Sometimes during the last stages of pregnancy, some mothers may find that a baby is yet to turn head-down causing panic and confusion.
This presentation is commonly referred to as breech birth presentation. A breech is a baby who is ‘sitting’ in the uterus late in pregnancy or during labour instead of being head down.
This occurs in about three to four percent of pregnancies at the time of delivery. This can be a vaginal delivery or via caesarean section.
What causes breech births?
Breech presentation is primarily a chance occurrence but in up to 15 percent of cases, it may be due to foetal, maternal or placental abnormalities. Some of the factors that increase the risk of breech presentation include:
· A mother with a contracted pelvis
· Abnormalities in the shape of the uterus including fibroids
· Abnormal placental location such as placenta praevia where the placenta implants lower in the uterus or over the cervix
· Older mothers with several previous pregnancies.
· Too much or too little amniotic fluid within the uterus
· Multiple pregnancies such as twins, triplets
· Abnormalities in the baby’s anatomy.
What are the dangers of having a breech birth?
A breech baby can be born vaginally without any problem, in most cases. However, there is a slightly increased risk of some of the dangers of having a vaginal breech birth include prolonged or poor progress of labour as the baby’s buttocks and feet do not provide an effective wedge to help dilate the cervix.
There is a risk of the cord being delivered before the baby which compromises the oxygen supply to the baby.
Cord prolapse is an obstetric emergency requiring urgent delivery of the baby via emergency caesarean section.
There is also increased risk of injury to both the baby and mother as well as the risk of baby’s-after-coming head getting trapped during delivery.
Is it possible to know if I’ll have a breech birth before delivery?
Yes. It is possible to make a diagnosis of breech presentation during antenatal clinic follow-up. A mother with a baby in breech presentation may report perceiving kicks in the lower part of her belly and significant discomfort below her ribs from pressure by the baby’s head.
As the attending midwife or obstetrician conducts a physical examination, he or she will feel the baby’s hard skull in the top of the uterus and a soft mass (such as buttocks) in the lower part.
An ultrasound scan would then confirm that the baby is in breech presentation.
It is also possible to detect breech presentation during labour. A vaginal examination when the cervix has started to dilate allows the midwife or obstetrician to feel the soft buttocks, anal orifice or feet of the baby.
If yes, can it be managed before I deliver?
Yes. Detecting a baby in breech presentation in late pregnancy or early labour allows for an appropriate plan for delivery to be formulated in good time.
What expertise is required to deliver such a baby?
A team of experienced midwives and obstetricians is required to ensure the safe delivery of such a baby. In order to ensure good outcomes for both mother and baby, breech births should never be attempted at home or birthing facilities without appropriately trained staff and adequate equipment.
What can be done to minimise chances of my having a breech birth?
If diagnosed at or near term and the mother meets the necessary criteria, an attempt can be made to turn the baby manually so that they present head first. This procedure is called external cephalic version (ECV) and is performed by trained medical personnel under controlled conditions in an appropriate medical facility. If successful, it allows for a vaginal delivery to be attempted safely.
If ECV fails or the mother does not qualify for the procedure, a planned caesarean delivery is the next most commonly used mode of delivery for a baby in breech presentation. This will usually be scheduled for when the pregnancy has gone beyond 39 weeks to ensure the baby is fully mature.
For women coming into hospital in an advanced stage of labour, or women who opt for a vaginal delivery, a vaginal breech birth can be conducted by trained and experienced medical personnel with appropriate manoeuvres carried out to safely extract the baby and minimise injury to the mother.
Dr Kinuthia is a consultant obstetrician gynaecologist and Professor Temmerman is the chair Department of Obstetrics and Gynecology at Aga Khan University Hospital
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