In my last blog post, I briefly mentioned breech births via C-sections as a potential contributor to the high rates of Cesarean sections in the United States. Data from 2019 as reported by the Centers for Disease Control shows that 31.7% of all deliveries are by Cesarean. Breech presentation is the most common reason for a planned Cesarean section in the United States. In 2019, 11.8% of all Cesareans were breech births.
In this blog post, I would like to share some more information about why vaginal breech birth is, as Henci Goer says, “a reasonable choice.”
What is a breech birth?
A breech baby is when the baby presents with its buttocks, knees, or feet in the birth canal. Babies are usually born with the largest part of the body first, which is the head. The contractions help shape the baby’s skull. Breech birth can cause potential problems when the umbilical cord moves down the birth canal first and is trapped between the baby and the mother’s pelvis. Vaginal breech birth may increase the change of injury to the baby.
There are three main types of breech presentations: complete, incomplete, and frank.
Breech Birth Practices in the US
Prior to the 1970s, obstetricians were trained on how to deliver breech babies vaginally. Starting in the 1970s, obstetricians moved to deliver breech babies by Cesarean section as it was seen as a solution to complications related to pregnancy and labor. Data from the Term Breech Trial reporting that planned C-section is better for breech presentation compared to planned vaginal birth led to an increase in C-sections. Ultimately, this led to a decrease in practitioners trained to perform vaginal breech births. Lack of training, skills, and experience with vaginal breech birth is potentially a reason why the US has such a high Cesarean rate.
In 2001, the American College of Obstetricians and Gynecologists (ACOG) stated that “planned vaginal breech may no longer be appropriate.” However, that recommendation has changed as of 2018. ACOG noted that practitioners should offer external cephalic version (ECV) as an alternative to Cesarean. The decision of the mode of delivery should consider the patient’s wishes and the experience of the health provider.
Breech Birth Techniques
Turning the Baby Head Down: Home Version
This technique can be done early in pregnancy. It is recommended to do this technique three times a day for ten to fifteen minutes. Lie on your back with knees bent and elevate the hips about 12 inches using cushions. Another position is the knee-chest position. Kneel with the hips flexed and the upper body flat on a comfortable surface. Keep the thighs apart, so they do not press on the belly.
Medical Technique: External Cephalic Version (ECV)
This is a medical technique that is done at thirty-seven weeks. A drug is administered to help keep the uterus relaxed, and the baby’s heart rate is monitored through external electronic fetal monitoring. Once the medication has taken effect, the provider will try to flip the baby by manipulating the belly.
ECV is safe, effective and can be done during labor and according to ACOG, 20-30% of those eligible for ECV are not offered it in the United States. Potential reasons why ECV is not offered include health insurance plans, hospital reimbursement policies, and lack of provider training and expertise. This is concerning especially knowing that these barriers contribute to the poor maternal and infant health outcomes.
More details on these techniques can be found in chapter two of The Thinking Woman’s Guide to a Better Birth by Henci Goer.
Risks of Cesarean Section vs. Breech Birth
Cesarean section can reduce the percentage of babies born in distress, and reduce the possibility of birth injuries and deaths. On the other hand, it does not entirely mitigate the risks of breech birth. It causes increased maternal risks both long term and short term. Cesareans can lead to severe infections, prolonged hospital stays, hysterectomies, and maternal deaths. Vaginal breech birth can increase the risk of birth injury compared with C-sections, although almost all babies recover from these injuries. C-sections can also cause injuries to the baby that may require suturing.
Vaginal Breech Birth is a Choice
I was fascinated when I learned that a breech baby could be delivered vaginally, and it does not have to be done by C-section. If you read my last blog post, I referenced Chummy, who delivered a breech baby on Call a Midwife. I was curious to know if the technique that Chummy used was accurate, and through my research, I confirmed that the method she used was accurate. The video below shows this technique.
When deciding about birthing mode for a breech presenting baby, it is imperative to learn about all available options and consider the risks and benefits. It is important that providers are continuing to remain up to date with new information to provide their patients with the most accurate and relevant information.
This blog post offers a limited amount of information on breech births. I encourage you to do your own research and seek medical advice from a trusted health provider.