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The good news is that, by 37 weeks, only 3–4 percent of babies remain in the breech (bottom-down) position. This means that the majority of the time, babies are head-down in preparation for delivery. But what happens if they remain breech? Here are some options your doctor may review with you:

  1. Delivery by scheduled C-sectionIt is now common in the US to deliver breech babies by C-section (this does not include breech twins!). This is because of a study that came out in 2000 showing that breech babies born vaginally had higher rates of perinatal death (5.7 percent) than those delivered by C-section (only 0.4 percent). Because of this data, most obstetricians in the US stopped performing breech vaginal deliveries.
  2. Undergo external cephalic versionAn external cephalic version (ECV) is when your doctor uses a series of maneuvers on your abdomen to try and turn your baby into the head-down position. Success rates vary but usually run about 50–60 percent for ECV. This is often done once you are term, and usually on labor and delivery so your baby can be monitored. The benefits (if it works) are pretty obvious: avoiding a C-section! Risks can include discomfort, fetal distress, bleeding, incidental breaking of the bag of water, or need for emergency C-section (this last one is very rare).
  3. Attempt a vaginal breech deliveryIt is true that the majority of obstetricians and hospitals will not perform or allow term vaginal breech deliveries for the reasons listed above. However, some obstetricians who have a breadth of experience in this area may offer it. If this is to be undertaken, a thorough discussion of the risks must be carried out first. There are also very strict criteria about who can undergo an attempt for breech delivery. For example, certain types of breech positions and babies that are too big or too small are excluded. A woman’s pelvis must also be big enough to be thought to be a good size to allow a safe delivery.
  4. Try alternative measuresThere are other methods that can be tried to encourage your baby to turn into a head-down position: acupuncture, pelvic tilt maneuvers, and moxibustion (burning an herb close to an acupuncture point near your pinky toe). Of all these measures studied, only moxibustion has been shown to possibly be helpful, but more studies are needed to confirm this.

Takeaways

  • 3-4 percent of babies will be breech at term.
  • Most breech babies are born by C-section in the US.
  • An external cephalic version can be tried to help turn your baby.
  • Vaginal breech deliveries are rarely performed, but can be considered in certain scenarios.

References

  1. American Congress of Obstetricians/Gynecologists. Committee Opinion #340: Mode of Term Singleton Breech Delivery.
  2. American Congress of Obstetricians/Gynecologists. Practice Bulletin #13: External Cephalic Version.
  3. Hofmeyr GJ, Kulier R. Cephalic version by postural management for breech presentation. Cochrane Database of Systematic Reviews 2012, Issue 10. Art. No.: CD000051. DOI: 10.1002/14651858.CD000051.pub2.
  4. Coyle ME, Smith CA, Peat B. Cephalic version by moxibustion for breech presentation. Cochrane Database of Systematic Reviews 2012, Issue 5. Art. No.: CD003928. DOI: 10.1002/14651858.CD003928.pub3.

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