Breech Presentation: What is the best way to deliver?

Hi Doc,

Question, my wife is about 4-5 weeks due for birth, and the baby is still in breach position. Is it still possible for her to be a normal birth or will it be a CS already? This will be our first baby, and our OB suggested that she undergo CS to make sure that the baby will not be harmed.

Thank you!

 

Hi Daddy D.

Thank you for that question.

A breech presentation is very rare. It happens in only 3-4% of all pregnancies.

http://www.irishhealth.com/content/image/13345/babyfeet.jpg

There are several reasons why the baby presents with his/her feet first in the birth canal. The most common reason is the narrow pelvic bone of the mother. It could also be a short umbilical cord or a baby with a slightly bigger head than the usual. (Don’t panic. Some babies have slightly bigger heads than others but they are still considered within normal limits. I had a big head as an infant and I think I turned out alright … I think.)

Back to the issue.

It is the recommendation of both the American College of Obstetricians  and Gynecologists, as well as, the Philippine Obstetrical and Gynecological Society, to do a Caesarean Section for breech presentations  in first pregnancies. The main reason is that the mother’s pelvis has never been tested for adequacy before.

Now, if it is a second, third or fourth pregnancy, that is a matter for you and your doctor to discuss.

A multiparous woman, or a woman who has delivered babies already has a wider pelvis which has allowed the passage of a baby before. She also has a more relaxed abdominal wall and muscles to allow for manipulation.

These factors may help your doctor to consider or attempt an External Cephalic Version. This is pretty mush repositioning the head of your baby through gently massage and manipulation so that the head will become the presenting part.

Or the doctor may attempt an out right breech extraction … delivery of the baby … feet first!

Warning!

The two procedures above are very specialized.The opportunity to perform those techniques are very rare considering the chance of having a breech baby is only 3 out of 100 pregnancies. Sometimes, in our fifteen years total of training from college, med school and residency, you are only given the chance ONCE  … and that one time DOES NOT make you an expert!

Please ask your doctor is he/she is:

(1) confident in performing those techniques?

(2) how many of those procedures has he/she done before?

(3) what are the outcomes of the babies that went through those methods of delivery?

Possible complications of ECV are:

(1) premature detachment of the placenta or abruptio placenta (remember: the placenta is your baby’s oxygen supply – early separation may lead to loss of oxygen to your baby and internal bleeding)

(2) cord coil or entanglement of the baby’s umbilical cord around the neck or limbs – again leading to loss of oxygen

Possible complications of breech extraction:

(1) cord prolapse, meaning the cord will go out ahead of the baby’s feet or butt leading to compression of the baby’s oxygen supply

(2) entrapment of the after-coming head – sometimes the head is wider than the trunk and the shoulders so that the head cannot pass through even if the entire body is already out the vagina

(3) brachial plexus injury – breech extraction entails more manipulation than a normal head-first delivery, these maneuvers may cause accidents like injury to the nerves in the neck and upper arm area

Once you and your wife have understood and accepted these known risks, then you can decide what manner of delivery to choose for your baby.

To the other parents, don’t be afraid of these risks. All deliveries whether normal, breech or CS have risks. Many doctors are confident and skilled in doing complicated procedures. It is important for the doctor to be honest in informing the patient if he/she is not comfortable in doing a particular method.

Please trust your doctor, they know what is best and they  will try to the best of their abilities to protect the mother and baby. No doctor will deliberately harm their patient.

I hope my advice will help you decide and be happy with your decision.

Good luck!

Doc D

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