Breech

What is breech?

This means that baby is lying head up, with his/her buttock or legs down towards the cervix (neck of womb). Although this is common in early pregnancy, most babies will turn head down (cephalic) by 36-37 weeks of pregnancy.

What happens if my baby is still breech at 36 weeks?

You have 2 main options:

1. External cephalic version (ECV)

This is generally a safe procedure that is performed from 36-37 weeks of pregnancy, and involves firm pressure on your abdomen to try and turn baby to head down position. It will be performed in the labour ward. You will be given medications to relax the uterus (this may cause your heart to beat faster temporarily). You may feel uncomfortable during the procedure, but should inform your gynaecologist if you feel pain. The procedure will take a few minutes. If it is unsuccessful, there may be one or two more attempts to try and turn your baby, if you are okay to continue with it. Your baby’s heartbeat will be monitored before and after the procedure. Success rate is 50%. There is 5% chance that your baby still turn back to breech even if ECV is successful.

ECV cannot be done for women whose water bag have broken, who have twins, recent vaginal bleeding, abnormal baby heartbeat or who need caesarean section for other reasons.

Pros: If successful, you will be able to attempt a normal vaginal delivery (hence avoiding a caesarean section).

Cons: 1 in 200 chance of needing an emergency caesarean section immediately after ECV due to bleeding or changes in your baby’s heartbeat. When you do go into labour, you have a slightly higher chance of needing an emergency caesarean section or assisted vaginal delivery (vacuum or forceps) compared to someone whose baby has always been in head down position. 

2. Caesarean section

One may opt to go straight for caesarean section, e.g. not keen for ECV or in certain cases where ECV may be difficult e.g. multiple fibroids, high body mass index (BMI) etc. 

In a very select group of women, vaginal breech delivery may be possible; however this is uncommonly done these days. A planned caesarean section is generally safe for your baby than a vaginal breech delivery (although it carries slightly more risk for you).

What else do I need to take note of if my baby is breech?

You have a higher chance of cord or limb prolapse if your water bag breaks. This means that the umbilical cord or baby’s foot/leg may drop out of your cervix first. If it is the cord, this is an emergency as baby’s oxygen supply can get cut off and he/she may end up with permanent brain damage, cerebral palsy or death. Cord prolapse generally does not happen if baby is head down as the head usually blocks other things from dropping out.If your baby is breech and you start having contractions and/or your waters break, you must contact your gynaecologist and go to the labour ward immediately.