At the 38-week appointment for our second child, a confused look crossed the midwife’s face as she felt my wife’s belly. A couple of weeks earlier, she’d thought the baby’s head was down. Now, she wasn’t so sure. An ultrasound confirmed it: Our son was footling breech, with his head up and his feet down—a tricky type of breech presentation to deal with. Great, we thought, and tried not to panic.
It's fairly common Many babies are in a breech position around 32 weeks gestation, but most of them turn themselves head down by 34 to 36 weeks, says Vicki Van Wagner, a registered midwife at Mount Sinai hospital in Toronto and an associate professor at Ryerson University’s midwifery education program. But three to four percent of babies in Canada will remain breech at term. In the past decade, most obstetricians and gynaecologists would recommend a Caesarean section for couples in our, um, position, although more recent guidelines now encourage alternatives to a C-section.
Choices We were given a few options: to go ahead and schedule the C-section, or to try turning the baby at another midwife clinic that specializes in a procedure called an external cephalic version (ECV). Even though we had always loved our experience with our midwives, the idea of trying to turn the baby sounded painful, and when we were told there was a possibility the cord could be wrapped around his neck, it also seemed kind of scary.
While the procedure is not invasive, some women find the pressure on the belly and uterus painful, says Van Wagner. “It is not comfortable,” she says. however, it’s much more bearable than childbirth, and, if successful, it can spare new moms the pain of recovering from a Caesarean.
Possible breech birth complications Risks associated with ECV can, in extreme cases, include early labour, bradycardia (cord entanglement and a slow heart rate for the baby), early separation of the placenta, and, in very extreme cases, fetal death. (But the risk is only one in 5,000, according to one meta-analysis.) According to the World health Organization, ECV is successful in turning the baby in about 70 percent of cases.
Bill Mundle, an obstetrician and medical director of maternal fetal medicine at Windsor Regional hospital, in Windsor, Ont., tries to reassure parents of breech babies. “There’s really not a lot of danger to ECV,” he says. “If it works, that’s great. If it doesn’t, then you know you’ve tried everything you can. Avoiding a Caesarean section is better for mum and for baby.” Women at Mundle’s clinic can opt for an epidural during the ECV procedure, if they want it.
The Society of Obstetricians and Gynaecologists now agrees with Mundle, even if that means attempting a breech vaginal delivery (in cases where it is appropriate). In 2009, the society released new guidelines stating that physicians should no longer automatically plan C-sections in cases of breech birth—something that’s been controversial within obstetrics over the years. There’s the risk that attempting a vaginal birth might result in having an emergency C-section anyway, but the C-section rate is the same for women having a vertex, or head-down, delivery, Mundle explains.
Not all types of breech presentation are candidates for vaginal birth, however. Footling breeches, like our son, “are absolute no-go’s,” Mundle says. My wife ended up delivering via planned C-section. But frank breech (legs tucked in and pointed straight up) and complete breech (legs tucked in with feet crossed) are both potential candidates for vaginal birth.
Other solutions Acupuncture can also help get babies to turn, says midwife Van Wagner. She often advises her patients to try going for a swim. Some studies suggest that playing music or talking to the baby while aiming your voice low in your partner’s abdomen might even work, too.
A version of this article appeared in our November 2012 issue with the headline “Feet First,” p. 83.
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