopping in your uterus. But by 36 weeks, most babies’ heads are pointing down toward the birth canal and, without much room at this point, stay there until it’s time for labour. However, about four percent of babies will end up in the breech position, where their heads are up and their bums are pointed toward the birth canal.
It’s not always known why a baby ends up in the breech position. Two of the more common reasons are the shape of the mom’s uterus and the presence of fibroids inside or outside of the uterus. But sometimes a breech position “just happens,” says Laurie Hintzen, a midwife at Diversity Midwives.
There are three types of breech positions: a complete breech, a frank breech and an incomplete breech. An incomplete breech is also referred to as a kneeling breech or footling breech, depending on the position of the baby.
Complete breech: The baby’s bum is down and either one or both knees are bent and crossed, as if the baby is sitting cross-legged.
Frank breech: The baby is bent at the hip, with the lower legs lying flat up against the body and the feet up by the head.
Incomplete breech: The baby has one or both knees or feet dangling (a footling breech is an incomplete breech with one or both feet dangling toward the birth canal, while a kneeling breech has one or both knees dangling).
If my baby is breech, what can I do? You might hear the words “Your baby is breech” as early as the 18- to 20-week ultrasound. But at that stage, babies are so small that they still have lots of time to move around and flip, says Hintzen. If your baby is still in a breech position toward the end of your pregnancy, you may be encouraged to try to rotate him. Here are a few activities you can try:
1. Get on all fours as often as you can. With your back flat and your uterus hanging down, crawl backward slowly, then forward. The movement of your pelvis going back and forth may encourage your baby to rotate.
2. If you can swim, go to a pool and do some gentle laps. With your uterus suspended, your baby may turn.
3. Play music or a recording of your own voice with the device or headphones low on the belly—your baby’s head may turn toward the sound.
What else can be done? Between 34 and 37 weeks, your doctor or midwife may try an external cephalic version (ECV). For this procedure, a doctor or midwife will place gel on your belly and to try to rotate the baby with her hands gliding over your abdomen. “This can be uncomfortable,” says Hintzen. “The doctor or midwife will do a little turn, check everything on the ultrasound and continue turning the baby slowly.”
Some chiropractors are certified in the Webster technique, where the chiropractor aligns the pelvis, which is supposed to allow the baby to move into the correct position more easily.
Are there risks with a breech birth? With a kneeling or footling breech, there is a higher risk of cord prolapse (where the umbilical cord comes down the birth canal before the baby). When this occurs, the fetus can put pressure on the umbilical cord, which could restrict blood flow to the fetus. You will likely be advised to have a C-section if your baby is still in a footling breech position before labour begins.
Babies in a complete or frank breech position can be delivered vaginally in some cases, but your healthcare provider needs to be trained to do this. Since the release of a 2009 report from the Society of Obstetricians and Gynaecologists of Canada, there is a growing push to try for vaginal deliveries of breech babies whenever possible, but in many cases, a C-section ends up being the safest route. Talk to your doctor or midwife about the best plan for you.