Vaginal delivery in breech position

During the conversation about giving birth to a baby in breech position, there will be discussed what you and your partner’s wishes are and what you can expect.

A vaginal breech birth is very similar to a delivery of a baby in head-down position. The main difference is that in a breech position the head is born last. The head of the baby is the largest part, this can sometimes make the birth of the head more difficult.

When a baby is delivered in breech position, there is a greater chance of problems and of a caesarean section. Therefore, with a breech birth we always recommend giving birth in the hospital. An obstetrician specializes in guiding breech births and will therefore always be present for the birth.

What happens during a breech birth?

In the case of a vaginal breech birth, we usually wait until the contractions start on their own, just like with a baby in head-down position. During a breech birth, there will more caregivers in the room than when a baby is born in head-down position. During labour you will be cared for by a midwife or a junior doctor. A specialist nurse will also take care of you. The OLVG is a training hospital and you will be asked if a student can observe your breech birth. During the second stage (pushing) phase, the obstetrician will be present and often also an obstetrician in training. It is important that obstetricians and midwives in training learn to manage a vaginal breech delivery. Throughout your labour, we will observe your baby by monitoring the baby’s heart rate via a continuous heart tracing (CTG). In some of the birthing rooms at OLVG the CTG is wireless and therefore you have the possibility to walk around or take a shower.

In the case of a breech birth, there is a greater chance that we recommend medication to stimulate the contractions, even though you have contractions yourself. This is because we want to be sure that the contractions during the second stage (pushing phase) are powerful enough to make the birth run smoothly. Stimulation of contractions is via an infusion (IV) in your arm (drip). You can also move freely with an IV.

During a breech birth you can decide for yourself in which position you want to labour. You can labour sitting, standing or lying down and even in our bath, if it is available. We do not however recommend birthing with a breech position in the bath as, we would not have enough insight of your progress and would not be able to intervene quickly enough if necessary.

It may be that the obstetrician asks you during the birth to adopt an all-fours position or to turn to a lying position. This also has to do with the smooth running of the last part of the delivery.

During a breech birth you can get pain relief. For example, an epidural or a pump with Remifentanil (pain killer).

Usually, after giving birth, the baby will be placed on your tummy and you can breastfeed immediately if desired.

Sometimes the baby needs additional help to start breathing immediately after a breech birth. If this happens, the baby will receive help in the labour room and the baby will be returned to you as soon as possible.

When is vaginal delivery not possible?

A vaginal delivery of a baby in breech position is not possible if:

• The baby’s feet are presenting first at the time of delivery. In this scenario the baby’s feet are then under the tailbone. The baby is in fact standing upright in the pelvis.
• If your baby is lying in another position (such as transversely [across] or diagonally) your tummy..
• The placenta lies over the cervix
• There are other reasons why the obstetrician would discourage a vaginal breech delivery.

Benefits of vaginal breech delivery

• If your baby is born vaginally, you are usually well enough to go home the same day because you do not have an operation wound.
• There is a smaller chance of complications for yourself.
• With a vaginal delivery there is less chance of complications in subsequent pregnancies.

Possible problems with vaginal breech delivery

Complications can occur during every birth, even with a delivery of a baby in head-down position. Below you can read more about some of the problems which can occur with a vaginal breech birth.

• You have a greater chance of birth ending in a caesarean section than with a baby in head-down position.

We recommend a caesarean section during childbirth if:

• The labour does not progress sufficiently, despite good contractions.
• If we’re worried about your baby’s condition.
• If during the pushing-phase your baby’s bottom doesn’t descend (through the pelvis) quickly enough.
• As the head is born last, your baby may need a little more time to start breathing. This is usually short-lived and after 5 minutes there is no difference in condition compared to babies born vaginally in head-down position.
• If during the birth the obstetrician has had to help your baby with the birth of the arms, there is a small risk for the baby of a broken collarbone or a broken upper arm. There is also a small risk of nerve damage in this area.

More information about complications can be read in the additional information.

Warning: actual images