My baby’s breech – now what?

One of the wonderful experiences of being pregnant is the ability to interact with your baby even before they’re born. Gently prod your stomach, and you might feel them kick back in response. You might even be able to identify a little head or rump, and imagining how they’re positioned can help you feel closer to them.

When you focus on your baby inside, you’ll most likely picture them in the usual position with their head down, facing your spine. Dr Calvin Makgato, a gynaecologist and obstetrician at Mediclinic Vereeniging says this head-down position is technically called the cephalic or vertex presentation. It is considered the normal position for a vaginal birth because the baby’s head, with its chin tucked towards its chest, becomes as compact as possible for delivery.

But there are several different ways a baby can be positioned in the womb, explains Dr Makgatho:

• Transverse position – the baby lies sideways across the uterus, with its back or shoulder towards the birth canal.
• Oblique position – the baby is positioned diagonally, which is rare, with the head resting on the mother’s pelvis instead of aligning with the birth canal.
• Brow and face presentations – the baby’s head is not tucked in and the face is what presents first.
• Compound presentation – an arm or leg, or a hand, may be alongside the head in line with the birth canal.
• Breech position – the baby’s feet or buttocks are nearest to the birth canal.

While most babies naturally settle into the vertex position, occasionally they may lie in other positions that come with certain considerations. For example, when a baby lies transverse, there might be concerns like birth trauma, postpartum bleeding, or early labour. This can happen if you’re expecting more than one baby or due to the shape of your uterus.

Similarly, an oblique position might also relate to the structure of the uterus, or it could be due to having too much amniotic fluid or a baby that’s a bit big for your pelvis. Here, there might be a risk of the birth being obstructed since the baby’s head isn’t lined up with the birth canal, and there’s a possibility of slight pressure on the umbilical cord from the baby's head.

In a face or brow presentation, the baby’s face might be at risk of injury, and mothers could experience a longer labour. With a compound presentation, where a limb like a hand is alongside the head, there is a risk of the uterus tearing. Dr Makgato says when a baby is positioned differently during birth, it can sometimes cause complications for the baby and extend or block labour. In some cases, an unexpected C-section might be needed, and if necessary, the baby might receive special care in the neonatal ICU to support their breathing and oxygen needs.

But Dr Makgato says you shouldn’t be overly concerned if your baby is not lying in vertex position right now. “It’s common for babies to be in a breech position in early pregnancy; they usually turn towards the end of gestation,” he reassures.

If your baby is still in the breech position by the 34th week, your doctor might suggest trying an external cephalic version (ECV). This is a safe procedure where the doctor or midwife gently presses on your belly to help turn the baby so they’re head-first. They might give you medication to prevent pain and ensure it doesn’t start early labour, as you might experience some cramping. Throughout this two-hour process, your baby's health will be closely monitored to keep everything safe for both of you.

ECV isn't recommended in some cases. For instance, if you’re pregnant with more than one baby, have low amniotic fluid, an irregularly shaped uterus, high blood pressure, your baby's heart rate is too high or low, or if you've had vaginal bleeding during pregnancy, this procedure might not be suitable for you.

If your baby is in the breech position, you might consider seeing a chiropractor for help. While chiropractors can’t perform procedures like ECV, they can adjust the joints in your pelvis and work with the nerves and ligaments in your uterus and abdomen. This can create more space in your pelvis, possibly helping your baby to move into the right position. However, it's important to check with your obstetrician first before trying this.

If either of these procedures is successful, you’ll be able to have a natural birth; however, if your baby remains in a breech position, your doctor is likely to recommend a C-section.