A B C D E F G H I J K L M N O P R S T U V W

BREECH PRESENTATION

What is Breech Presentation ?

A breech presentation is when the bottom (or breech) of the baby, rather than the head, is lowermost in the pelvis. At delivery, about one baby in 25 is in the breech position. A breech presentation is usually suspected at a routine antenatal examination by your doctor or midwife: a soft baby's bottom is felt above the pelvis, rather than a smooth hard head. A breech presentation can be confirmed by a vaginal examination or by an ultrasound (a sort of radar) scan. If the baby is in a breech position at 36 weeks or later, the pregnancy is carefully assessed in order to decide how to deliver the baby.

How does Breech Presentation occur ?

Breech presentation is much more common early in pregnancy. Usually, the baby turns around of its own accord so that the head of the baby is pointing down (presenting) at the pelvis. If the baby's legs are stretched out alongside its body, it is unable to turn around.

Why does Breech Presentation occur ?

In most cases no direct cause is found. Conditions which will make a breech presentation more likely include abnormalities of the womb, such as fibroids. Having twins or a low lying afterbirth (placenta) can be the cause. In a premature delivery, breech presentation is also more likely.

Treatment Involved for Breech Presentation

When any baby is delivered in the more usual head-first position, its head takes several hours to pass through the mother's pelvis. As it does so, the head slowly moulds to fit the shape of the pelvis. However, for a breech-first delivery, the head has only minutes to pass through the pelvis. For a comfortable breech delivery, the size of the pelvis must therefore be slightly larger to allow the baby's head to pass through without damage. If you have previously delivered a good-sized baby, there will be no need for us to check the size of your pelvis. If it is your first baby, we will need to check in various ways to be sure that the head will fit through the pelvis. These checks include a careful vaginal examination or an x-ray of your pelvis.

Although the antenatal examination provides a clue as to the size of the baby (and particularly the head), an ultrasound scan will also exclude the rare type of breech presentation where the feet or knees of the baby are down at the pelvis: in these cases, we are less likely to do a vaginal delivery than when the baby's breech (bottom) fits snugly in the pelvis. Sometimes a breech presentation is not recognized until you are actually in labour. The best method of delivering the baby is then based on a number of things: your "track record" of vaginal deliveries, how far on the pregnancy is, how far into the pelvis the breech has descended, how far the neck of the womb has opened, and the size of your pelvis and the baby. Several treatment options are available, and you should discuss them with your doctor or midwife. Caesarean section will be advised, either if you have had a previous Caesarean section, or if you have another complication of pregnancy in addition to your baby being breech. Some doctors consider that a Caesarean section should be done on all women in whom a breech presentation is present in late pregnancy. Others will recommend Caesarean section only in cases in which assessment of your pelvis and the baby suggest that a straightforward vaginal delivery is unlikely. If the decision is made to aim for a vaginal delivery , delivery must be in hospital.

Management of labour is similar to that of a labour in which the baby's head is coming first. Continuous recording of the baby's heart rate is often done to check that all is well. You will usually be advised to have an epidural anaesthetic, which prevents the urge to push the baby out before the neck of the womb is completely open. What is involved is an injection into the base of your back, which causes very little discomfort. If there are any problems during labour, a Caesarean section can and will be performed. The usual method of vaginal delivery is by what is called an assisted breech delivery. This means that the attending doctor merely checks that the legs, body and arms of the baby are pushed out by the mother, without any problems. In order to ensure that the baby's head is not born too quickly, the delivery of the head is controlled by the doctor, either by hand or with forceps gently placed around the baby's head. A paediatrician will be there to check the baby after delivery. A third option called external version is to turn the baby into the head-first presentation. In late pregnancy, some doctors offer this technique, as it can avoid the need for Caesarean section or assisted breech delivery. The baby's breech is gently massaged out of the pelvis, and the baby encouraged to somersault around into the head-first presentation. This method will not be used if a Caesarean section needs to be performed anyway, or if there has been bleeding in late pregnancy, or in a twin pregnancy. This technique is only performed when the baby is mature (ie 37 weeks or more). It is very uncommon for the baby to turn back. There is a small risk that the baby will be distressed by turning, and would then need to be delivered immediately. This is rare. External version is now recommended by the Royal College of Obstetricians and Gynaecologists as a good option for many women who have a breech baby.

During Treatment of Breech Presentation

The baby may change positions during the course of pregnancy. If you are booked for Caesarean section because the baby is breech, 1 in 10 babies will turn to a head-down position before the operation can be done. Should this happen to you, you will be able to go home and await natural labour.

After Treatment of Breech Presentation

Although there is a slightly increased risk of another breech presentation, in future pregnancies the baby is most likely to present head-first.

If Breech Presentation is Left Untreated

An external version is attempted to prevent the need for a Caesarean section. A Caesarean section is usually recommended because there is concern about the risk to your health or the baby's health. If a Caesarean section was advised because your pelvis was too small, and this was not done, then there may be difficulty with a vaginal delivery. If a Caesarean section was advised because you have had a previous Caesarean section, and it was not done, then there is a small risk of the womb rupturing during labour.