Complications of breech delivery carry a huge responsibility than a regular vaginal delivery. In nearly 3–4% of all pregnancies, the baby will be born breech. A breech pregnancy provides several unique challenges for the woman and the unborn child since, in a “normal” pregnancy, the baby will naturally turn within the womb into a head-down position to prepare for birth.
WHAT IS BREECH:
When your baby is positioned to emerge from your womb first through the feet or buttocks, it is termed a breech baby. It’s normal for a baby to remain head up and foot down until 36 weeks of GA. If this position exits more than 36 weeks, it’s treated as a breech baby.
TYPES OF BREECH POSITIONS:
Breech babies can be positioned in any one of the following ways
*Frank breech-In this position the baby lies with their butt facing the vaginal canal and with the legs pointing straight up in front of the body and feet close to the head.
* Complete breech-The baby lies with their butt facing the vaginal canal and the knees and hips are folded under themselves.
* Footling breech: The baby lies with one or both legs pointing downwards.
WHY BREECH HAPPENS:
Many elements that could contribute to the breech position include:
*The baby didn’t turn to its normal head down position, just by chance during delivery
*Low-lying placenta
*Too much or too little amniotic fluid.
*Multiple pregnancies make it hard for each baby to be in the right position.
* Primigravida(First pregnancy for women)
Very rarely, there may be some problems with the baby itself. These problems could be picked up around 20 weeks of pregnancy.
HOW TO HANDLE THE TERM BREECH?
During 37 weeks of pregnancy, if your baby is still in the breech position, your doctor might suggest you any of the following ways:
* Try to position your baby head-first inside your uterus. (ECV)
*Planned cesarean delivery
WHAT IS ECV AND HOW IT IS DONE:
*ECV (External cephalic version) is a method that tries to turn a breech baby into a head-down position so you can have a normal vaginal delivery.
*ECV is done at 36-37 weeks of GA or until the early stages of labour.
* An ultrasound scan will be performed before and at the end of the procedure.
*Medications will be given to relax abdominal muscles. Then, the doctor will try to turn your baby by placing one hand over the baby’s bottom and the other hand behind the baby’s head gently on your abdomen.
*Mother can get little pain after the ECV process. You will be again connected to a CTG monitor to track the baby’s heartbeat. A USG scan is again done to check the baby’s position.
*ECV only succeeds for 50% of women.
The external cephalic version helps in a small increase in the rate of vaginal birth, but still, the chance of cesarean section and instrumental deliveries like forceps and vacuum is high.
So, a breech delivery:
You! Discuss with your obstetrician about the risks and advantages of all the procedures involved in the management of a breech pregnancy. Assisted breech delivery is an art and can be done by a well-experienced obstetrician. But because of neonatal problems and unexpected complications, worldwide it’s recommended that a planned cesarean delivery is better for a term breech baby.
No need to worry about the next pregnancy and delivery. You still can have a normal vaginal birth (VBAC-Vaginal Birth After Cesarean) in your subsequent pregnancy.
