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Nancy SullivanFootling Breech Delivery
by Nancy Sullivan, CNM, MS, FACNM

Q. My first baby was born via c-section because he was a "footling breech." Apparently, he was feet down, and the cord was wrapped tightly around one of his feet. The doctor did not think it was because of any uterine abnormality. My question is, am I any more likely to have the same situation again than any other person? It is dangerous to try to have a footling breech vaginally?

A. Yes, it is dangerous to try to have a vaginal birth with a footling breech. "Footling" means the baby is more or less standing up in the uterus, with his feet hanging down at the cervix. When the cervix starts to open, this leaves space around the feet, and the umbilical cord can drift down into that space and "prolapse," or fall out into the vagina. If it does this, it will become strangulated, and blood flow to the baby is cut off. There is a high risk of stillbirth. The other breech, or butt-first presentations, frank (legs straight up) and complete (legs tucked up) are not likely to cause this problem, as the butt is filling out the space over the cervix and keeps the cord from falling down, just as the head does in a "vertex" birth. So, I would not recommend that anyone try a vaginal delivery with a footling breech.

Lastly, you want to know if your chances of having another breech baby are high. The overall risk is 3-4% of all women at term (it is higher with preterm births), but once you have had a breech baby, your risk for another one increases somewhat. This may be because of the shape of your pelvis, or, who knows. If your new baby is breech at term, your doctor will almost certainly advise a repeat cesarean. On the other hand, if it is vertex or head down, you should try to find someone who is willing to work with you to have a vaginal birth. The success rate is 70-80% - certainly worth a try!

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