What is breech presentation and how can it affect delivery?

By Elizabeth Stein, CNM

In a normal, vertex presentation, the baby's head is down at the mother's cervix and comes first at delivery. At term approximately 96 percent of all babies are vertex. Breech presentation means buttocks and/or feet first. This is not normal and it's more serious than the baby's head being up instead of down.

During your pregnancy, your baby constantly moves in the uterus and may be in any position. The baby and the shape of your uterus determine the presentation. Since we cannot control either of these factors, procedures such as version -- attempting to turn your unborn baby -- are risky. Your baby may not turn, or he might get tangled in the umbilical cord. The placenta could be pulled away from the wall of the uterus (placental abruption), necessitating an emergency cesarean section. If the baby is successfully turned, labor should be induced at that time, since approximately half will turn back to breech. Half of these inductions fail, resulting in a cesarean section.

When you go into labor, your baby's presentation is very important. It's both difficult and risky to deliver a breech baby vaginally. The largest part of the baby is his head. In a breech delivery, the head is delivered last. The smaller parts (legs, body, arms) may slide out before the cervix is fully dilated, but the larger head may get stuck. During a difficult, stressful delivery, your baby could be damaged or even die. Women whose first baby is in breech presentation are advised to have a cesarean section, to avoid unnecessary risks.

By the 36th or 37th week of your pregnancy (your due date is 40 weeks), the baby has picked its final position. Your midwife or doctor can feel where the baby's head is through your abdominal wall or by vaginal exam if your cervix is open. If the head is up, this should be confirmed by ultrasound. A full discussion about delivery options, issues, risks, and benefits should take place. Occasionally a baby will turn and become vertex, but don't count on it. Your doctor should perform a final exam just prior to the cesarean to make sure your baby is still breech. Cesarean sections are usually scheduled between 38 and 39 weeks, before labor can begin naturally.

Can any woman safely deliver a breech baby vaginally? If a woman has delivered one or more babies vaginally and this baby is the same size or smaller (by abdominal palpation and ultrasound), a vaginal delivery might be considered if the buttocks come first (not feet) and the head is flexed forward.

Another consideration is the experience and skill of your obstetrician. The older, experienced physicians were very skilled at vaginal breech delivery, since breech presentation was not considered a reason to perform a cesarean section. This skill, which is really an art, is not being passed on, since the vast majority of breech babies are now delivered by cesarean section.

The information on this Web site is designed for educational purposes only. It is not intended to be a substitute for informed medical advice or care. You should not use this information to diagnose or treat any health problems or illnesses without consulting your pediatrician or family doctor. Please consult a doctor with any questions or concerns you might have regarding your or your child's condition.

American Baby


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