What if my baby is breech?

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Generally the term “breech” scares women. They have heard about how risky breech is, and they worry about the birth of their child. 

Doctors do not help by stressing how risky it is, and almost always recommend an elective C-section, or find an excuse in labour to perform the surgical birth.

But some women (like you, reader!) are learning that breech is a variation of normal (uncommon, but normal). That 3- 4 out of 100 babies are breech.

And that it may actually be quite safe to birth a breech baby spontaneously, vaginally and naturally.

But what about birthing a breech baby at home?
Well, one of the number one “rules” for birthing a breech baby is “hands off”.

That’s a perfect candidate for an unassisted home birth!

However, you may not wish to try birthing your baby while it’s breech, and that’s okay too. You can try the techniques listed on the Spinning Babies website (https://spinningbabies.com/learn-more/baby-positions/breech/) on their turning a breech baby page https://spinningbabies.com/learn-more/baby-positions/breech/flip-a-breech/

You may also like to see a Webster-trained chiropractor to make sure your body is optimally positioned for your baby, ( https://spinningbabies.com/learn-more/techniques/professional-help/ )

 or you may see a doctor to perform an ECV (https://www.pregnancybirthbaby.org.au/external-cephalic-version-ecv)

It’s your birth, and your choice!

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Birthing a Breech Baby

If you do wish to vaginally birth a breech baby, or you find out in labour that baby is breech, these are some steps you can take to help ensure a safe birth.

Please note there are a few kinds of breech:

• “Complete breech” is when both of the baby's knees are bent and his feet and bottom are closest to the birth canal.

• “Incomplete breech” is when one of the baby's knees is bent and his foot and bottom are closest to the birth canal.

• These can also be called “footling breech” where one or both feet are presenting.

• “Frank breech” is when the baby's legs are folded flat up against his head and his bottom is closest to the birth canal.

• Very very rarely, there is breech with knees presenting.

• And finally, transverse breech when baby is sideways across the uterus.

**If a baby stays traverse, they CANNOT be birthed vaginally. The head OR buttocks/legs must be presenting. This is the ONLY breech position that must be changed before birth, for birth to occur naturally.**

(Generally, throughout this article, when referring to breech, for ease of wording, it is assumed baby is “Frank breech” or “complete breech”.)

If you have time, do some reading, and maybe some watching or listening on breech birth. Our resources page has podcasts and books that cover the topic in brief,  and the links below this article at the bottom of the page go into greater detail. And you can search YouTube for natural breech births to help you visualize what you are reading and hearing.  

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Now, prepare as you would for a standard birth. Lay out out your supplies, relax, and move around in labour.

Listen to your body and move as it wants. Hip swaying and spinning babies movements and use of a rebozo may help baby get into optimal position in your pelvis.

You may wish to try to keep the room warmer than usual. If the baby’s legs and torso come out first and get too cold, it could startle the baby into taking its first breath inside the mother, and potentially inhaling amniotic fluid.

Some people feel it safe to have a waterbirth with a breech baby, as the water is warm and helps the baby to not start breathing until it is fully out and has surfaced.

However, others caution against a water birth, as gravity helps the baby descend best when breech, and the buoyancy in the water may hinder the natural movements of baby, making it harder to release the head.

Either way, everyone agrees water is certainly beneficial as pain relief in the earlier stages of labour.

The most recommended position to birth a breech baby is a squatting position, or standing squat, followed by a kneeling position. (however, do what feels best for you at the time)

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If there are any complications, (covered below) deal with them calmly and appropriately. try to avoid touching baby unless necessary.

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After birth, care for baby and mother, and deliver the placenta as usual!

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What a normal spontaneous breech birth can look like: “10 MECHANISMS OF UPRIGHT BREECH BIRTH

This video shows excerpts from an upright breech birth in a Brazilian hospital. The birth is shown twice: first in slow-motion with the 10 mechanisms noted as they occur, then at normal speed.

The 10 mechanisms of an upright physiological breech birth are:

1. Buttocks/feet emerge sacrum-transverse

2. Body restitutes to sacrum-anterior as trunk is born

3. Legs release spontaneously

4. Chest crease ("cleavage”) means arms are not behind head

5. Baby does tummy crunches to release arms & flex head

6. Arms release spontaneously

7. Full perineum = head is flexed

8. Head releases spontaneously

9. Baby passed to mother

10. Cord remains intact even if resuscitation is needed

If these mechanisms are present and the baby has good color and tone, there is no need to provide hands-on assistance. Approximately 70% of upright breech births will proceed spontaneously without any need for maneuvers (see Louwen et al. 2017).”

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“We suggest that for upright breech births, a delay of 90 seconds or more occurring at any point during emergence indicates a completely spontaneous birth is unlikely and consideration should be given to assisting the birth. Encouraging maternal movement and effort before performing hands‐on interventions will help to spontaneously resolve minor delays, or to confirm the need for manual assistance.” Sara Wickham quoting Reitter et al 2020

Complications in breech birth

• Cord prolapse

Generally, in a breech birth, the cord will always emerge before the head. This is rarely cause for concern, since by the time the arms and legs are out, it is fully visible and unlikely to be compressed. 

However, by the time the head is visible, you have about 3 minutes as the head will start to compress the cord. Some midwives reckon that you may even have up to 8 minutes, and that it is better not to rush the head out, and in doing so, injure the baby.

• Transverse

Transverse babies cannot be birthed vaginally. If all efforts to turn baby have failed, and labour has progressed without baby moving down, you may need to transfer to a hospital for advice or a c-section. While it is disappointing to not complete your birth unassisted, sometimes it is for good reason. For example, one mother with a transverse baby had an extremely short cord and baby was physically unable to move down. If she had completed an ECV or tried to push baby out, the cord would have broken or placenta torn away from the wall, causing severe bleeding for baby and mother, with the baby potentially still stuck in the womb. This is one instance I feel assistance is best.

Obviously, consider all your options at the time and make the decision YOU feel is best.

• Stuck legs

       If the baby’s bum presenting is first, and if the legs do not spontaneously release, you can gently sweep across to release them, or bend at the knee one by one to unhook the feet.
You should then let the baby’s body hang naturally so the weight of the baby can encourage the rest of the baby to be born spontaneously, and you or your assistant is just prepared to catch!

• Stuck/Nuchal Arm

Sometimes after baby’s legs come out, one or both arms gets stuck. This usually always requires assistance from a partner or friend, as the birthing woman is generally unable to reach down to release the baby appropriately.

You will need to gently free each arm.  The assistant grasps the baby’s thighs with their thumbs on the baby’s back over the sacrum and with the back uppermost gently pulls downward and turns the baby through 180 degrees until the posterior (rear ) arm comes to lie anteriorly (forward) and is released under the symphysis pubis (pubic bone), while at the same time, the other shoulder is brought into the pelvic cavity.

The elbow will appear below the symphysis pubis, and simply that arm and hand can be delivered by sweeping it from the shoulder with two fingers, down and across the fetal body.  

This manoeuvre is repeated in reverse to deliver the other arm. (Lovset’s manoeuvre https://www.ambulance.qld.gov.au/docs/clinical/cpp/CPP_Breech%20delivery.pdf )

The baby’s body should then be allowed to hang from the vulva for a few seconds again until the nape of the neck (hairline) is visible at the front of the vulva.
Wait for spontaneous delivery of the head, as it most often it will come out naturally.

• Stuck/Head

Sometimes, after the legs and arms have been released spontaneously, or assisted to be released, the head gets stuck in the pelvis or on the mother’s soft tissue. If there has been two contractions, and the head has not moved, you may need to assist.

First - Vaginal examination to determine if a rim of cervix remains and if present, attempt to push over the head with your fingers.
If you can create an airway, and the mother can change positions slightly, the baby may come out with another contraction.

If it is not so simple to release, then think of the cervix like a tight turtleneck sweater. You cannot pull it straight off. If you tried, you would notice how it cinches around your neck and gets hooked on your chin and back of your head. A sweater neck is pulled forward off your face: the baby's head can be pivoted in your body so they are "looking" back up your birth canal into your uterus, and the legs are gently lifted up towards your stomach and then down again with a small amount of traction (Brachts Maneuver https://medicalguidelines.msf.org/viewport/ONC/english/6-1-breech-presentation-51417177.html  )

Another thing to imagine is when you deliver a head first baby, your baggy belly still has the baby's body inside to push against. When you deliver breech, you are empty for the part where you push the head, so you have less force. Arrange yourself so you are not needing your hands to catch, and grab and ball up your belly in your hands and squish like you are sort of doing a heimlich maneuver on yourself for extra force. Or you can have a friend or assistant push on your uterus for you.
You can also just push just above your pelvic bone with a hand or hard fist.
You can do this while the other person is gently rotating and pulling on your baby as per maneuver above or below.

Lastly-   If the fetal head is well engaged, perform a version of the Mauriceau-Smellie-Veit manoeuvre.

The baby should be turned face towards the mothers back.

The assistant should support the baby’s body on their forearm/right hand and put their index and ring fingers into the vagina to gently grasp and support the baby’s upper jaw/cheekbones, one finger each side of the nose. (Don’t put fingers in mouth or lower jaw) 

Attempt to gently tilt the head down towards the neck. Flex the head by applying pressure with the left hand on the back of the head and shoulders and right hand/fingers on baby’s jaw. 

Avoid excess traction on the baby’s shoulders and trunk.

Concurrently, the mother or other assistant can firmly press on the uterus just above the pelvis to help encourage head descent.

(Mauriceau-Smellie-Veit manoeuvre https://www.ambulance.qld.gov.au/docs/clinical/cpp/CPP_Breech%20delivery.pdf )

Once the back of the baby’s head has descended underneath the symphysis (pubic bone), the head may be delivered.

•  Other helpful notes:

• Meconium/meconium stained amniotic fluid is common in breech births and is not necessarily an indicator of foetal distress

• Nuchal cord may be common in 30% of breech births https://breechbirth.org.uk/2021/06/02/nuchal-cord-and-the-breech/ 

• Avoid touching baby until the head is appearing, if possible, so you don’t startle baby into breathing inside the mother

• If the baby has been stuck, be prepared to rub the baby or give CPR, as sometimes baby will need some extra help after birth, after having needed help to be born

The main takeaway : “For a normal breech birth, the time honoured advice ‘hands off the breech,’ is still the safest advice”

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Some further reading 

http://www.breechwithoutborders.org/ (multi cultural breech resources)

http://www.breechwithoutborders.org/2018/05/breech-birth-videos-photos-stories.html (videos and stories)

http://www.breechbirth.net/  - includes the Aussie Facebook group link, and website birth stories - Australian chapter of Coalition for Breech birth (http://breechbirth.ca/) 

http://www.milescircuit.com/ (Optimal positioning of baby for birth)

https://www.healthline.com/health/betty-ann-daviss-midwife-breech-births#Previously,-breech-was-just-a-variation-of-the-norm (short article on midwife who has attended 150+ planned vaginal breech births)

https://www.aims.org.uk/journal/item/hands-off-that-breech (article on breech by independent midwife)

https://spinningbabies.com (Getting baby into optimal position for birth, also ECV info)

https://www.pregnancy.com.au/birth/breech-birth/ (Birth articles and birth stories)

http://www.gentlebirth.org/archives/breechbr.html#Safety (Safety of breech birth studies, tips on breech birth, more links)

https://www.informedpregnancy.com/heads-up (Short Documentary “Heads Up” on the disappearing art of breech birth)

https://www.youtube.com/watch?v=P0NB7JGIqGc&t=189s (Ina May Gaskin Video - Tips for Breech Birth)

https://www.youtube.com/watch?v=S-o7DKnxOg8 (Ina May Gaskin video - Footling Breech Birth)

https://www.youtube.com/watch?v=Q5kTuEkPapE (Ina May Gaskin video - Risk Assessment for Breech Birth)

https://midwiferytoday.com/?s=breech (articles and e-book on breech)

https://indiebirth.org/beautiful-breech-opening-the-doors-to-an-option-many-women-are-told-isnt-possible/ (Podcast on breech by midwives)

http://rixarixa.blogspot.com/p/breech.html (a HUGE list of breech articles, studies, stories, conferences etc)
http://rixarixa.blogspot.com/2017/12/indie-birth-podcast-on-my-breech.html (podcast and interview with above site curator Dr Rixa Freeze and Indie birth’s Maryn Green)

https://www.freebirthsociety.com/blogs/the-free-birth-podcast/a-mother-knows-mies-transformational-breech-freebirth (podcast breech birth story)