Giving Birth: Is a Cesarean Necessary if Your Baby is Breech?

I am due in a week. At a recent appointment, I asked if the baby's head was down and after an exam and ultrasound we found out it is up. Now I am being told most likely I will have a cesarean two days before my due date! (My baby is expected to weigh between eight and nine pounds.) Aren't there alternatives?


Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

Yes, there may be some alternatives. Breech tilt exercises may help encourage your baby to turn if the butt has not yet engaged. This involves lying on a securely placed ironing board or on several pillows with your buttocks elevated for 20 to 30 minutes three to four times per day (or as you can tolerate) Wear loose clothing and try to do this a couple of hours following a meal.

External version may also be attempted if the baby's presenting part is not engaged and there is confirmation of enough amniotic fluid. Version is not as successful this late in pregnancy and with a large baby.

Some chiropractors use the "Webster turning technique," which is 80 percent successful.

One of the problems with vaginal breech births is that obstetric residents are not getting much experience doing breech births these days, so they will often opt for cesarean. It is important to find a doctor or midwife skilled in vaginal breech births if you plan to pursue this option.

Research on the safety of vaginal breech birth, which has been extensive, is mixed. Some research shows that vaginal birth is safe when the baby is in the breech presentation if the mothers are selected carefully. The mother's pelvis should be very adequate and the baby should probably not weigh more than nine pounds, among other criterion. Other research says that breech babies -- especially first babies -- should be delivered by cesarean. The statistics in these studies demonstrate that morbidity and mortality is higher if vaginal birth is attempted because of the elevated risk of trauma to the mother and birth injuries to the baby.

I wish you the best with this difficult situation. If, in the end, you do decide to opt for a cesarean, there are things you can do to make the experience a more satisfying one. Some women choose not to receive additional sedation after the birth so they can watch and even snuggle with their baby while the abdomen is being sutured. Some dads provide the baby the close skin to skin contact and stay close to the mother's head until the surgery and repair is complete. You should be able to breastfeed in the recovery area and keep your baby with you as long as hospital protocols allow.

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