Breech and Abnormal Presentation or Positions in LaborKatlyn Joy |21, January 2013
Every pregnant woman has wondered at times, how will this baby fit through here?! Most of the time, thankfully, the baby is in a normal position for birth. The ideal position and presentation is with baby head down, head-first in the birth canal, chin tucked to chest, facing down, neck down, face and body angled to either the left or right and arms folded on the chest. This allows for the baby to pass safely through the mother's pelvis with the baby's body facing mother's back.
However, in approximately 1 in 25 births a baby is breech. There are various types of breech births or abnormal presentations. Presentation refers to the part of the baby's body which is leading the way through the birth canal. Position is either facing rearward or towards mother's back or facing forward or face up. Different presentations and positions create different challenges for labor and delivery. Since the baby's head is the largest part of the baby, it is ideal that this is the part which descends first through the vagina or birth canal.
Types of Abnormal Positions or Presentation
Facing up or forward.
In this position baby is often not tucking the chin or bending the neck, but rather has a straightened neck. This will require a wider space in the birth canal and will cause the mother to have a painful back labor. Some babies will turn in the midst of labor on their own without intervention. However, should they stay in that position, some special measures may be required. Delivery requiring forceps or a vacuum extractor may be needed or possibly a c-section.
In this position, baby is leading with his buttocks and his feet are up near his head.
Baby is again bottom first but the feet are near the baby's bottom rather than straightened up near his head.
Footling or incomplete breech.
With this position the one or both of baby's feet lead the way out of the cervix.
Transverse lie or shoulder or oblique position.
This is a rarer situation where baby is lying as if in a hammock, across the abdomen and often the shoulder is the presenting part of the baby.
Risks of a Baby Being Breech
In the worst case scenario, if labor is allowed to progress to a vaginal delivery and the body, which is smaller, can be delivered but the head could become stuck which could cause nerve damage in the infant as the spinal cord and nerves are stretched. This is especially problematic with first babies as the mother's pelvis and tissues have not been stretched by an earlier birth.
Other risks could be due to a cord prolapse, where the cord can slip into the birth canal and become blocked or compressed causing baby's oxygen and blood supply to be limited or cut off which in turn can cause brain damage.
The risk to the mother includes damage to the uterus, cervix or vagina.
While sometimes the cause may be unknown, there are certain risk factors for a breech birth. Often times at least one of the babies in a multiple birth will be breech. Breech babies are first babies less often than in subsequent births. If there is a problem with the amount of amniotic fluid, whether too little or too much, there is an increased risk.
Women who have uterine fibroids or have an usually shaped uterus have more breech babies. Also with a history of premature birth, or if the labor starts too soon the risk of breech goes up.
Placenta previa is also associated with breech babies. This is where part or all of the placenta covers a portion or the entire opening of the cervix.
What Options are Available?
Often in if baby is still small enough, there is a chance baby will get into the correct position prior to birth. Once baby gets larger and the uterus more crowded, the chances of turning on her own are smaller. About 90 percent of babies who are breech prior to 27 weeks will turn correctly, while if a baby is breech at 37 weeks, there's a 90 percent chance she'll stay breech.
Often an external version or physical turning of the baby will be attempted at around 37 weeks. This procedure requires mom to be given medication to relax the uterus while the doctor monitors the position of the baby via ultrasound. The baby's heartbeat will be monitored while the doctor pushes on the mother's abdomen in an attempt to get the baby into the proper position for birth.
If this procedure is unsuccessful, it is most likely that a cesarean delivery will be scheduled. Few doctors are willing to take a chance on a vaginal birth and few have experience with such deliveries.
Should you have a c-section planned and you go into labor, you need to go to the hospital due to risks of a prolapsed cord.
Some options include trying pelvic tilt exercises or using music to get baby to turn into the right birthing position. While they may not be successful, they don't pose any hazards to mother or child so ask your doctor for tips.
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