Q&A: I wonder how breech babies are delivered.

Babies are meant to be delivered headfirst. But occasionally a baby presents with his feet or butt first. This type of presentation, called breech, occurs in about three to four percent of all deliveries.

Let's talk about what it means to be breech and what your doctor may discuss with you.

Babies in utero can be quite the little gymnasts and occasionally end up "getting stuck" in a breech position. (Many babies actually present as breech early in the pregnancy, but then move into a head-down position before their due date). There are three forms of breech presentation:

• Complete Breech: Baby is tucked into a ball with the butt pointing down
• Frank Breech: Baby is situated with his or her hips flexed and knees extended (pike position)
• Footling or Incomplete Breech:In this case, Baby's presenting part is the foot

Although babies can be delivered breech, there are risks. Some problems include potential troubles with the umbilical cord, so most doctors opt to deliver breech babies via C-section.

Quite often in the case of twins, one baby or both may be breech. When a mother delivers her baby early (pre-term) these babies are also commonly found in breech position.

Some doctors are OK with delivering babies in the breech position (if their gestational age is close to full term). Think you'd like to go ahead with a vaginal delivery if you learn your baby is breech? If this isn't a first-time delivery, if it is determined that you have an adequate (large enough) pelvis, and if your baby is not too large, vaginal birth may be an option for you.

Your doctor can determine by ultrasound and sometimes by external palpation (physically feeling around mom's belly) the position of the baby. If it is determined that the baby is breech, you'll have a few options: You can elect to have a C-section; or you and your doctor may agree to an ECV (external cephalic version), a fancy name for turning the baby from the outside. (An ECV can be done if your baby has not turned by the time you are 37 weeks.)

Not every woman is a good candidate for an ECV. If you experience any of the following problems, ECV may not be right for you:

• Low lying placenta or one that is covering the cervix
• Non-reactive, non-stress test
• Small for gestational age baby
• Vaginal bleeding
• A low level of amniotic fluid
• An abnormal fetal heart rate
• Premature rupture of the membranes ("water has broken")
• Twins or other multiple pregnancy

Having a successful ECV can save you from a C-section, but there a few risks to be considered. These risks include:

• Premature labor
• Premature rupture of the membranes
• A small amount of blood loss for either the baby or the mother
• Fetal distress leading to an emergency C-section
• The baby might turn back to the breech position after the ECV is done

ECVs are always done at the hospital in the labor and delivery unit. Before undergoing an ECV, chances are you'll have an ultrasound, you'll be administered an IV with medication to relax your uterus, and an anesthesiologist will be on standby (just in the case the uterus manipulation causes you to go into labor. According to a study by Dr. Richard Fischer, MD, at Cooper University Hospital in Hamilton, New Jersey, ECV can decrease the rate of C-section by 50 percent.

As with any concerns or questions with regards to you or your baby, ask a lot of questions and discuss your options with your doctor.