Breech Presentation

Definition - What does Breech Presentation mean?

Breech presentation refers to a baby that is in a vertical position but with the bottoms or feet pointing towards the mother’s cervix instead of the head pointing down in a normal cephalic position. This presentation creates a mechanical problem during vaginal delivery. Breech presentation accounts for about 3% to 4%of all term pregnancies. A higher percentage of breech presentations occur during the early weeks of pregnancy with about 25% of babies being breech at 28 weeks or less and 7% at 32 weeks.

FertilitySmarts explains Breech Presentation

There are three different types of breech:

  • Frank breech (65%): Here, the baby’s bottoms are directed towards the mother’s bottom with its legs straight up in front of its body and the feet pointing to the head.
  • Footling breech (25%): In this position, one or both of the baby’s feet are aimed at the birth canal and will be the first to deliver.
  • Complete breech (10%): The buttocks are down with the legs bent at the knees and feet near the buttocks.

In the early stages of pregnancy, a breech presentation may not be an issue. This is because as the pregnancy proceeds, most of the babies are likely to flip their head down with gravity somewhere around 5-7 months, provided there is enough room to direct the baby’s head.

However, the problem arises if the breech baby fails to move naturally to a head down-position close to term, which is about 34 to 37 weeks. At this point, the doctor will perform a maneuver called external cephalic version to move the baby from buttocks or foot first to a head-first position. This technique consists of applying pressure to the mother’s abdomen to flip the baby inside the uterus to a head-first position.

When the cephalic version is not successful, the doctor will then decide between the options of delivering the baby either vaginally or via C-section. Vaginally delivery is only possible in case of a frank breech that is full term. There are a few other conditions necessary for performing a vaginal delivery on a breech baby, such as:

  • The baby does not show any signs of distress during the strict monitoring of its heart rate.
  • The size of the mother’s pelvis and the baby's body are adequate for the baby to pass through the birth canal.
  • The process of labor is smooth without many hurdles.
  • All the necessities for undergoing a cesarean delivery are easily accessible

Nonetheless, most doctors prefer doing a cesarean section for babies in a breech position, in particular, for the preemies. This is because the head of premature babies is larger in proportion to the body, and thus may get stuck during vaginal delivery. The trapped head then presses the umbilical cord, cutting off the oxygen and blood supply to the baby, which in the worst scenario leads to death.

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