Breech presentation and breech delivery

Throughout pregnancy, there is enough space in the uterus for the fetus to change its position from time to time. By the 36th week of pregnancy, in most cases, the fetus is in a head-down position. This is the natural and safest position for childbirth.

What is breech presentation?

In 4% of cases, in the last stages of pregnancy, the fetus does not turn and lies buttocks first. There are three types of breech presentation:

• Pure breech presentation. The buttocks are born first. The legs are extended along the body and the feet are right next to the head. This type of breech presentation is the most common.
• Complete breech presentation. The buttocks are down near the birth canal. The fetus sits cross-legged with the feet near the buttocks.
• Foot (incomplete) breech presentation. The feet are extended below the buttocks and are born first.

Causes breech

In more than half of breech presentations, the reason why the fetus did not turn on time is unknown. Sometimes breech presentation is associated with:

• the onset of labor before the 37th week (premature birth) - just before the moment when the fetus can turn over.
• multiple pregnancy: There may not be enough room in the uterus for two or more fetuses to turn head down.
• fetal developmental abnormalities, including the heart, digestive system, and brain diseases (Down syndrome, encephalitis, and hydrocephalus).
• polyhydramnios or oligohydramnios.
• problems with the uterus, for example, when it is irregularly shaped or the presence of a tumor (benign formation) on its walls.

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Symptoms breech

It is unlikely that you can tell if your baby is breech based on symptoms. But if you are 36 weeks pregnant and feel like your baby's head is up or his feet are down, consult your doctor.

A pregnant woman may not always feel that her baby is lying incorrectly (breech presentation). As a rule, this becomes known at the onset of labor or during labor.

Before the 36th week of pregnancy, you are unlikely to feel the fetus freely turning up and down. Even after the 36th week, it is not entirely clear what position the baby is in. But sometimes a pregnant woman may feel intense movements of the legs in the lower abdomen or that the fetus's head is located at the top.

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Diagnostics breech

The doctor will examine the upper and lower abdomen and examine the cervix for signs of breech presentation. Ultrasound diagnostics will give an accurate picture of the fetus's position.

You're more likely to find out if your baby is in breech presentation during your scheduled doctor visits in the last trimester of your pregnancy. Your doctor will:

• gently presses on different parts of the abdomen. Breech presentation can be determined by the position of the head (which is quite hard).
• examines the cervix, feeling the round, smooth surface of the fetus's head or the soft, uneven surface of the buttocks (breech presentation).

If the doctor suspects breech presentation, an additional ultrasound scan is performed to confirm the diagnosis.

If the doctor tries to turn the fetus head down:

• An ultrasound scan should be performed before, after, and possibly during the procedure to determine the position of the fetus and its heart rate.
• Electronic fetal heart rate monitoring should be performed before and after the procedure.

An active fetus whose heartbeat increases during movement is considered healthy. If the rhythm is disturbed, the procedure should be stopped.

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Treatment breech

How to safely deliver a breech baby?

Sometimes the doctor can turn the baby head down, which is called external version of the fetus head down. Experts strongly recommend doing this procedure whenever possible. No matter how the fetus is positioned, each labor and delivery is different. Consult with your doctor about the safest way to give birth to a baby with breech presentation.

In some cases, women give birth naturally, but usually, in breech presentation, a cesarean section is performed for the safety of the fetus. Only a small number of doctors have experience with natural breech births. You and your doctor may have developed a plan for labor and delivery, but you should remember that unexpected things often happen and the doctor needs to make a decision quickly to keep you and your baby safe.

Treatment overview

In most cases, by the 36th week of pregnancy, the fetus turns head down. This is the natural way for a baby to be born. If the fetus is in breech presentation in the later stages of pregnancy, the attending physician will likely recommend a cesarean section. If the baby can be turned before labor begins, the woman can try to give birth naturally.

Unfolding of the fetus with breech presentation

Trying to turn the baby increases the chances of a natural birth. You can also try different positions at home. Although this method has not been studied enough, it is considered safe and effective.

External cephalic version of the fetus is performed in medical institutions with constant monitoring of the fetal heartbeat. An ultrasound should also be done before and after the procedure. The doctor will give you a medicine to drink to relax the muscles of the uterus. To turn the fetus, the doctor presses on certain areas of the abdomen. The procedure can be repeated several times if the fetus cannot be turned on the first try.

You can try different body positions at home. Gently lift your pelvis above your head several times a day for several weeks.

If the doctor has managed to turn the baby head down, the position of the fetus should be checked from time to time until labor begins. If the fetus is in the correct position, there is no need for a cesarean section. The birth will be natural or with the help of surgical intervention - it all depends on the progress of labor. As studies show, women who have given birth before are at a lower risk of a cesarean section after successful turning of the fetus compared to those who are giving birth for the first time.

Breech birth

In most cases of breech presentation, a cesarean section is performed to protect the fetus. If the fetus is still in breech presentation or suddenly turns pelvic down just before labor, the doctor will prescribe a cesarean section. But sometimes this surgical intervention is impossible and not recommended. In case of rapid labor, the baby can only be delivered vaginally. When twins are born, the second twin (with breech presentation) is best delivered vaginally. The risk is significantly reduced if the doctor has extensive experience with such deliveries. A baby with breech presentation can be delivered by:

• perinatologist
• family doctor with appropriate qualifications
• obstetrician

Your pediatrician or family doctor may be present during labor in case your baby needs emergency care after birth.

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How to make the right decision?

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

• Visit your doctor regularly during pregnancy. Knowing about breech presentation can help prevent possible complications.
• Maintain a balanced diet.
• Avoid harmful substances such as smoking, drinking alcohol or drugs that are harmful to the baby.

How to give birth to a breech baby?

If your baby is in a breech position, ask your doctor about different positions that can help the baby turn. Although there is no evidence that these positions help the baby turn, there is also no evidence that they can harm the baby. It is natural to be worried and upset when you learn that your baby is in the wrong position, especially if you are unable to turn it. If you are concerned about your baby's health, talk to your doctor. Most babies born in breech presentation are healthy. After a cesarean section, you will need help from family and caregivers for the first few weeks. Although you will be able to walk within a few days, you should still avoid heavy lifting.