Vaginal delivery in breech position and breech birth

	Treatment Overview
	What To Expect After Treatment
	Why It Is Done
	How Well It Works
	Risks
	What To Think About
	References
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A vaginal delivery is the birth of a fetus through the mother's birth canal, or vagina. Babies known to be in a breech position are usually delivered by cesarean section (C-section). But sometimes a cesarean isn't possible, such as when a breech birth progresses too quickly. And a cesarean delivery is not usually recommended when a second twin is breech.

There are risks for the baby with a vaginal breech delivery. But in certain situations—such as if the doctor has a lot of experience doing breech deliveries, or a mother has a medical condition that makes a cesarean delivery risky for her—a vaginal breech delivery may be planned.¹

There are several different types of vaginal breech deliveries.

• The delivery can occur without help from a doctor (spontaneous breech birth). During a spontaneous breech birth, the fetus comes out of the vagina without problems. The doctor just supports the fetus's body as it emerges from the birth canal.
• A doctor may need to help deliver the upper part of the fetus's body (partial breech extraction). During a partial breech extraction, a doctor pulls gently downward on the fetus and rotates its body as needed to deliver the shoulders, arms, and head.
• Sometimes a doctor may need to help the fetus during the entire delivery (total breech extraction). This is usually done only when the fetus is having problems and needs to be delivered as quickly as possible.

During a partial or total breech extraction, the doctor may need to reach into the birth canal in order to move part of the fetus into a better position for delivery. If the doctor is having difficulty delivering the fetus's head, forceps may be used to guide the head through the birth canal. Forceps may also be used to speed delivery if the fetus is in danger.

During some breech vaginal births, an episiotomy is necessary to enlarge the vagina to help deliver the infant. This is done by making an incision in the lower part of the vagina (toward the anus). The incision is closed with stitches after the birth.

Should a breech vaginal labor cause severe problems for the fetus or mother, an emergency cesarean section is done to deliver the fetus.

A few hours after an uncomplicated vaginal delivery, you can get up and move around. If you had an episiotomy, you may feel the need to spend a day resting before you start moving around too much. An episiotomy incision will heal in 1 to 3 weeks. The vaginal area is sore for several days.

Women are generally advised to avoid having sex for 4 to 6 weeks after giving birth, to allow the vagina and the area around it to fully recover.

Recovery from a vaginal delivery is usually easier and quicker than from a C-section.

Sometimes it is possible to have a planned vaginal delivery with a breech birth. Talk with your doctor about what options might be best for you and your baby.

And even though you and your doctor have a birth plan for labor and delivery, plans can change. If something unexpected happens, your doctor may need to make some quick decisions to keep you or your baby safe.

Vaginal delivery of a fetus in the breech position may be recommended if:¹

• Twin fetuses are present, with the first twin head-down.
• A mother is in the late stages of labor, and the fetus and mother are not having any problems. Such a vaginal delivery may be allowed to continue even if a cesarean delivery was planned.
• The fetus has died or is known to have a fatal condition and will not live after birth. In these cases, a C-section is not done because of the risks to the mother.

There are risks for the baby with a vaginal breech delivery. There are also risks for the mother with a cesarean delivery. If the baby cannot be turned, a cesarean delivery is usually planned. But sometimes, a cesarean breech birth is not possible or is not the best choice. When a breech labor progresses too quickly, a vaginal birth may be the only option. Or during a twin birth, a second twin who is breech may best be delivered vaginally.¹ Risks are lowest for the newborn when a doctor has a lot of experience doing breech delivery.²

But in certain situations—such as if the doctor has a lot of experience doing breech deliveries, or a mother has a medical condition that makes a cesarean delivery risky for her—a vaginal breech delivery may be planned.¹

Risks

Types of injuries that can occur during a vaginal breech delivery include:

• Fetal brain damage or death due to lack of blood flow through the umbilical cord. This can be caused by squeezing (compression) of the umbilical cord. The cord can get caught between the legs of the fetus or between the birth canal and the head of the fetus. It can also be caused when the umbilical cord drops out of the birth canal (cord prolapse) before the fetus is delivered.
• Damage to the fetus's head if the head gets caught in the pelvis and is difficult to deliver. These types of injuries include tears in the covering of the brain or swelling caused by bleeding under the scalp.
• Damage to an arm when it gets caught alongside the head during delivery (nuchal arm). This can result in a broken bone, bruising, or tearing of the muscle.
• Injury to the fetus's spinal cord.
• Damage to the fetus's genitals or internal organs.

The labor and delivery of a breech infant sometimes takes longer than that of an infant in the head-down position. The feet or buttocks of a breech infant do not put as much pressure on the cervix as the head would, slowing cervical opening (dilation).

A vaginal delivery of a breech fetus should only be aided by a doctor who is experienced in breech delivery.

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Citations

1. American College of Obstetricians and Gynecologists (2006). Mode of term singleton breech delivery. ACOG Committee Opinion No. 340. Washington, DC: American College of Obstetricians and Gynecologists.

2. Su M, et al. (2003). Factors associated with adverse perinatal outcome in the Term Breech Trial. American Journal of Obstetrics and Gynecology, 189: 740–745.