On Monday’s Counting On birth special, Joy-Anna Duggar and her husband, Austin Forsyth, detailed the recent birth of their son, Gideon Martin Forsyth. Unfortunately, the delivery wasn’t quite what they’d expected.

Duggar had decided to have a home birth, but after being in labor for more than 20 hours, her midwife determined the baby was breech. Duggar was rushed to the hospital for an emergency C-section. “I really wanted to at least try it,” she said of a home birth. “We’re only about 30 minutes from the hospital, so it’s not too bad in case of an emergency or a change of plans.”

So what does it mean for a baby to be in the breech position — and does it always result in a C-section? Here’s what you need to know.

What does it mean for a baby to be breech?

The ideal position for a fetus to be in before birth is head down; that makes for the smoothest sailing through the birth canal. But not all babies are positioned that way. When the baby’s bottom or feet are down, this is called breech. Breech positioning happens in up to 4% of pregnancies carried to term, according to the American College of Obstetricians and Gynecologists (ACOG).

As a woman’s due date comes closer (at about the 32nd to 36th weeks of pregnancy, according to the Cleveland Clinic), most babies naturally settle into optimal delivery position, with their heads pointed down and facing mom’s back. But sometimes this doesn’t happen. That’s why health care providers check for breech positioning by feeling a woman’s bump to locate the baby’s head and bottom. An ultrasound or pelvic exam can confirm if a baby is indeed in a breech position.

Joy-Anna Duggar

What causes breech positioning?

According to ACOG, it’s not always possible to determine why a fetus is breech. However, there are some factors that seem to increase an expectant mom’s chances of having a baby in this position — such as being pregnant with twins (or more!) or having an underlying health issue affecting the uterus, like fibroids. While breech position certainly isn’t ideal, it doesn’t usually mean anything is wrong with the developing fetus’s health, ACOG explains.

Is it possible to turn a breech baby?

Rather miraculously, yes. Health care providers can turn the baby inside mom’s womb — you won’t believe it until you watch this video — using a procedure called an external cephalic version (ECV). “It involves actually physically turning the baby by placing hands on the woman’s uterus to almost help the baby do somersaults inside the uterus,” Joanne Stone, MD, director of maternal fetal medicine for the Mount Sinai Health System in New York, previously told Health.

ECV isn’t always an option; when it’s not, some women have been known to attempt at-home techniques thought to help babies turn on their own, like elevating their hips for periods of time throughout the day or playing music to their belly, although these tricks don’t always work.

Austin Forsyth and Joy-Anna Duggar
| Credit: Amy Rachelle King/Instagram

Are breech babies always born via C-section?

If a health care provider is able to reposition a breech baby, the baby can be delivered vaginally. But attempts at turning a breech baby aren’t always successful, according to the U.S. National Library of Medicine. After an unsuccessful attempt at repositioning, most women go on to deliver breech babies via C-section.

That’s because it’s dangerous to deliver a breech fetus vaginally, not just for the baby but also for mom. Doing so means the largest part of the baby — the head — is delivered last. When smaller parts of the baby’s body come out first, the cervix won’t necessarily expand wide enough for the larger head and shoulders to follow. That can mean the baby gets stuck in the birth canal, which could lead to injury or even death. The umbilical cord may also slip or become pinched, depriving the baby of oxygen.

Yes, a C-section also carries risks — as all surgeries do. But the procedure is considered the safest option for delivering breech babies. “Both vaginal birth and cesarean birth carry certain risks when a fetus is breech,” according to ACOG. “However, the risk of complications is higher with a planned vaginal delivery than with a planned cesarean delivery.”

Typically, pregnant women know ahead of time that their developing baby is breech and can schedule a C-section rather than find out during labor and be rushed to a hospital for an emergency procedure. While it’s still unclear why Duggar wasn’t scheduled for a C-section, the family says that she and baby Gideon got the care they needed, and everyone is doing well now.

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