Most babies are born head first, with the face down. In about 3% to 4% of births, however, the buttocks or feet are the first to emerge. There are several types of breech birth:
- In a frank breech, the thighs are flexed and the legs are extended. In the womb, the fetus looks like it's folded in half at the middle, with its feet near its head; its buttocks are closest to the birth canal and are the first to emerge. 65% of breech births are frank.
- In a complete breech, the thighs, hips, and knees are flexed, so that the fetus is in a fetal position. Again, it is born butt-first. These constitute 10% of breech births.
- In an incomplete or footling breech, one or both of the fetus's thighs are extended, with one or both knees below the buttocks, so that a foot or a knee emerges first. 25% of breech births are this type.
Very premature fetuses are more prone to breech birth because before 36 weeks the wee mite moves around a lot in the womb, after which it usually spontaneously assumes a head-down position. Besides prematurity, other risk factors for breech delivery include multiple fetuses, uterine abnormalities, fetal abnormalities, or fibroids. A breech baby is generally identified by abdominal palpation or vaginal examination and confirmed by ultrasound, after which the mother may attempt to remedy the situation by lying with her feet higher than her head for several minutes a few times a day, or by having a specialist perform a technique called external version. This involves applying pressure on the abdominal wall to attempt to force the fetus to change position; it's successful about 50% of the time, though occasionally the wee tike may rotate back to the breech position.
Most western doctors deal with a breech birth by performing a Caesarean section, but in fact the majority of women whose fetuses are in a frank breech can achieve normal vaginal birth. When the time comes, the mother should be in a semi-reclining position, and not squatting, as is more normal with regular birth, for this may cause the baby's arms to be swept up over its head as it's being born, potentially causing damage. The mother should not be urged to push before the cervix is fully dilated; when the baby is ready to be born, she will begin to push naturally, and she must do so continuously to properly expel the baby; she should conserve her strength until that time. Once the baby is born to the navel – affectionately known as the "hang your hat on the butt" position – the mother must push continuously, for the baby could suffocate if not fully expelled within 5 minutes. The most dangerous situation is if the baby's back is towards the mother's back; in such a case, the midwife may have to manually rotate the baby as it's emerging. The person delivering the baby must also be careful to ease the pressure on the baby's neck as it's being born, as there is a risk of spinal cord damage. In general, however, more damage is done by exerting undue force on the baby to get it out than by the baby getting stuck; an experienced midwife will know how to encourage the baby to emerge naturally and successfully.
For an excellent website describing breech births and how they can be managed at home, see Moondragon Birthing Services' website at
http://www.geocities.com/HotSprings/Spa/9786/obgyn37.html
Note, though, that this is a very woman-friendly, home-birth oriented organization. Doctors are more likely to favour hospital births and C-sections with breech births.