Why Doctors Perform C-Sections for Babies in Breech

C-sections are considered the safest delivery method for breech babies. Find out why, and whether it's ever possible to deliver a breech baby vaginally. 

baby born via cesarean section

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In the United States, about 4 percent of babies are breech during a full-term pregnancy. This means that the feet or butt—rather than the head—are closest to the cervix and positioned to be delivered first. Before 1959, virtually all breech babies were delivered vaginally. Today, however, most are born by cesarean section. Find out the reason behind this trend, and what to do if you want a vaginal breech delivery.

Why Are Breech Babies Born by C-Section?

When babies are in a breech position, several delivery complications emerge. For starters, their feet or bottom may tangle with the umbilical cord, causing issues such as umbilical cord prolapse. Their body may also emerge from the cervix before it's fully dilated, and the head may get stuck in the birth canal.

Beginning in the 1960s, obstetricians started delivering breech babies via C-section because they preferred predictability and presumed greater safety. A 2014 study out of ACTA Obstetricia et Gynecologica supports this approach.

Dutch researchers evaluated the outcomes of more than 58,000 pregnant people who had term breech deliveries. They found a 10-fold increase in neonatal mortality in breech babies delivered vaginally compared to those delivered by elective C-sections. (Researchers found a death rate of 1.6 per 1,000 babies delivered with a planned vaginal breech birth. There were no deaths in the C-section group.)

This isn't the first study to find improved outcomes among breech babies delivered via C-section. In 2000, a study known as the Term Breech Trial (TBT) found significantly fewer newborn deaths among breech babies who were delivered via planned C-section compared to those who were delivered vaginally.

"The impact of this study was stunning," says Heather Weldon, M.D., an OB-GYN at Southwest Medical Group OB/GYN Associates in Vancouver, Washington. "Within months, breech C-sections went from 50 percent to 80 percent and, by 2006, 90 percent."

Vaginal Delivery for Breech Babies

Despite these findings, vaginal deliveries may be safe for breech babies in certain situations. If a pregnant person has delivered one or more babies vaginally and this baby is the same size or smaller (by abdominal palpation and ultrasound), a vaginal delivery might be considered if the buttocks come first (not feet) and the head is flexed forward.

The downside, though, is that the 2000 TBT study changed how American doctors are trained. Since the TBT, "there's an entire generation of OB-GYNs who aren't practicing in a day when planned vaginal delivery is an acceptable approach for term breech babies," says Alison G. Cahill, M.D., Chief of the Division of Maternal-Fetal Medicine at the Washington University in St. Louis School of Medicine. "So they haven't been trained how to do them."

The American College of Obstetrics and Gynecology's Committee Opinion on Mode of Term Singleton Breech Delivery highlights this reality: "Cesarean delivery will be the preferred mode of delivery for most physicians because of the diminishing expertise in vaginal breech delivery," the statement says.

Oregon Health & Science University (OHSU) in Portland is among a few hospitals nationwide to support vaginal breech delivery. "Without hospital-based options, some patients attempt high-risk deliveries at home," says Leonardo Pereira, M.D., OHSU's chief of maternal-fetal medicine. "OHSU has established safety criteria for patients, and we are training clinicians to deliver breeches vaginally in order to make the service available at more hospitals in the future."

To find an appropriately trained doctor or midwife, call your closest academic health center and ask whether vaginal breech delivery is offered or whether they can refer you to providers who do offer it. You can also look for providers at midwife.org or birthpartners.org.

C-Section vs. Vaginal Delivery: Which Should I Choose?

Many studies have shown C-sections to be safer, but they aren't without substantial risks, too. If you're at term, and your baby is breech, discuss these options with your doctor to determine the best approach for you and your baby:

An external cephalic version

This procedure involves lifting and turning your baby from the outside to correct breech presentation. It's only tried if you're at least 36 weeks pregnant—if it's performed before then, the baby could change position again or need to be delivered too early. Although unlikely, the procedure can stimulate labor. A "version" is about 50% effective.

Waiting it out

Another option is patience. "If you don't attempt a version, there's a small chance your baby might flip itself to the head-down position by the time you're in labor," Dr. Cahill says.

Scheduling a C-section

The TBT suggests performing a C-section at 39 weeks if your baby is in the breech position, says Dr. Cahill. (In general, C-sections that are unplanned or performed after you're already in labor have more risks than scheduled C-sections, she explains.)

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