Pregnancy: Should You Be Concerned if Your Baby is Breech?

I am 32 weeks into my pregnancy and my baby is breech. My doctor said if the baby hasn't turned in two weeks, they will try to turn him at the hospital. I am just hoping that being in the breech position doesn't mean he is abnormal or unhealthily. Should I be concerned if the baby doesn't turn?

Question:

The vast majority of breech babies are fine. There are, unfortunately, increased risks of problems (abnormalities) in babies that stay breech into the last few months of pregnancy. Therefore, you have some reason to be concerned about your baby's health. Remember, an increased risk does not mean a high risk, just a higher risk than normal. Fortunately, the normal risk is low, so even an increased risk is still low.

Breech position is one of the more common positions during pregnancy. There are many myths surrounding the breech birth position. Some people believe the baby is always breech until a certain time in the pregnancy and some believe there is a certain amount of time a baby must be breech. None of this is true. There is a higher rate of breech earlier in pregnancy, but some babies are head down from the start and some are in the breech position for the entire pregnancy. About 30 percent or so are breech earlier in pregnancy (16 to 20 weeks), but only about 3 percent are breech at birth. Most do turn around at sometime during the pregnancy, but when they turn around is subject to chance, as far as we can tell.

When we see a breech baby later in pregnancy (after 34 weeks), we talk about version. This is the process of turning the baby by pushing on your belly to get it to turn around. That can be very uncomfortable, but is sometimes the only way to avoid the higher risk cesarean birth. It can be done with or without sedation or medications to decrease contractions. Sometimes it is attempted with an epidural. The attempt is usually made around 36 to 37 weeks (that is far enough along to do an emergency cesarean if needed) and is successful about half of the time. Risks can include fetal distress requiring an emergency cesarean, labor or ruptured membranes. If the baby stays breech, most doctors would suggest a cesarean birth.

If you meet certain criteria, a breech delivery can be very safe, though it is not done much these days. If your pelvis, on X-ray or CT, is normal sized, if your baby is not too big and if your baby is in the right position and labor progresses well you may be a good candidate for a vaginal breech birth. About 75 percent of all pregnant women meet those criteria. But you also need a doctor that has had adequate training in breech deliveries. This is becoming more and more rare these days.

There is an alternative to the version called moxibustion: burning certain herbs around certain places in the feet -- a practice originating in China. They claim a 75 percent success rate. As a skeptical Westerner, I can't see how that would work, so will reserve judgment as to its overall success rate. On the other hand, the risks are small, so if you have a skilled practitioner in your area, it may be worth a try.

Finally, there are positions that you can try, which some claim to help the baby turn. A knee-chest position (on your hands and knees, with your butt raised in the air) and rocking your pelvis several times a day has been tried, as has lying on a slant board (like your ironing board leaning up against your couch), with your head down and feet slanted uphill. Do that several times a day and it may help the baby turn (as well as giving you a runny nose from the increased swelling in your face). At this time there is no solid evidence to support that these positions actually work, but again you face no risk in trying them.

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