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In the vast majority of term pregnancies the fetus will be in the vertex, or "head-down" position at delivery. When the fetus is not in this position it is referred to as breech. Early in pregnancy the breech position is common. However, when the pregnant woman approaches her due date only 3% of babies will remain in the breech position. The majority of breech pregnancies in this country are delivered by cesarean section. However, as many as 17% are still delivered vaginally, although this number is quite variable at different hospitals. Some experienced midwives will deliver a breech baby at home, but for the most part, this may be considered risky. It depends upon the midwife, the pregnant client and her desire to remain at home and the health and well being of both the pregnant client and her baby. This would be a very careful decision the woman and her midwife would have to make together.
Most of the time, the midwife can determine the position of the baby by feeling the pregnant woman's abdomen. This is an examination known as "Leopold's maneuvers". The fetal heart tones will be heard high on the belly, usually around the belly button height and the baby's head will be felt as a round hard ball that can move back and forth without moving the rest of the baby's body. If this exam leads the midwife or health care provider to believe that the baby is breech and the expectant mother desires it, an ultrasound study can be performed to confirm this condition.
Although the cause of breech positioning is not always known, sometimes it can be linked to certain conditions. These conditions include premature labor, problems with the amount of amniotic fluid, problems with the placenta (the "after-birth"), tumors that change the shape of the uterus, and women who have had several previous pregnancies.
The reason that so many breech babies are delivered by cesarean section is twofold. First of all, many health care providers are concerned that there are increased risks for both mother and baby during a vaginal breech delivery (not to mention potential law-suits). The actual scientific information on this topic is inadequate however, due to the difficulty in performing this type of study. And second, many obstetrical training programs no longer train physicians in the technique of vaginal breech delivery. Many midwives have more experience delivering a breech presentation vaginally than most physicians.
As an alternative to cesarean section, your midwife or health care provider could attempt to manually turn the fetus out of the breech position. This procedure is referred to as "external version". It is best performed 3 weeks before the due date, and may be done in the hospital or at home with an experienced midwife and a very cooperative mother. The fetus is closely monitored, either way. External version is successful in up to 65% of breech pregnancies, although you must meet certain criteria in order to be considered a candidate for this procedure.
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Breech Presentation
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