Is Breech Delivery Safe?
Thanks to modern day advancements in medicine and technology, safe deliveries of healthy babies are more controllable and possible than ever before. Before the advent of sonograms, the ability to prepare and respond to a baby set to be born breech—in an inverted position with the feet or buttocks set to travel through the birth canal before the head—was often more challenging to diagnose. While identifying breech birth positions in advance of labor is now easier and more accurate, the number of babies who find themselves positioned for a breech birth is still high.
What is Breech Delivery?
In an ideal vaginal birth, the baby is positioned with his head in the pelvis and leaves the birth canal head-first. With the head being the widest part of the body, the shoulders and body can more easily pass through the birth canal when they follow the head. In a breech delivery scenario, the baby is situated in an inverse position, with the challenge of needing to leave the birth canal feet or buttocks first. There are three types of breech positions:
- Complete breech: Buttocks point down with legs folded at the knees and feet near the buttocks
- Frank breech: Buttocks aimed at the birth canal with legs sticking straight up in front of the baby’s body and the feet near the head.
- Footling breech: One or both feet are pointed down and in position to deliver before the rest of the body
How Many Women Still Deliver Breech?
Approximately one out of every 25 full-term babies are breech positioned.
What are the Risks of a Breech Delivery
A study conducted in The Netherlands found that “breech babies born vaginally had a 33 percent higher risk of injury or death compared to those born by C-section.”1 When babies attempt to leave the birth canal feet first, their head can get stuck before exiting, and they are at risk of other health complications such as broken bones and bleeding. Breech babies born vaginally also tend to have lower Apgar scores compared to breech babies born via C-section. Apgar scores are an indication of a baby’s general health at the time of birth and are used to identify if immediate emergency care is required. Apgar stands for appearance (skin color), pulse, grimace response (reflexes), activity (muscle tone), and respiration.2
However, the study may have been flawed. When the “researchers re-assessed babies from high-income countries two years later, the risks from vaginal breech births seemed to disappear completely: 3.1% of the toddlers born by planned C-section died or had severe neurological disorders, while 2.8% of those born vaginally did.”3 Overall their study wasn’t large enough to catch anything but very large increases in morbidity. In other words, there might have been a smaller effect, but this study wasn’t big enough to see it.
Then, in 2006, the Premoda study, an observational study of more than 8,000 women in France and Belgium, found no difference in the rates of serious illness or deaths between breech babies delivered by trial of labor and those delivered by C-section. This is often used as a rebuttal against the TBT, as it seems to show that well-selected cases done in high-income countries are safe.
Can Breech Babies be Born Vaginally Or Must They be Birthed Via C-Section?
While vaginal breech births are possible, the risks are higher than when born via C-section. Still, as recently as 2007, 40 percent of women faced with a breech birth and given the option for a C-section still chose to have a vaginal birth—despite the risks.
What to Do if Your Baby is in a Breech Position
Before or during labor, if your OBGYN determines that your baby is in a breech position, he or she may recommend a C-section. If your birth plan involves a vaginal birth, and you strongly want to pursue that approach despite the risks, you and your doctor will need to collaborate on the best course of action to produce the safest and healthiest possible outcome for both you and your baby.
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