A breech presentation is quite common in the early months of pregnancy as there is plenty of room for the fetus to swim around. A very good percentage of babies present in the normal head down position (vertex) at the onset of labor. However, about 3 to 4 percent of babies remain in breech positions, with the head up toward the mother's ribs instead of down at week 40. That would mean the feet or buttocks will have to be delivered first.


Types of breech presentations..


1. Frank -

this is the most common presentation where the baby's legs are flexed up over the abdomen, with the knees straight and the feet near the head. The buttocks point toward the pelvis (as shown in the image above).


2. Complete breech -

here the fetus sits cross-legged, in a yoga position with the buttocks and feet in the pelvis. This is the least common type of breech where the feet and buttocks present together


3. Footling or incomplete breech -

here fetus is in a standing position with one or both legs held straight downward. One or both feet present first





The Facts..


• Controversy is ongoing as to which method of delivery is better in breech cases: vaginal or cesarean


• Vaginal delivery is possible after an assessment is made on baby size, the size of the mothers pelvis, the type of breech position and the stage of pregnancy


• Vaginal delivery may either be easy with lesser need of medical intervention, or difficult with necessary hand maneuvers required (assisted breech deliveries).


• Physicians experienced in the technique of breech birth must be available to perform the birth or assist in the delivery


• Many medical experts believe cesarean is a safer bet when it comes to safety issues


• Baby size matters if baby is in breech position


• Not too large and not too small and in the frank position pose the least risk if vaginal delivery is proposed


• If the baby is large there is the danger of baby's head being trapped


• If the baby is small there is the danger of cord prolapse (the cord falls through the cervix into the vagina)



C-section becomes very Probable..


• If there is severe fetal growth restriction


• If it is a very large fetus


• If the head is hyperextended meaning the chin is up and the head bends backward instead of forward


• If there is a history of a perinatal death


• If the pelvic size is inadequate


• If the previous baby was with birth trauma


• If the fetus is premature because of maternal illness



External Cephalic Version (ECV)


• In some situations, a non-surgical method to change baby's position will be used.


• Most versions are done between weeks 37 and 39


• The whole procedure may take few hours, including monitoring the baby after the version


• An attempt will be made to turn the baby into the vertex position manually.


• The doctor will use his hands at certain key points on the lower abdomen and gently shift baby to the head down position.


• The mother will be given light medication to relax the uterus after which the baby will be pushed gently.


• An ultrasound will be used to determine the breech position and amniotic fluid level; the procedure will be performed under ultrasonic guidance to help the doctor in changing baby's position.


• ECV is usually conducted before labor or in the early stages of labor.


• A doctor trained in this procedure is required to do it.


• About 50% of the cases are successful