When your baby comes bottom first

The vast majority of unborn babies are usually positioned such that the head is usually located near the birth canal. This is the natural and optimal positioning for a normal delivery. However, a small number of babies may be positioned bottom first towards the end of the pregnancy. This is referred to as breech presentation, and requires special planning for how the baby will be born.

There are many reasons why babies may positioned with the bottom first.Your midwife or obstetrician will normally suspect that your baby is breech during antenatal care visits. An ultrasound scan is usually done to confirm the positioning and look for causative factors. Possible reasons that might account for breech presentations include uterine fibroids, an abnormally placed placenta, and reduced or even increased amount of fluid around the baby. Premature babies and twins may also present bottom first. But for most cases, there is usually no apparent cause for a breech presentation.

Most babies in breech presentation will have moved to head first by the last 3 to 4 weeks of the pregnancy.Hence there is not much reason to worry about breech presentation, where there is no apparent cause, till about 37 weeks of pregnancy. Beyond this time, it becomes more unlikely that the baby will turn spontaneously to head first. Hence plans for delivery must be made.

Your obstetrician may suggest manually turning your baby to head first after the 37th week. Safety criteria for both you and your baby must be fulfilled first before this is recommended. The procedure is termed as external cephalic version (ECV), and is successful in about 50% of cases. Once the baby is turned to head first, you would then normally continue antenatal care and wait for spontaneous labor. Some babies will however return to a breech position even after a successful ECV.

If ECV is not for you, or becomes unsuccessful, decisions about your delivery must then be made. A Cesarean Section (CS) may be recommended. You may also have the choice to consider delivering your baby vaginally bottom first. You are more likely to have a successful vaginal breech delivery if your baby is not too large, labor progresses smoothly, and you have delivered vaginally before.This option though has become rarer following scientific studies that favor CS delivery with breech presentations due to potential complications with a vaginal birth. Be sure to have a detailed discussion with your obstetrician about breech delivery options prior to making final decisions.

There is never any good reason to get into a panic mode if your baby appears to be positioned bottom first. The majority will sort themselves out. For the remainder, a discussion with your obstetrician or midwife will normally chart the best way forwards based on your specific circumstances. What eventually matters is a safe delivery for you and your baby.