A while ago, a woman came into the birthing area of our large metropolitan hospital. As I ran through the routine admission physical, I felt the hallmark "bobble head" under my patient's right rib. The baby was breech (hind end down) and undiagnosed until labor -- something that strikes fear in the heart of any midwife.
How is a breech baby diagnosed?
By performing a thorough abdominal exam, an experienced doctor or midwife can usually determine baby's position. Heads are round and hard, and they bounce against your fingers when felt through the top of a mother's uterus. Baby's buttocks will move as one mass, and they're a bit softer and don't bounce against your hand. If the baby is positioned deep in the pelvis, if the mother is heavy or if the care provider is inexperienced, it may not be possible to ascertain baby's position unless an ultrasound is performed.
Why are some babies breech?
Some babies are breech because they fit better that way. Babies are just like us -- they want to be comfortable and take the path of least resistance. If the uterus has not developed symmetrically, the baby's heavier head may fit better in a roomier part of the uterus. Women who have had many children are at higher risk, as are women with a small pelvis or an abnormally shaped pelvis. If there's an obstacle in the way, like a fibroid (a benign tumor in the uterus), baby may not be able to turn into a head-down position. And many preterm babies are born breech because they have not yet turned to a more favorable position. At term or 40 weeks, only 3 to 4 percent of babies are breech, whereas at seven months, 25 percent present as breech. When it comes to twins, one baby is often breech.