Written by Pradeep
A breech birth is defined as the birth of a baby in the 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 a breech baby through the 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 the 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.
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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 a 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.
Depending on the source, there are four main kinds of breech namely:
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. It constitutes around 65 to 70 percent of the total breech births.
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
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
Here the fetus is in a 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 start of the 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 feeling the fetal part in your pelvis. However, a better and most reliable confirmation about the position is done by getting an ultrasound done.
Your baby is more likely to settle himself in a breech position if:
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 at a technique that suits you both. It is important to closely monitor the baby for any risks.
Mentioned below are some techniques that may help in bringing breech presentations to normal presentations. However, no valid proof is present to establish their safety. Make sure you consult your doctor before attempting them.
ECV or the external cephalic version is a specialized procedure done by externally applying pressure from the abdomen and trying to manipulate the fetus in a 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 the external cephalic version is premature separation of the placenta from the uterine wall.
Chiropractors apply techniques that reduce 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 applicable in the 8th month of pregnancy.
Here are a few natural ways that turn a breech baby into a normal position. Please note that none of these has any scientific backup. None of the studies have revealed that a mother’s position affects the position of the fetus. Gravity
Allow the gravity to 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.
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 a 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 to 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. You can do it by placing headphones on the lower part of the stomach. This prompts the baby to turn in the direction of the sound.
The first most favorable type of safe breech vaginal delivery is frank breech and the complete breech is the second safest type of breech. The risks such as head entrapment and cord prolapse are common with kneeling and footling type of breech.
Following are some of the important factors affecting the safety of breech babies:
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 the delivery breech. More often the dangers of delivering a breech baby vaginal delivery 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.
A woman having a spacious and roomy pelvis is likely to have a vaginal breech delivery.
An ultrasound helps to diagnose it. Hyperextension or stargazing position accounts for less than 5 percent of the breech babies.
In such cases, Cesarean deliveries are an absolute must.
Complications are more frequent in premature babies if delivered through the vaginal route.
Normal progressing, spontaneous labor needing no significant intervention is a positive sign.
In a twin pregnancy, if the first one is born in cephalic presentation, the chances of the second one being a safe breech delivery are more. A breech birth is the birth of a baby in breech presentation.
Most commonly, the risk involes the use of forceps to push the baby’s head outside the birth canal. Compression of the umbilical cord, because the baby’s biggest part of 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, doctors go for an immediate c-section to safely deliver the baby. The failure of the fetal head to negotiate the maternal mid-pelvis can bring about head entrapment. 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.
Doctors consider Cesarean 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 mother can deliver a full-term baby in the frank breech presentation 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 one has to consider the size of the baby as well.