About breech presentation and what it represents

What is breech presentation?
In normal labour, we expect the head of a foetus to emanate first from the birth canal. Breech presentation refers to when the hind parts (buttocks or feet) present first at the birth canal during labour.

The types of breech presentations 
Extended or footling breech – the legs of the baby present straight out  of the birth canal. The baby can be seen as literally standing.

Complete breech; The baby has his hips completely folded at the abdomen and the legs also folded so that the buttocks present initially with the legs following closely.

Frank presentation; The baby has his hips folded close to the abdomen, the knees are extended and the feet are near the head.

How common are breech births?
About 3 per cent of all babies born at full term have breech presentation. Preterm babies are quite often in breech positions unless the mother has reached 36 weeks of pregnancy.

Is breech presentation done without a C- section delivery?
With the evolution of time and science advancement, the medical fraternity has tended to discourage deliberate vaginal breech deliveries. However, in emergency situations when a mother arrives at the hospital in advanced labour and the doctor had not known prior to her labour that the baby was in breech position, the doctor is forced to do an assisted vaginal delivery. The medical practitioner manipulates the delivery in a manner to achieve a position that will minimise injury to the mother and the baby. He is the one in the best position to determine a technique of handling the baby as he comes out depending on dynamics of labour itself and the stage at which the mother is in labour. He knows when to apply a little pressure, and when to wait for the mother’s labour contractions to assist in delivery and also when to or not to adjust the inclination of the baby’s head. However, mothers are dissuaded from intentional vaginal breech deliveries since there is a higher likelihood of infant mortality rate.

What if a mother declines a C-section?

• For a mother to attempt a vaginal assisted breech birth electively, she must satisfy the following criteria:
• The baby must not be big. Normally the weight should be less than 3.8kg
• The mother should not be a primigravida – it should not be her first time to deliver. The birth canal should have at least had one previous birth and the maternal pelvis must be roomy
• The baby should not have a footling breech (one or both of the feet pointing down and coming out first).
• This is because in many cases the cervix does not open fully so the baby’s head can be trapped. (A lot of the cases also get cord prolapse)
• Foetal head must be flexed when coming out. This means it should be inclined frontward as if looking at the chest as opposed to facing up
• The mother should be handled by an experienced health practitioner.

If all of these are observed, the baby will be as normal as any other born through a normal delivery. The best breech to deliver is extended breech where the feet are facing upwards and the bottoms present first. The diameter presented is minimum and almost of the same size as the foetal head.

External version
In the olden days, management of breech presentation was by turning the foetus while still in the womb at 34- 36 weeks gestation, by applying firm directional pressure. However, this procedure was abandoned because of its many setbacks which include:

• Babies had returned to breech position by the time they were being delivered
• Accidents such as placental injury occurred due to the firm pressure on the womb
• Spontaneous breakage of amniotic fluid
• At times, the newborn would have the umbilical cord entangled, which could cause foetal distress or death.
  This would then force doctors to deliver the baby prematurely

As a result, practitioners who still turn the baby externally do this at full term and immediately deliver the mother to minimise risks.

Clinical conditions that may cause breech presentation

• Hydrocephalic babies
• Multiple pregnancies
• Excess amniotic fluid
• A low lying placenta
• Uterine fibroids or inborn deformities
• Premature labour and birth

Whenever a mother suspects her baby is in breech position, the possibilities are ruled out by a scan. Unfortunately, nothing can prevent breech presentation.

END: PG 26 /40