Breech baby

By 8 months, the baby in the womb positions itself as it does not have much place to move about. Most babies position themselves head-down otherwise known as cephalic position during this time. In very few cases the baby positions itself feet-down or in breech presentation.

By the beginning of the third trimester, the medical practitioner will physically feel the mother's abdomen and will be able to tell the positioning of the baby. This is usually done using Leopold's maneuver. Location of the heart beat, position of the baby's bottom and head helps the doctor determine the position of the baby. About 25% babies are positioned breech during this time but they turn to normal position on their own within the next couple of months.

When the mother is approaching full term and the baby is still positioned breech, the medical practitioner may conduct a pelvic examination or an ultrasound to confirm the positioning of the baby. At 37 weeks about 3-4% babies are in breech position. Even after 37 weeks if the baby is presenting breech position then it might not turn on its own to the cephalic position. In general breech babies are delivered through a cesarean section. Generally normal delivery is not advised for a breech position baby when:

• The baby is large
  
• Baby is very small
  
• Mother has narrow pelvis
  
• Mother has a low lying placenta
  
• Baby's feet are below its bottom.
  

Breech types

Frank breech: Bottom first with feet up near the head (feet straight up).

Complete breech: Bottom first with legs crossed in Indian style.

Footling breech (incomplete breech: One or both feet are positioned to come out first.

Stargazers: When the baby is in any one of the above mentioned positions but is extending its neck completely as though it is watching a star it is called as stargazer. Babies positioned like this are usually delivered using c-section.

Helping baby from breech to cephalic

ECV: External Cephalic Version is a procedure wherein pressure is applied to the mother's abdomen for manual manipulation of the baby's position. The pressure helps the baby take a head-down position. ECV has its own limitations and many a times the baby moves back to the breech position. Women with pregnancy complications like low amniotic acid, bleeding and twins cannot undergo this procedure.

Tilt position: The Breech Tilt inversion technique is used to help a breech baby flip to a head-down position. The mother is asked to lie on a couch placing her feet up on an ironing board. The head is positioned down while the feet are placed up. 20 minutes a day is the recommended duration. This exercise needs to be done only after approval from the authorized medical personnel or midwife.

Chances of having a breech baby

A mother who has had one or more of the following conditions may have a breech baby: multiple pregnancies, excessive amniotic fluid, baby having anomalies, placenta lying low, uterus anomalies and Placenta previa.

Dystocia

Abnormal or difficult childbirth or labor is termed as dystocia. Cervical dystocia is a condition where the cervix fails to dilate during labor. Shoulder dystocia is the condition where the shoulder gets stuck in pelvis while delivering the child. Dystocia is noticed just before or during the delivery. Depending on how the baby is presenting itself for delivery cephalic (head comes out first) or breech the doctor decides the type of delivery.

Causes of dystocia

Dystocia can occur due to one or more factors, both maternal and fetal:

• The expulsive force of the uterus during all stages of delivery may not be strong enough.
  
• Large fetus
  
• Fetus size may not fit the size or portion of the pelvis.
  
• Abnormally bony pelvis or fractured pelvis in mother.
  
• Breech baby
  
• Tumor in fetus
  
• Uterine complications in mother
  
• Obese mother
  
• Herniated bladder in mother
  
• Ruptured uterus/diaphragm in mother
  
• Genetic defects in mother
  

Physical examination of the mother is done and labor progress is charted on a labor curve. Uterine contraction patterns are reviewed using an intrauterine pressure catheter. Oxytocin is used to improve contractions when they are inadequate. Forceps are used often when there is abnormal fetal positioning.

Cesarean section

Cesarean section or C-section is a surgical method of delivering a baby. A cut is made across the belly just above the pubic area. A horizontal incision is made in the lower uterine portion. LSCS - Lower segment Cesarean section is the preferred type of Cesarean surgery today as it allows the uterus to remain strong for future childbirth. The uterus is opened along with the amniotic sac and the baby is delivered. This is resorted to when a vaginal delivery is not possible; either because of risk to the mother or baby. Typical cases where Cesarean section is opted for are fetal distress, breech baby, uterine rupture, prolonged labor, hypertension in mother, tachycardia in mother or child or contracted pelvis. In cases of twin pregnancy or triplets, Cesarean section is opted. When the baby's heart rate is abnormally high or the baby has developmental problems, the obstetrician might suggest a c-section. But being a surgical procedure, Cesarean section carries some amount of risk. There can be chances of hemorrhage leading to anemia or need for blood transfusion. There is risk of infection at incision site or injury to other organs. The recovery time is longer than a normal vaginal delivery.