When a baby is positioned bottom or feet first in the womb instead of head first, this is known as a breech presentation. While most babies naturally turn to a head-down position before birth, some remain in a breech position.
Understanding Breech Presentation
Breech presentation means the baby’s lower body is positioned to enter the birth canal first. There are distinct types of breech positions. Frank breech, the most common type, occurs when the baby’s hips are flexed, but the legs are extended straight up with the feet near the face. In a complete breech, both the baby’s hips and knees are flexed, appearing as if the baby is sitting cross-legged. A footling breech involves one or both feet presenting first. Breech presentation occurs in about 3% to 4% of all full-term pregnancies.
Attempting to Change Position
Before labor begins, healthcare providers may attempt to change the baby’s position through External Cephalic Version (ECV). This manual procedure involves a doctor applying firm pressure to the mother’s abdomen to gently turn the baby from a breech to a head-down position. ECV is typically attempted late in pregnancy, around 36 to 37 weeks, when there is still enough amniotic fluid and space for the baby to move. Success rates for ECV range from 40% to 80%, depending on factors like maternal parity and amniotic fluid volume. The procedure is performed in a hospital setting with continuous monitoring to ensure the baby’s well-being. If ECV is successful, a vaginal delivery becomes an option; otherwise, other delivery methods are considered.
Delivery Options for Breech Babies
Vaginal Breech Delivery
While less common today, vaginal breech delivery remains an option for some pregnancies under specific conditions. Criteria for a safe vaginal breech birth include the type of breech, with frank or complete breech often preferred, and an estimated fetal weight between 2500 grams and 4000 grams. The mother’s pelvis must be adequately sized, and the medical team needs experience in managing such deliveries, with continuous monitoring available.
During a vaginal breech delivery, the medical team carefully manages the process, often allowing the baby to descend spontaneously to a certain point. Specific maneuvers may be used to assist the delivery of the arms and head. Traction on the baby is generally avoided to prevent complications.
Cesarean Section for Breech
Cesarean section (C-section) is the most common delivery method for breech babies in many countries, primarily due to safety considerations. A C-section is typically recommended for certain breech types, such as footling breech, or if the baby is very large or very small. Other reasons include multiple pregnancies, certain maternal health conditions, or if criteria for a safe vaginal breech delivery are not met.
A planned C-section for a breech baby is usually scheduled around 39 weeks of pregnancy. This surgical procedure involves an incision in the mother’s abdomen and uterus to deliver the baby. While C-sections are considered safer for breech presentations, they are a major surgical procedure with associated recovery times.
Making the Delivery Decision
The decision regarding the delivery method for a breech baby is an individualized process, made in close consultation with healthcare providers. Factors influencing this choice include the specific type of breech presentation, the estimated size of the baby, the mother’s health, and her previous obstetric history. The medical team’s experience in managing vaginal breech births is also important. Patient preferences, based on a thorough understanding of the risks and benefits of each option, play a role. Open communication between the expectant parent and the healthcare team is important to ensure the safest and most appropriate delivery plan is chosen.