When it comes to breech, birthing parents deserve options




Most of the time, babies in utero turn head-down, or cephalic, before they are ready to be born. But sometimes they are breech, with bottom or feet down.


In the United States, nearly all breech presenting babies are birthed through Cesarean section (surgical intervention). But it doesn’t have to be this way. Breech presentation can be viewed as a variation of normal – occurring in about 3-4% of term pregnancies – and there are ways to safely support vaginal breech birth.


One way to support breech birth is to ensure that birth attendants are trained in physiologic breech. Unfortunately, residency programs in the US are now rarely training obstetrician physicians (OB doctors) in physiologic breech birth. Physicians may be trained that it’s so dangerous it should never be offered as an option. There are some OB physicians in practice who have the skills and the comfort level to support vaginal breech birth. There are also many midwives who are skilled and can support out of hospital breech birth. 


Because breech birth is different from head-first in terms of its risks, how descent may progress, and what type of maneuvers are required when baby needs help to be born, it is imperative that birth professionals like family practice or specialty OBs and midwives are trained. Experience and training makes vaginal breech birth safer.


Birthing parents should be given their options. One pregnant person with a breech-presenting baby may feel most comfortable with a planned Cesarean birth. Another might like to try an external cephalic version (ECV) first to attempt to flip baby head-down – or utilize other methods such as inversions (see Spinning Babies), moxibustion or acupuncture, or work with a Webster trained chiropractor to make space for baby to move head-down. 


Some birthing parents are comfortable with an experienced midwife supporting them to birth their breech baby at home, and some might prefer to birth vaginally in a hospital setting. A problem we have in the US is that because most family practice and specialty OBs are not trained and/or comfortable with safe breech birth, the birthing person’s choices are limited. A vaginal breech birth in a hospital setting is not an option at most American hospitals. 


Birthing parents deserve to have choices when their baby is in a breech position. They should be given access to evidence-based information around potential impacts to their baby and to their body, including risks to future pregnancies if C-section is considered. They should have a supportive discussion with their care provider to talk over their goals, and the benefits and risks of available options. They deserve to have access to perinatal professionals who are trained in vaginal breech birth if they prefer low intervention, physiologic birth.


To learn more about breech birth, Breech Without Borders is an inspiring organization. They offer trainings, suggest ways to advocate for vaginal breech birth options, and publish a blog. I also love the information at Evidence Based Birth. 


Here’s some further reading:


Evidence on Breech Birth with Dr. Rebecca Dekker and Sara Ailshire - EBB Podcast


Breech Vaginal Birth with Dr. Rixa Freeze and Dr. David Hayes - EBB Podcast


Breech Without Borders Advocacy Resources


Birthing Instincts Vaginal Breech Birth 



Photo Credit: freepik.com

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