Breech Baby

A breech presentation is quite common in the early months of pregnancy as there is plenty of room for the fetus to swim around. A very good percentage of babies present in the normal head down position (vertex) at the onset of labor. However, about 3 to 4 percent of babies remain in breech positions, with the head up toward the mother's ribs instead of down at week 40. That would mean the feet or buttocks will have to be delivered first.

Types of breech presentations..

• 1. Frank - this is the most common presentation where the baby's legs are flexed up over the abdomen, with the knees straight and the feet near the head. The buttocks point toward the pelvis (as shown in the image above).
• Complete breech - here the fetus sits cross-legged, in a yoga position with the buttocks and feet in the pelvis. This is the least common type of breech where the feet and buttocks present together
• 3. Footling or incomplete breech - here fetus is in a standing position with one or both legs held straight downward. One or both feet present first

The Causes..

There is no particular cause for babies to present this way. But there are certain conditions that make it conducive for babies to assume the breech position. Breech presentation however is more common at premature labor than at term since babies assume breech position at the end of the second trimester.

• The mother has had more than one pregnancy
• The mother is carrying more than one baby
• The uterus has either too much or too little fluid
• Misshapen uterus or uterus with abnormal growths like fibroids
• The mother has placenta previa
• The chance of having breech baby increases if the previous delivery was by the breech

Doctors find out if it is a breech baby through abdominal examination, and confirms it with a vaginal examination and an ultrasound.

The Problems..

• Difficult delivery of the fetal head
• Umbilical cord obstruction or prolapse
• In breech delivery, the largest and the least pliable part, namely the baby's head is born last. As such the head has not had enough time to mold or narrow during labor therefore
• causing delay in delivery
• causing baby's head to get stuck
• causing baby to lose oxygen due to the compressed cord
• causing baby to have a hard time fitting through the pelvis
• causing trauma and damage to the baby
• The main danger to mother is the increased likelihood of having a cesarean delivery

The Facts..

• Controversy is ongoing as to which method of delivery is better in breech cases: vaginal or cesarean
• Vaginal delivery is possible after an assessment is made on baby size, the size of the mothers pelvis, the type of breech position and the stage of pregnancy
• Vaginal delivery may either be easy with lesser need of medical intervention, or difficult with necessary hand maneuvers required (assisted breech deliveries).
• Physicians experienced in the technique of breech birth must be available to perform the birth or assist in the delivery
• Many medical experts believe cesarean is a safer bet when it comes to safety issues
• Baby size matters if baby is in breech position
• Not too large and not too small and in the frank position pose the least risk if vaginal delivery is proposed
• If the baby is large there is the danger of baby's head being trapped
• If the baby is small there is the danger of cord prolapse (the cord falls through the cervix into the vagina)

C-section becomes very Probable..

• If there is severe fetal growth restriction
• If it is a very large fetus
• If the head is hyperextended meaning the chin is up and the head bends backward instead of forward
• If there is a history of a perinatal death
• If the pelvic size is inadequate
• If the previous baby was with birth trauma
• If the fetus is premature because of maternal illness

External Cephalic Version (ECV)

• In some situations, a non-surgical method to change baby's position will be used.
• Most versions are done between weeks 37 and 39
• The whole procedure may take few hours, including monitoring the baby after the version
• An attempt will be made to turn the baby into the vertex position manually.
• The doctor will use his hands at certain key points on the lower abdomen and gently shift baby to the head down position.
• The mother will be given light medication to relax the uterus after which the baby will be pushed gently.
• An ultrasound will be used to determine the breech position and amniotic fluid level; the procedure will be performed under ultrasonic guidance to help the doctor in changing baby's position.
• ECV is usually conducted before labor or in the early stages of labor.
• A doctor trained in this procedure is required to do it.
• About 50% of the cases are successful