Breech presentation

3 to 4% of pregnancies involve breech presentation. In a complete breech, the baby appears to be sitting with hips and knees flexed. In incomplete breech presentation, the baby's legs and feet are raised towards his chin and the foetal buttocks present. The physician establishes this diagnosis during the physical examination, but many babies who are in breech presentation during the 7th month of pregnancy will become cephalic without any intervention.

Attempts at version

Breech birth generally takes longer and should only be permitted when the physician is certain that the baby's head will easily emerge; external version can be attempted to help the baby's head emerge first.

Version is performed with ultrasound control and monitoring of the foetal heart sounds when there is ample fluid, and the baby can still be turned with nothing to maintain him in this position. However, it can happen that the day after successful external version, the baby once again returns to breech presentation! This manipulation can fail, if for example, the umbilical cord is too short, or there is inadequate fluid. For the above reasons, it is not universally accepted.

Vaginal delivery or caesarean

Whether attempts at external version fail, or breech presentation is accepted for the birth of the baby, the decision on caesarean section or vaginal delivery should be made before childbirth, and it depends on your doctor's comfort level and whether the baby's head, emerging last, can deliver easily.

The size of the head, its biparietal diameter, the position of the chin flexed against the chest are then evaluated on ultrasound, and compared with the diameter of the mother's pelvis. The pelvis may be measured by radiopelvietry or adequacy may be confirmed by digital examination and delivery of prior babies of acceptable size.

Breech birth

With any traction exerted on the breech, there is a possible risk that the baby's head will flex or even raise his arms. An inopportune digital examination can induce premature breathing. Thus, procedures are limited to making certain that the baby's back is in front, or to lower the baby's arm if it hinders his descent through the birth canal. At the right time, the mother is asked to bear down and push with all her might.

Upon emergence of the baby, he often resumes the position which he adopted in his mother's uterus, with his cute head rounded and black and blue marks on his genitalia resulting from the stress of delivery. On rare occasions, the baby's head may become entrapped, which is dangerous to the newborn. This complication should be discussed with your doctor.