A breech presentation occurs when a baby is positioned feet or buttocks first in the uterus instead of the typical head-down position. This orientation can pose challenges during delivery, especially in twin pregnancies. This article explores managing breech presentation in twins, covering its causes, medical and non-medical methods for turning babies, and delivery options.
Understanding Breech Presentation in Twins
Breech presentation is common in twin pregnancies, with one or both babies positioned with their bottom or feet facing the birth canal. This differs from the ideal head-down, or cephalic, position. The confined space within the uterus when carrying two fetuses is a primary reason twins may not settle into a head-down position. Other factors include uterine abnormalities, amniotic fluid issues, or placenta previa.
There are several types of breech positions. A frank breech has the baby’s buttocks aimed at the birth canal, with legs extended straight up. In a complete breech, the baby’s buttocks point downward, with hips and knees flexed, appearing as if sitting cross-legged. A footling breech occurs when one or both feet are positioned to deliver first. Achieving a head-down position for one or both twins is often desired to facilitate vaginal birth and reduce risks like head entrapment or cord prolapse.
Medical Procedures for Turning Breech Twins
External Cephalic Version (ECV) is a medical procedure where a healthcare provider attempts to turn the baby by applying gentle pressure to the mother’s abdomen. This procedure is typically performed in a hospital setting, allowing for immediate medical attention if complications arise.
For twin pregnancies, ECV is usually considered primarily for the first twin if it is breech and the second twin is in a favorable position, or if the first twin is breech and the second twin is transverse. Success rates for ECV in single pregnancies range from 50-60%, but specific success rates for twins can vary and are often lower due to the complexities of multiple fetuses. Risks associated with ECV can include placental abruption or changes in fetal heart rate, which is why it is performed under careful monitoring.
Non-Medical Approaches to Turning Breech Twins
Non-medical methods can encourage breech twins to turn. These approaches often involve specific exercises or alternative therapies, though their scientific efficacy is not as robustly proven as medical procedures. One common technique involves pelvic tilts or inversions, aiming to use gravity to encourage the baby to shift position. Expectant mothers may try positions such as lying with their hips elevated or kneeling on an incline.
Chiropractic care, specifically the Webster Technique, is another non-medical option. This technique focuses on balancing the pelvis and reducing uterine constraint, theoretically creating more space for the baby to turn. Acupuncture and moxibustion, an ancient Chinese therapy, are also considered ways to stimulate fetal movement and rotation. It is important to discuss any non-medical interventions with a healthcare provider to ensure safety and understand their potential benefits and limitations.
Delivery Options When Twins Remain Breech
When attempts to turn breech twins are unsuccessful, or if turning is not pursued, healthcare providers will discuss various delivery options. The primary considerations are typically vaginal birth or a Cesarean section (C-section). The decision for the mode of delivery for breech twins depends on several factors, including the position of the first twin, the estimated size of both babies, and the healthcare provider’s experience.
If the first twin is breech, a C-section is often recommended to minimize risks. However, if the first twin is head-down and the second twin is breech, a vaginal delivery for the first twin might be attempted, followed by potential interventions to deliver the second twin. A balanced discussion with the medical team allows parents to understand the potential benefits and risks associated with each delivery scenario, ensuring they are well-prepared for the birthing process.