1. Consider the possibility that your baby might turn. Around half of all babies start out bottom down early in pregnancy. Most turn head-down by 32-34 weeks. If baby hasn’t turned by 36 weeks he or she is likely to remain in the breech position. For some unknown reason, three to four percent of babies never turn head-down.
2. If your baby hasn’t turned on her own by 36-37 weeks, your doctor (or a specialist you are referred to) can attempt a maneuver called external version, in which he or she manipulates your abdomen to turn baby into the head-down position. External version is successful 60-70 percent of the time (40-50% for first pregnancies), but some babies turn back and require a second attempt. A few stubborn babies keep reverting to the breech position and remain there. A version is generally a safe and only mildly uncomfortable procedure, yet sometimes it can be painful to mother and can cause distress to baby.
3. Another alternative is to search out a doctor who has experience in vaginal delivery of breech babies. He or she will most likely be affiliated with a hospital that has the technology and support staffs to properly care for the baby should a complication occur. We have found that most doctors experienced in vaginal delivery of breech babies either practice at a university hospital obstetrical center, or have gray hair and began delivering babies at least twenty years ago, when over 90 percent of breech babies were delivered vaginally. You may get discouraged. Many of the doctors who have this kind of experience are now retired. Since in the past ten years most breech babies have been delivered surgically, newly trained obstetricians may never even have witnessed a vaginal breech birth. Also, if the obstetrical standard in your community is that breech babies are to be delivered surgically, don’t be surprised if your doctor is forced to comply with this standard.
4. Obstetricians and hospital centers with a lot of experience in vaginal breech deliveries usually follow the American College of Obstetricians and Gynecologists Guidelines for breech delivery. The criteria you need for a safe vaginal delivery of a breech baby include: baby is in the frank breech position, bottom down instead of feet first or legs crossed in tailor sit; baby weighs between 5.5 and 8 pounds (baby’s head getting stuck during delivery is more likely to occur in small and premature babies, probably because the head is proportionally larger than the rest of baby’s body); baby is mature or at least older than 36 weeks; baby’s head is tucked down, chin on chest, prior to delivery; mother is judged to have an adequate pelvis as determined by a technique called the fetal pelvic index; mother’s labor progresses normally; and the hospital facility and staff is equipped for an emergency cesarean within 30 minutes. (Mother having delivered a previous baby vaginally adds another plus to the okay list.) If your baby is a footling or a complete breech, weighs over nine pounds, or is premature, your doctor will probably choose to deliver your baby surgically. Be aware that each specialist is likely to have his or her own variations on these criteria. Also, remember that an x-ray diagnosis of “inadequate pelvis” may be inaccurate since your pelvic outlet will enlarge during delivery, especially in the squatting position.
5. If you wish to have a vaginal delivery of your breech baby and your doctor feels that you meet the criteria, expect that your labor will be monitored more closely than most. Even though you will experience careful surveillance during labor, take special care not to let the fear factor interfere with your labor. Here’s where a professional labor assistant can help, making sure that birth attendants are not hovering over you “waiting for something to happen.”