Feet First—Breech PresentationDr. Gerard M. DiLeo
You’ve just learned from your OB-GYN that your baby is situated in a breech position. What does this mean for you and your little one? Breech babies are situated in the uterus with their feet pointing down and their heads tucked under your rib cage. Not the optimal position for delivery. But most babies bounce back and forth from a feet-down to head-down position throughout pregnancy. Those who get stuck feet-first in the later stages of pregnancy are known as breech.
According to Dr. Andrew Jenis, chairman of the Department of Emergency Medicine at Cortland Memorial Hospital in Cortland, New York, at 28 weeks gestation about 30 percent of all babies present in the breech position, but by full term, many turn on their own (3 to 4 percent of babies arrive in the world feet first).
Types of Breech Presentation
- Frank Breech: This is the most common breech position (65 to 70 percent of all breech babies are in this position). In this presentation, Baby’s bottom comes first, his legs flexed at the hip and his knees extended (with his feet near his ears).
- Complete Breech: A complete breech baby looks like he is sitting cross-legged in the womb (with his hips and knees flexed).
- Footling Breech: Footling breech babies have one foot stretched out and the other tucked underneath, much like a bird standing on one foot. This is a rare breech position for full-term babies, but is common with premature fetuses.
- Kneeling Breech: This is a very rare position in which the baby is in a kneeling position, with one or both legs extended at the hips and flexed at the knees.
Breech Baby Delivery Risks
Most types of breech presentations can’t be delivered vaginally—the laws of physics will not allow it to go smoothly. A frank breech baby, on the other hand, can be delivered vaginally, the buttocks alone acting as an efficient dilating wedge (much like the head would).
But the statistics on delivering breech babies vaginally are a concern. Assuming of course the delivery was frank breech, the statistics say there is still an increase in the number of babies born who may suffer from “soft” neurological complications.
Besides an increased risk of obvious trauma, soft neurological complications often go unnoticed but haunt parents later in the form of hyperactivity, attention deficit disorder, dyslexia, and a host of other problems. Since studies on the legitimacy of this theory are still inconclusive, many doctors advise in favor of Cesarean delivery for frank breech presentations.
Managing Breech Presentation
Cesarean delivery is currently the most popular approach to seeking the best outcome for these babies. We must consider, however, the increased risks to the mother that come with Cesarean section. It’s true that the complication rate in private practice is low, but it’s still higher than with vaginal delivery.
So the answer seems to lie with convincing these little babies to assume a head-first presentation. That sort of diplomacy is called external cephalic version, a technique in which the baby is physically turned to the head-first position. This can be a rather forceful procedure involving two physicians, one pushing against the mother’s abdomen, the other doing a pelvic exam to exert pressure there.
This technique fell into disfavor because mothers really weren’t crazy about it, and there seemed to be a feeling that there was probably a pretty good reason for the baby to be breech in the first place.
In the past, this procedure didn’t fare well (not to mention it being rather uncomfortable for the mother-to-be). Perinatologist Dr. Steve Fortunata, MD, espouses the newer thinking on the subject. The reason version failed often in the past was that the patients who were scheduled for version may not have been selected very well (and chances are, for these women versions should have been passed over in favor of a C-section).
Now, criteria are in place to help doctors decipher just who’s the best (and safest) candidate for a version. Doctors consider points such as how low the breech baby is and where the back is placed in the womb, making versions safer and frequently successful. Ultrasonographic guidance and gentle manipulation while a drug that relaxes the womb is used have made the procedure desirable once again. Add to that the need to bring down C-section rates and suddenly it begins to make a lot of sense.