Q&A: I know my baby is breech, but don't know if I should wait to schedule the C-section.
My doctor has scheduled a C-section because my baby is breech. She tried to turn the baby but this failed. Should I wait or schedule a C-section for my breech baby?
While some doctors believe vaginal breech birth is safe, most American obstetricians don’t offer breech vaginal birth. So the choices usually include three options: attempt to get the baby to turn, schedule a Cesarean, or wait until labor to give the baby every last chance to turn.
Your doctor already tried what is called an external cephalic version, in which we basically grasp the baby through the mom’s abdomen and try to maneuver it into a forward summersault or back flip. Sometimes it works and sometimes it doesn’t. Factors that influence success of version include:
- Whether it is a first baby or not (first babies are more likely to be engaged into the pelvis and immovable)
- Gestational age (earlier is easier)
- Exact position of the fetus (if the fetal spine is back against the mom’s spine you can’t get hold of the fetal “poles” to move it; it works best when the baby seems to be lying on its side)
- Maternal weight (a thick abdominal wall is harder to work through)
- Relaxation of the uterus and abdominal wall (if it hurts and you tense up it is harder to push the baby around; ditto if the uterus contracts during the version)
If the baby wasn’t in a favorable position for the external cephalic version or if you didn’t have an epidural for it, you could consider trying again, since those things might make a difference in success. But if the baby was engaged in your pelvis, version isn’t likely to be effective.
Other techniques to get the baby to turn include the Chinese medical treatment moxibustion, in which an herb is burned in a special location on the mom’s toe. Surprisingly, this was shown in blinded scientific studies to be more successful than no treatment. (Remember doing nothing sometimes works too.) You would need a practitioner of Chinese medicine to help you with this.
Exercises to help the baby dislodge from the pelvis, like lying on your back head down (with a strong spotter!) on a slant board, or doing the yoga positions downward dog or child’s pose with your butt in the air are said to work sometimes, although I haven’t seen data. But once the baby is engaged in the pelvis, it is unlikely to move.
So assuming your active intervention options are depleted, do you schedule Cesarean or keep on hoping? The plus for scheduling Cesarean is that scheduled surgery, where you haven’t eaten recently, etc., is safer than urgent surgery during labor. Plus scheduling surgery assures that your doctor is awake and available and that surgery isn’t delayed waiting to assemble your team. The newest recommendations though strongly support waiting until 39 completed weeks before scheduling any elective delivery—seven days before the due date. Earlier than that can land the baby in the NICU unnecessarily. You can certainly decide you would rather wait until labor, but that increases the chance the C-section will need to be done urgently.
The real crux is: what’s the chance that the baby is going to turn on its own before you start labor? Your doctor may be able to help you to assess this. Personally I haven’t had anyone that I couldn’t do an external version on have her baby flip back to head first on its own, but you can always hope.