Breech Births: Understanding the Different Presentations and Options
During the last weeks of pregnancy, babies typically position themselves with their heads ready to come out of the vagina first, known as a vertex presentation.
However, in some cases, a breech presentation occurs, where the baby's buttocks, feet, or both are positioned to come out first.
Let's explore the different types of breech presentations and what it means for both mom and baby.
Types of Breech Birth Presentations
Complete Breech: The baby's buttocks point downward, with folded legs at the knees and feet near the buttocks.
Frank Breech: Here, the baby's buttocks are aimed at the birth canal, with legs straight up in front of their body and feet near the head.
Footling Breech: In this position, one or both of the baby's feet point downward and will deliver before the rest of the body.
Causes of Breech Presentation
While the exact causes of breech presentations are not fully understood, certain factors can increase the likelihood of it happening:
Having been pregnant before
Carrying multiples
A history of premature delivery
Abnormalities in the uterus, such as fibroids or an abnormally shaped uterus
Too much or too little amniotic fluid
Placenta previa, where the placenta covers part or all of the uterus's opening
Diagnosing a Breech Presentation
A few weeks before the due date, healthcare providers will feel the mother's lower abdomen to determine the baby's position.
They may also use ultrasound or pelvic exams to confirm if the baby is in a breech position.
Special x-rays can help assess if a vaginal delivery is possible or if other options need to be considered.
Addressing Breech Presentations
If a breech presentation is identified, there are various methods to try and turn the baby between the 32nd and 37th weeks of pregnancy. Some techniques include:
External Cephalic Version (ECV): A non-surgical procedure where gentle pressure is applied to the abdomen to turn the baby into the head-down position.
Medical Supervision: ECV is closely monitored, and the baby's heartbeat is continuously checked. If any issues arise, the procedure can be stopped or followed by a cesarean delivery.
Vaginal Delivery vs. Cesarean for Breech Birth
Most healthcare providers tend to recommend a cesarean delivery for breech presentations, especially for premature babies.
However, a vaginal delivery might be attempted if certain conditions are met, such as the baby being in a frank breech presentation, no signs of distress, and appropriate facilities available for cesarean if needed.
Risks and Considerations
A vaginal delivery for breech presentation comes with some challenges, like the baby's head being the last part to emerge.
Forceps might be used to guide the head out, and cord prolapse can be a potential issue.
Cesarean delivery is often preferred for breech births, particularly for premature babies, to ensure a safe delivery for both mother and baby.
