As the fetus develops inside the uterus it will move from a head up position to a head down position in preparation for delivery.
In some cases the baby will remain in a head up position until it is too big to rotate inside the uterus. These breech presentation babies can cause problems for your baby and your doctor.
There are several different types of breech presentation including a complete breech, an incomplete or footling breech, a frank breech, and face or shoulder presentations.
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The incidence of breech presentation is about three percent (1 in 33) deliveries at term. But your baby is more likely to be head up in the uterus earlier during your pregnancy. Prematurity is one of the main causes of breech presentations during labor.
About one third of babies are breech at week twenty, falling to one quarter by week twenty eight. About nine percent (1 in 11) are still breech by week thirty six. Most of these will turn spontaneously by the following week but if yours has not the chances are that you will have a breech baby at term.
If your baby is in a breech presentation you will have the option of external cephalic version (ECV). Most doctors in the United States will recommend delivery by cesarean section while their European counterparts still choose to deliver in the breech presentation.
External cephalic version is a safe procedure that is successful in up to 75% of deliveries. The procedure is most frequently performed just before the onset of labor or during the early stages of labor. The incidence of complications is very low.
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If you choose external cephalic version the doctor, usually a perinatologist, will begin by performing an ultrasound to establish the position of the baby inside the uterus. Not all doctors are trained in the procedure and if your doctor recommends ECV you should check if they are trained to do it.
The doctor will determine whether the baby is comfortable and then administer an I.V.The delivery of fluid, often glucose, directly into the vein using a plastic catheter, and bag of fluid.
Visit our comprehensive glossary for more pregnancy terms and definitions. containing a uterine muscle relaxant called ritodrine. Using gentle movements of the hands placed on the abdomen, the doctor will manually move the baby into the vertex or head down position. Ultrasound is used to guide the doctor throughout the procedure.
In the United States, mothers who choose not to undergo external cephalic version will be encouraged to have a cesarean section; a procedure that has slightly lower birth trauma and mortality rates than a vaginal delivery.
Vaginal delivery of breech presentation babies present their own problems. Electronic fetal monitoring using a fetal scalp monitor after the rupturing of the membranes will be required. The first stage of labor is usually longer with a breech presentation delivery since the soft tissues of the buttocks are less efficient at dilating the cervix as the baby's skull.
The softer tissues of the baby's buttocks also mean that the vaginal tissues are not sufficiently stretched to permit the head to pass through the birth canalThe passage through which the baby passes during delivery from the inlet of the true pelvis to the vaginal orifice.
Visit our comprehensive glossary for more pregnancy terms and definitions.. In most cases vaginal delivery of a breech baby will require the use of forcepsA medical instrument of which there are many varieties which consists of two handles and two flat sides. They are sometimes used to deliver a baby, especially when speed is necessary to overcome fetal distress, or dystocia. A forceps delivery will leave superficial marks on the baby's head and face which will disappear in a few days.
Visit our comprehensive glossary for more pregnancy terms and definitions. and an episiotomyA surgical procedure in which an incision is made in the perineum to enlarge the vaginal opening and faciliate delivery of the baby or prevent tearing of the perineum. It is closed with absorbable sutures.
There are two types of episiotomy; the medilateral, cut at 45 degrees with midline, and median cut in the midline. The former offers more room for delivery but is more painful postpartum, while the latter heals more easily, but provides less room for delivery.
Visit our comprehensive glossary for more pregnancy terms and definitions..
Doctors performing a vaginal delivery of a breech presentation baby will carefully monitor the position of the umbilical cordA flexible structure that connects the fetus to the placenta during pregnancy. It carries blood, oxygen, nourishment and waste to the placenta. It is first formed during the fifth week of pregnancy and contains the yolk sac and body stalk.
Visit our comprehensive glossary for more pregnancy terms and definitions. to make sure that it does not become compressed. Once the baby's chest is free the baby will usually want to start breathing and may experience mild fetal distress while the head is still in the birth canal.
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