A breech birth is defined as the birth of baby in breech position- the baby is born through the pelvis with feet or buttocks first as against the normal presentation of the baby in which the baby is born head first. The process of delivery of breech baby through vagina is a little complicated and mostly the baby is delivered by Cesarean section. Due to this most of the doctors are not fully trained for delivering breech vaginally.
By the time pregnancy reaches 8th month (32-33 weeks) the uterine space is completely occupied by the growing fetus and the babies settle their heads down in the pelvis- called the cephalic presentation.
What Happens If My Baby Is In A Breech Position?
If the baby is in breech presentation, it implies that the baby is destined to come out via feet or buttocks first.Besides the breech and cephalic presentation, there is another fetal presentation called the transverse lie where the baby is present in sideways position with his arm, shoulder or back presenting first. In breech presentation, usually the fetal heart sounds are heard right above the umbilical region and you may feel a sense of discomfort as the baby presses his head under your diaphragm, just below your ribs. Ultrasound is important for detecting the position of the fetus, amount of amniotic fluid and even the placental location.
Types of Breech
Depending on the source, there are four main kinds of breech namely:
Frank breech: In this breech the bottom of the baby comes out first followed by her or his flexed legs at the hip and extended at knees. This is the most common type of breech and constitutes around 65 to 70 percent of the total breech births
Complete breech:In this type of breech the baby’s knees and hip are usually flexed or sitting cross-legged or with a feet lying beside the buttocks
Footling breech: In this type of breech either one or both feet of the baby comes first and the buttocks are placed high up. The condition is common in premature babies
Kneeling breech: Here the fetus is in kneeling position with either one or both extended legs at the hips and usually flexed at the knees. This condition is very rare
Your doctor will be able to inform you about the position of the fetus by the starting of third trimester by palpating the baby from the abdomen.
At 36 weeks of pregnancy, the position of the baby is not clear by abdominal examination so the doctor clarifies the situation by doing an internal examination and feels the fetal part in your pelvis. However a better and most reliable confirmation about the position is done by getting an ultrasound done.
What Causes A Breech?
Your baby is more likely to settle himself in a breech position if:
This is a multiple pregnancy
You have had a history of a premature birth
Your uterus has either too much or too little amniotic fluid
You have a condition of placental pravia or fibroids
How To Turn A Breech Baby?
Between the 32nd and 37th week of pregnancy, turning a breech baby can be tried, though always in consultation with the doctor. Varying techniques are applied and all have different success rates. You and your doctor will together arrive on a technique that suits you both. The baby is closely monitored for any risks.
Techniques To Change Breech Position
Mentioned below are some techniques that are known to help in bringing breech presentation to normal presentation. However no valid proof is present to establish their safety. Make sure you consult your doctor before attempting them.
ECV or external cephalic version
ECV or external cephalic version is a specialized procedure done by externally applying pressure from the abdomen and trying to manipulate the fetus in head-down position. The success rate of turning breech fetus to cephalic is 58 percent while ECV is 90 percent successful in bringing transverse lie to normal position.
One of the main complications of external cephalic version is premature separation of placenta from the uterine wall.
Chiropractic: Webster Breech Technique
Chiropractors apply techniques that reduces the stress on a woman’s pelvis, thus relaxing the uterus and the surrounding muscles making if viable for the baby to turn position. This technique is generally applied in the 8th month of pregnancy.
How To Turn A Breech Baby Naturally?
Allow the gravity rectify the presentation of the fetus. Some people believe that you can follow the following two positions twice a day from 32 weeks of pregnancy.
Simply lie down on your back and slowly lift your pelvis to about 8 to 10 inches above the floor. Take a pillow to support and stay for at least 10 to 15 minutes in this position
You can also get down on your knees with the help of your forearms and stay for at least 10 to 15 minutes
Scientifically so far none of the studies have revealed that mother’s position affects the position of the fetus
This is an ancient Chinese method of stimulating main acupressure points by burning herbs. The expert usually burns mughwort-a herb, close to the acupressure points of your toes. The Chinese belief is that this would stimulate baby’s activity and causes it to change its position on its own.
Some experts are of the opinion that pregnant women practicing hypnosis (‘a state of profound relaxation’) from 37 weeks to 40 weeks of pregnancy are more prone to get their fetus come down to normal presentation.
All babies do respond to music, and so many pregnant women try and use the sound to turn a baby. This is done by placing headphones on the lower part of the stomach thus prompting a abby to turn towards the direction of the sound.
Important Factors Influencing The Safety Of Breech Baby
The first most favorable type of safe breech vaginal delivery is of frank breech and complete breech are the second safest type of breech.
The risks such as head entrapment and cord prolapsed are common with kneeling and footling type of breech.Following are some of the important factors affecting the safety of the breech babies:
Birth attendant’s skill
An important factor for the safety of the breech baby is the experience and skill of the birth attendant. Doctors who have seen or assisted in breech deliveries previously are more efficient in delivery breech. It is seen that majority of the dangers encountered by the breech babies during vaginal deliveries are due to the errors made by attendants or caregivers
Parity implies the number of times a female has conceived. The possibility of safe vaginal delivery is more in a woman who has already given birth vaginally in comparison to the one who has not delivered vaginally.
Fetal size and maternal pelvic size
A woman having spacious and roomy pelvis is likely to have vaginal breech delivery.
Hyperextension of the fetal head
This is diagnosed with the help of ultrasound. Hyperextension or star-gazing position accounts for less than 5 percent of the breech babies.
In such cases Cesarean deliveries are absolutely must.
Maturity of the baby
Complications are more frequent in premature babies if delivered through vaginal route.
Progress of labor
Normal progressing, spontaneous labor needing no significant intervention is a positive sign.
In twin pregnancy if the first one is born in cephalic presentation, the chances of the second one being a safe breech delivery is more.
A breech birth is defined as the baby in breech presentation.
Risk Of Breech Presentation
Most commonly, use of forceps to push the baby’s head outside the birth canal is done. Compression of the umbilical cord, because the baby’s biggest part the head comes out the last, may also happen thus distressing the baby by decreasing the oxygen supply to the baby. In such an event, a c-section is immediately performed to safely deliver the baby. Head entrapment is caused by the failure of the fetal head to negotiate the maternal mid pelvis. Injury to the brain and skull may occur due to the rapid passage of the baby’s head through the mother’s pelvis, more likely in preterm babies.
Delivering A Breech Baby Naturally
Doctors consider Cesarean to be the safe bet when it comes to delivering a breech baby. If you would prefer a vaginal birth, you need to discuss the same with your doctor and weigh the risks associated. If you have had a vaginal delivery earlier, and a well-trained experienced birth doctor is available, you can vouch for it provided the doctor rules any complications and risks with the birth. A full term baby in the frank breech presentation can be more likely delivered vaginally, if the baby does not show any signs of distress during the birth. The baby also needs to be able to pass through the mother’s pelvis safely, so size of the baby is also considered.