Before the birth, the child takes a certain position in the mother’s belly. Usually, the baby is placed head downwards – towards the exit from the uterus. This is the correct, so-called cranial presentation, most convenient for childbirth. This is how up to 90% of children are born. But it happens that the baby is located differently – legs or buttocks frontwards. Such a pose is called “breech presentation”.
This position of the baby makes many future mothers worry. What is the difference between giving birth in pelvic presentation and the usual one? May the baby change its position before birth? How will a woman give birth – naturally or is it better to have a caesarean section? These are the most frequent questions about breech birth future mothers ask.
Breech Position: Is It Normal?
Until the third trimester of pregnancy, the baby is located in the mother’s stomach in a completely different way and the position he/she occupies is irrelevant. And this is understandable. The child is still small, and while he/she freely swims in the uterus, like a fish, the presentation will change many times. But as the child grows, it already becomes less room in the uterus and gradually the baby already seeks to occupy a certain position.
Doctors know this feature and up to a certain time adhere to waiting tactics. But the closer the birth, the more important it is how the child is located. After all, the tactics of childbirth depend on the presentation of the baby. By the 32nd week of pregnancy, the baby can already take the correct, headache presentation. But by 36 weeks the baby finally “determines” how he/she settles in the uterus. It happens that the baby can turn upside down just before the birth, and even during the birth itself. Therefore, do not worry about the baby’s presentation for up to 32–36 weeks. This is a completely normal phenomenon and the baby still has time to roll over.
But sometimes the baby doesn’t turn the head towards the exit of the uterus. Why is this happening?
Causes of Breech Position
It should be noted that breech presentation arises for no apparent reason. That is, from the side of both mother and child there is nothing that could cause such a situation in the uterus. But there are also some medical reasons – for example, a mother may have some congenital features of the structure of the uterus (two-horned, saddle-shaped), which do not allow the baby to take the correct position.
Sometimes if the tone of the uterus is lowered, then it does not respond to irritation when the child touches its walls. As a result, it is difficult for the baby to settle down correctly. If a woman waits for twins, then not every baby may be able to take the correct position. A baby may simply not have room to turn. In the case when a baby is born prematurely, he/she may simply not have time to turn the head down. Hydramnios or, conversely, hypamnions also sometimes provoke breech presentation of the baby.
But this does not mean at all that pelvic presentation is a serious anomaly. Usually, pregnancy in this situation is completely normal, but doctors always treat childbirth more attentively in this situation.
The Course of Pregnancy with Breech Presentation
Pregnancy with pelvic presentation proceeds in the same way as with the cranial one. Starting from the 32nd week of pregnancy, with the diagnosis of breech presentation, a certain set of exercises is recommended. Often, after the exercises, the rotation of the fetus on the head occurs within the first 7 days, if there are no aggravating circumstances (oligohydramnios or polyhydramnios, irregular uterus shape). The meaning of these exercises is to irritate the nerve receptors, increase the excitability and motor function of the uterus. If by the 37-38 week the baby has not changed the position, childbirth is carried out with the breech presentation. 2 weeks before the expected time of birth, hospitalization is offered in the hospital, where the issue of the mode of delivery is decided.
In the maternity hospital, the following points are assessed for deciding on the method of delivery (cesarean section or delivery through the birth canal):
- age of the woman (the first birth after 30 years is referred to as aggravating moments)
- how the past pregnancies proceeded, whether the childbirth took place and how it ended. An important point is the presence of natural births in the past.
- how the current pregnancy proceeds, is there any swelling, high blood pressure, renal dysfunction, etc.
- estimated weight of the fetus (estimated weight of the baby more than 3500 g inclines to make a decision in favor of cesarean section)
- condition of the fetus (signs of chronic hypoxia, lack of oxygen, which can be aggravated against the background of prolonged labor)
- the size of the mother’s pelvis (whether there is a tendency to the appearance of a clinically narrow pelvis during labor). It is possible to use radiopelvimetry (estimates of the size of the pelvis bone using x-ray radiation)
- the state of the cervix, its readiness for childbirth (the mature cervix is soft, shortened to 1.5-2 cm, located in the center of the pelvis, skips the tip of the finger)
- type of pelvic presentation. The most unfavorable is foot presentation.
- the position of the fetal head (with excessive extension according to the ultrasound, C-section is also recommended).
If there are complications during pregnancy, a narrow pelvis, the fetal weight of more than 3500 g, the age of a woman giving birth for the first time in more than 30 years, a C-section is usually performed. In general, the caesarean section with the breech presentation of the fetus is performed in more than 80% of cases.
What’s the Danger of Breech Birth?
First, the pelvic end (buttocks) of the fetus is much smaller in size than the head. Therefore, it presses on the lower part of the uterus with less force. As a result, the uterus contracts worse in response and the cervix opens worse. All this slows down childbirth and leads to weakness of birth.
Secondly, the head of the fetus during labor can be thrown back, which often leads to injuries and complicates its birth.
Often there is a pinching of the umbilical cord between the head and the wall of the birth canal, as well as the tilting of the arms of the fetus up to the head. When the umbilical cord is clamped, blood flow to the baby is hampered, and hypoxia begins.
All of the above applies to premature babies. The size of their body is still small, and the head is usually large, which greatly complicates its birth in breech presentation.
Often, it is possible for the umbilical cord or legs of the fetus to fall out before the contractions begin. Due to this, an infection can get into the uterus. As a result, not only a baby but also the mother can get infected (postpartum endometritis).
In addition, breech birth is more dangerous for boys. When giving birth, in the breech presentation, there is strong pressure on the scrotum, which can cause injuries.
Fear of Caesarean Section With Breech Presentation of the Fetus
There is no need to be afraid of cesarean section in case of breech presentation of the fetus. The surgery goes quite quickly – from 40 to 60 minutes – and, as a rule, mommy is conscious. General anesthesia with this type of abdominal surgery is used quite rarely, epidural anesthesia is used more often, i.e. only the lower part of the body is immobilized, but no harmful substances enter the patient’s blood, as the anesthesiologist injects anesthesia directly into the lumbar spine inside the spinal canal. And immediately after birth, mommy sees her newborn baby.
Sometimes doctors allow a woman to give birth in a natural way, but due to problems with the labor immediately in the process of delivery, the doctor may change the decision in favor of C-section surgery to save the mother and the child.
Do not be intimidated by the breech presentation and breech birth. Keep in mind that an experienced doctor, the right decision, a competent and calm behavior of a woman are the main components of a successful birth in any presentation of the fetus.
Born in Belarus, 1985, a pedagogue and family psychologist, mother. Taking part in procedures of social adaptation of the foster children in new families. Since 2015 is a chief editor of the motherhow.com project, selecting the best and up-to-date material for those, who are planning, expecting, and already having babies.