How does this happen; why this is a problem and what you can do about it?
A combination of maternal and fetal factors causes babies to be breech:
If you’ve had multiple full-term pregnancies the abdominal muscles relax. This allows for more fetal movement so babies are more likely to lie sideways or bottom down. The good news about this is the baby is also more likely to turn (with or without external assistance) and be head down when you enter labor. Even if the baby is breech at 38 or 39 weeks, if you’ve had multiple previous births, your ob provider should check to verify the position of the baby when you enter labor because babies can turn “at the last minute” or sometimes even in early labor.
A small percent of breech babies are breech due to a uterine anomaly called a septum or a bicornuate uterus. In these circumstances, there is essentially a muscular or fibrous wall that divides the uterus in half lengthwise. The “roomiest” part of the uterus is toward the top and the largest, least malleable part of the baby (the head) will lie at the top. Uterine anomalies predispose to breech position in all pregnancies, so if you have a uterine anomaly, you’ll probably know it with your first pregnancy.
In extremely rare instances (<1%) anatomic abnormalities of the baby can cause breech position.
Why is Breech Position a Problem?
During labor with the baby in the head-down position (vertex), the largest and firmest part of the baby (the skull) pushes on the cervix and dilates the cervix enough to allow the rest of the baby (body and limbs) to pass through the cervix.
In the breech position the buttocks (softest) part of the baby presses against the cervix. It may not dilate the cervix enough to allow passage of the head, thus leading to head entrapment. If the baby’s neck is extended, head entrapment in labor can cause spinal cord injury.
How You Can Change a Breech Position: Wiggle Bum
You’ll have the most success in turning your baby if you’re of normal body weight and you’ve had previous pregnancies. If you know your baby is breech at 37 weeks here’s a trick you can try to get the baby to turn on his own:
Sit on the floor on your hands and knees. (You might want to do this when no one is looking.) Rest on your elbows and stick your butt in the air. If you’re an experienced mom you may be able to feel the baby’s head in your upper abdomen, and you may be able to tell which side the back lies on, and which side the small parts (arms and legs) are on.
In this position, wiggle your bum back and forth. If you can feel the baby pretty well with your hands, you can use one hand to “elevate” the baby’s butt out of the pelvis to allow room for the baby to turn. While leaning on one elbow, use the opposite hand to exert gentle upward pressure on the baby’s butt (located just above your pubic bone). If the head is resting more on one side than another you may be able to “encourage” the baby to do a forward or backward “roll” to assume the vertex position. You don’t need to exert manual pressure on the baby for this to work. The “wiggle bum” exercise may be enough to encourage the baby to turn. Do this exercise several times a day until the baby turns.
What if you the baby doesn’t turn: External Cephalic Version
If your baby doesn’t turn to be head down, your ob provider may offer you an external cephalic version (ECV). This can be done with or without an epidural anesthetic. It involves giving you medication to relax the uterus while the ob provider manipulates the baby from the outside to try to turn the baby. ECV’s have a success rate of fifty percent. They cannot be done if the baby is not in a frank breech position (both hips flexed, both knees extended), if your fluid is low, or if your water is broken. If the baby doesn’t turn, and your ob provider does not feel comfortable offering you a vaginal breech birth, you will be advised to have a cesarean section if the baby is still breech when you present in labor.
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