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Breech Presentation Between
30 and
34 weeks, most babies prepare themselves for birth by
settling into a head down position. Unfortunately though, some three
percent of babies remain the other way up, with their feet or bottom
being born first. This may occur in the case of:
- Multiple pregnancies - occasionally the second twin is breech
- Women who experience placental problems - if the placenta is very
low-lying there may not be enough room for the head
- An abnormally shaped uterus, or when fibroid tumours are present
- The mother's pelvis being too small
- There being too much or too little amniotic fluid
- The baby being premature
- No exact reason - baby may just feel more comfortable in this
position
How would I know if my baby is breech?
Careful examination by your doctor, as you near your due-date, will
establish in what position your baby is lying. Sometimes a doctor
may be able to determine your baby's position, by just running his
hands over your abdomen, but he normally confirms his diagnosis by
means of an ultrasound scan.
Many babies at around 28 weeks are breech, but most of them do turn
in due time, so provided you are not too near to delivering, there
is little cause for concern.
Different breech positions
- Flexed breech: The baby is curled up, with her head under your ribs
and her bottom in your pelvis.
- Frank breech: Sixty-six percent of breech babies assume this
position, where the body is folded and the legs straight.
- Footling breech: A baby in this position, is born feet first, with
one if not both legs being extended while in the uterus.
- The transverse lie: This is a very rare position, where the baby is
lying across your abdomen. In this case a Caesarean section is
usually necessary.
Altered positions: Sometimes the baby constantly changes his
position, from head to bottom to transverse. This may indicate other
problems, and you may be hospitalised until your baby is born.
Disadvantages for the mother:
The main problem for the mother, when her baby is breech, is that
labour may take longer than it would under normal circumstances,
causing both mother and baby to be tired after the birth. A breech
presentation also increases the chances of having a caesarean
delivery.
Disadvantages for the baby:
The baby experiences problems during the second stage, where the
umbilical cord can descend ahead and become squashed between the
mother's pelvis and her body, thus reducing the oxygen supply. This
can happen if, the membranes rupture before the baby has descended,
as there will be nothing to prevent the cord from floating down
ahead - or in the case where the baby has descended, but because the
foot or bottom doesn't fit snuggly into the pelvis, it does leave
enough room for the cord to be able to slip through.
Turnaround
If your baby is still in the breech position at 35 weeks, you could
try help her turn by doing the following, :
With a few pillows stacked infront of you, kneel down, and relax
your body over the pillows, with your bottom in the air.
Lie on your back, on the floor with pillows supporting your hips,
and with knees bent, gently rock from side to side.
If neither of these techniques encourage your baby to assume a more
preferable position, and is still breech at 36 weeks, your doctor
may perform an external cephalic version, whereby he will guide the
baby into a head down position. During this external procedure, the
doctor will monitor the location of the placenta and the baby's
well-being by using an ultrasound scanner. Many doctors however, do
not favour this technique, firstly because it is not always possible
to turn a breech baby, and secondly , because of the risk of
disturbing the placenta or compressing the umbilical cord.
Vaginal delivery or Caesarean?
If you have previously had a normal birth, your baby is of average
size and he is lying either in a 'flexed' or 'frank' position, your
doctor may just suggest that you give vaginal birth a try. In this
case you will most likely be given an epidural anaesthetic, that
will control labour, so that you are not urged into 'pushing' too
soon, which could cause problems with the delivery of the baby's
head.
Sometimes though, it is clear from the measurements and other
indications that vaginal birth would cause the baby unecessary
difficulty, in which case an elective caesar will be performed. This
may come as a great disappointment to those mother's who were hoping
to deliver their baby's as little medical intervention as possible,
but it is important to remember that a difficult vaginal birth may
endanger the life of your precious miracle, so it is by far wiser to
opt for the safer choice.
Factors that need to be present for a vaginal delivery
- Your doctor is certain that the baby is not too big, or your pelvis
too narrow for the baby to pass safely through the birth canal.
- Your baby does not show any signs of distress.
- Your baby has reached 'full-term' at the start of labour.
- Your labour is progressing normally - the cervix is widening and
your baby is moving down the birth canal.
- You are in a hospital where anaesthesia is available should you need
a caesar at short notice.
- You are willing and able to 'assist' during labour.
- When a vaginal delivery is tried, electronic fetal monitoring will
be used to monitor your baby's heartbeat throughout labour. If there
are any signs that your baby may be in distress, you may well have
to have a caesarean.
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