Breech presentation and delivery with breech presentation

Throughout the pregnancy, the uterus has enough space for the fetus to change its position from time to time. By 36 weeks of gestation, in most cases the fetus occupies the position with the head down. This is the natural and safest position for delivery.

What is breech presentation?

In 4% of cases on the last lines of pregnancy the fetus does not unfold and lies with the buttocks forward. There are three types of breech presentation:

• Pure breech presentation. Buttocks are born first. The legs are stretched along the body and the feet are right next to the head. This type of breech presentation is most common.
• Full breech presentation. Buttocks are at the bottom near the birth canal. The fruit sits cross-legged, the feet are located near the buttocks.
• Leg (incomplete) breech presentation. The feet are stretched below the buttocks and are born first.

Causes of the breech presentation

In more than half the cases of breech presentation, the reason why the fetus did not turn around during the time is not known. Sometimes breech presentation is associated with:

• the beginning of labor until 37 weeks (premature birth) - just before the moment when the fruit can turn over.
• Multiplicity: for two or more fetuses in the uterus, there may not be enough room to turn your head down.
• abnormalities of fetal development, including the heart, digestive system and brain diseases (Down's syndrome, encephalitis and hydrops of the brain).
• polyhydramnios or lack of water.
• problems of the uterus, for example, when it is irregular in shape or the presence of a tumor (benign lesions) on its walls.

[1], [2], [3], [4],

Symptoms of the breech presentation

It is hardly possible to determine the breech presentation on the basis of symptoms. But if you are 36 weeks pregnant and feel that the baby's head is at the top or legs at the bottom, consult a doctor.

A pregnant woman can not always feel that her child is lying wrong (pelvic presentation). As a rule, it becomes known with the onset of labor or during labor.

Even before the 36th week of pregnancy, you hardly feel that the fruit is freely turned upside-down. Even after the 36th week, it is not entirely clear what position the child is in. But sometimes a pregnant woman can feel the intense movements of her legs in the lower abdomen or the fact that the head of the fruit is located at the top.

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Diagnostics of the breech presentation

The doctor will examine the upper and lower abdomen, as well as examine the cervix for signs of breech presentation. Ultrasound diagnosis will give an accurate picture of the location of the fetus.

You are more likely to learn about the breech presentation during the planned visits to the doctor in the last trimester of pregnancy. Doctor:

• gently presses on different parts of the abdomen. Gluteal presentation can be determined by the location of the head (which is sufficiently firm).
• examines the cervix, feeling for a round smooth surface of the head of the fetus or a soft uneven surface of the buttocks (breech presentation).

If the doctor suspects breech presentation, ultrasound diagnosis is additionally done to confirm the diagnosis.

If the doctor tries to turn the fruit head down:

• You need to do an ultrasound before, after and, probably, during the procedure to determine the position of the fetus and its heart rate.
• should do electronic monitoring of fetal heartbeats before and after the procedure.

An active fetus whose heart rate increases during movement is considered healthy. If the rhythm is violated, the procedure should be discontinued.

[6], [7]

Treatment of the breech presentation

How to safely give birth to a child with breech presentation?

Sometimes a doctor manages to turn the child head down, what is called an external turn of the fruit head down. Specialists strongly recommend doing this procedure if possible. It does not matter how the fruit is located, each generic activity and birth pass in its own way. Consult with your doctor how you can give birth to a child with breech presentation in the safest way.

In some cases, women give birth in the usual way, but, as a rule, with breech presentation for safety of the fetus do caesarean section. Only a small number of doctors have the experience of making births with breech presentation in a natural way. You and your doctor may have developed a plan for labor and delivery, but remember that very often surprises happen and the doctor needs to make a quick decision in order to protect you and your child.

Treatment Overview

In most cases, by the 36th week of pregnancy, the fetus turns head down. This is the natural way of giving birth to a child. If the fetus has a breech presentation at late pregnancy, the attending physician will probably recommend a caesarean section. If a child can develop before the onset of labor, a woman can try to give birth in a natural way.

Fetal unfolding with breech presentation

An attempt to deploy a child increases the chances of giving birth naturally. At home, you can also try to take a different position. Although this method has not been sufficiently studied, it is considered safe and effective.

External rotation of the fetus on the head is carried out in medical institutions with constant monitoring of the fetal heartbeat. You should also do ultrasound before and after the procedure. The doctor will give you a medical medication to relax the muscles of the uterus. To deploy the fetus, the doctor presses on certain areas of the abdomen. The procedure can be repeated several times if you can not deploy the fruit on the first try.

You yourself can take a different position of the body at home. Gently lift the pelvis above your head several times a day for several weeks.

If the doctor has managed to deploy the baby head down, then from time to time check the position of the fetus until the onset of labor. With the correct position of the fetus, there is no need for caesarean section. The birth will be natural or through surgical intervention - it all depends on the course of labor. Studies show that women who have previously given birth are less likely to have a caesarean section after successfully unfolding the fetus compared to those who give birth for the first time.

Breasts with breech presentation

In most cases of breech presentation, caesarean section is done to protect the fetus. If the fetus still remains in the breech presentation or is sharply turned by the pelvis down before the very birth, the doctor will appoint a cesarean section. But sometimes this surgical intervention can not be done and is not recommended. In the case of rapid childbirth a child can be born only in a natural way. When giving birth to twins, the second twin (with breech presentation) is best to give birth vaginally. The risk is significantly reduced if the doctor has a large experience of taking such births. A child with breech presentation can take:

• perinatologist
• family doctor with appropriate qualifications
• obstetrician

Your pediatrician or family doctor may be present during childbirth in case of emergency care after birth.

[8], [9], [10]

How to make the right decision?

With or without information on the breech presentation of the fetus, you can help the child to be born healthy.

• Visit your doctor regularly during pregnancy. Information on breech presentation of the fetus will help prevent possible complications.
• Adhere to a balanced diet.
• Avoid harmful substances, for example, smoking, alcoholic beverages or drugs that harm the child.

How to give birth to a child with breech presentation?

If the fetus is downside down, ask the doctor if you can take a different position of the body, which helps unfold the fetus. Although it has not been proven that this situation contributes to the unfolding of the fetus, it is also not proven that it can harm the child. Naturally, you are worried and upset when you learn that the fetus is located incorrectly, especially in cases when attempts to unfold it fail. If you are concerned about the health of the child, consult a doctor. Most children with breech presentation are born healthy. After childbirth with a caesarean section, you will need help from the family around and taking care of the baby for the first few weeks. Although you can walk in a few days, you still can not lift weights.