What is a breech presentation?
The breech presentation is the position of your baby where he of she is in a longitudinal lie with the buttocks and feet nearest to the cervix. Breech presentation occurs in 3 to 4% of all deliveries. The breech presentation is higher at approximately 22 to 25% in early gestational ages before 28 weeks and gradually decreases to 7 to 15% at 32 weeks gestational age, and at term, only 3 to 4%. The risk factors for the breech presentation are:
- Prematurity – Premature babies have a higher risk of being in a breech presentation as they have not been able to shift positions due to insignificant time.
- Uterine malformations or fibroids – There is abnormal shape of the uterus.
- Placenta previa
- Fetal anomalies such as central nervous system malformations or neck masses
- Multiple gestations
The Three Types of Baby Breech Presentation
There are three types of breech presentation:
- Frank breech – This occurs in 50 to 70% of breech presentations where the hips of the baby are flexed while the knee is extended. This is also known as the pike position.
- Complete breech – This occurs in 5 to 10% of babies with breech presentation where both the hips and knees are flexed. It is also known as the cannonball position.
- Footling or incomplete breech – Seen in 10 to 30% of breech presentations, the baby usually has one or both hips extended, with a presenting foot.
Below is a diagram from Medline Plus that shows the types of breech presentation:
Diagnosis of Baby Breech During Your Exam
Several weeks before your due date, your doctor will examine your abdomen to determine the position of the baby by feeling for the baby’s head, back, and buttocks. If your due date is near and the baby appears to be in a breech presentation, an ultrasound can be used to confirm the position of the baby. If necessary, special x-rays can help to confirm the baby’s position and the pelvis size to determine the probability of success if a vaginal delivery of the breech baby is attempted.
What can be done to help a baby turn to head-first during pregnancy?
Generally, it is recommended to attempt to turn the baby between the 32nd to 37th weeks of pregnancy.
External Cephalic Version
An external cephalic version (ECV) is a method that is used to turn the baby from the outside manually (transabdominal manual rotation) to a cephalic (head first) presentation. This procedure was first popular in the 1960s to 1970s but stopped after there were reports of fetal deaths. It was reintroduced in the 1980s and started becoming popular again in the 1990s due to improved outcome. The outcome might have improved due to the use of nonstress tests and better selection of candidates to undergo the procedure. In ECV, a medication is given to help the uterus relax and the baby’s heartbeat will be monitored throughout the procedure. In patients with an unsuccessful ECV, they may be sent home and plans will be made for either a vaginal breech delivery or having a scheduled caesarean section. If ECV is attempted after 39 weeks of gestation,caesarean may ensue in the event of unsuccessful ECV. The success rate varies from 35 to 86%. There is improvement in the rates of success in those with previous pregnancies, frank breech presentation, earlier gestational age, and in African American mothers. ECV failure does not reflect the skill of your doctor. ECV should not be attempted if:
- you are carrying multiple pregnancies
- there is concern regarding the health of the baby
- there is abnormality in the reproductive system
- there is placenta anomaly such as abruption or detachment
Webster Breech Technique
A technique developed by Larry Webster, a chiropractor, this technique helps chiropractors to decrease the stress on the pelvis of pregnant women. This aids in the relaxation of the uterus and its surrounding ligaments. The Webster breech technique enables the breech baby to turn more easily. A study conducted reported a success rate of 82%. It was also recommended that the technique be performed in the eighth month of pregnancy.
Delivery of a breech presentation – is it always by cesarean?
Most cases of breech presentations will result in a planned cesarean delivery. In some situations, a planned vaginal delivery can be considered. Both methods have their own risks but the risk of complications associated with a planned vaginal delivery is higher than a planned caesarean delivery.
Vaginal breech delivery
There are three types:
- Spontaneous breech delivery – This mostly occur in preterm deliveries and no traction or manipulation is required.
- Assisted breech delivery – This is the commonest type of vaginal breech delivery. The infant is delivered naturally up to the umbilical level where assistance is then needed in the delivery of the rest of the body.
- Total breech extraction – The feet of the baby are grasped and extracted. This method is only used for a breech presentation of a second twin as the cervix is dilated enough after the delivery of the first twin.
The complications of a vaginal delivery in a breech fetus includes the possibility where the baby’s head is stuck as the cervix has not dilated enough even after the delivery of the baby’s body. The baby’s head can be wedged against the bones of the pelvis. Another possibility is a prolapsed umbilical cord where it slips into the vagina before the baby. Increased pressure on the cord decreases the blood flow and oxygen to the baby.
A caesarean delivery is a surgery that delivers the baby through a surgical incision that is made in the mother’s abdomen and uterus. General anesthesia, epidural block, or spinal block can be used. A transverse incision is made near the pubic hairline and another made in the uterine wall. Complications include infection, injury to internal organs, or excessive bleeding. The anesthesia can also cause a set of complications on its own. A caesarean section also increases the risk of uterine rupture and complications with the placenta in future pregnancies.
What should I do if my baby is breech?
If your baby is breech, you should talk to your doctor about delivery plans especially if the due date for your baby is in several weeks. Besides the methods mentioned above (ECV, Webster breech technique) and the potential outcomes (vaginal breech delivery and caesarean delivery), there are some websites that talk about natural ways to help your baby turn to a cephalic position. However, before you try it out, you should talk to your doctor to make sure that it is not harmful for you to attempt it at home.