The baby is in a breech presentation when the baby enters the birth canal with the feet or buttocks pointing first.

Can be a serious complication of childbirth and pregnancy

A typical finding for a “normal birth” is when the baby is in a head first presentation.

Overall occurs generally between 5-10% of births when at term.

Causes or Risks:

-    Premature birth (25%)
-    Increasing size of fetus
-    Change in volume of amniotic fluid
-    Multiple pregnancy (twins, triplets or more)
-    Uterine Abnormalities
-    Caesarean Section on a previous birth
-    Fetal Abnormalities

Types of Breech

1.)    Frank Breech
-    Bottom comes first
-    Legs may be flexed at hip
-    Knees extended
-    Generally the most common form – over 60% of the time

2.)    Footling Breech
     -    One or both feet come first
-    Common with premature births
-    Uncommon with term births

3.)    Complete Breech
     -    Hips and Knees are flexed
-    Sitting cross legged
-    Feet at bottom

4.)    Kneeling Breech
     -    Both legs on hips are extended
-    Both knees are flexed
-    May occur with only one flexed knee
-    Occurance is rare

Natural process with a Breech Baby

Typically internal rotation occurs by the pelvic floor muscles.

The baby will turn so that baby is facing one of the mother’s thighs.

The shoulders soon follow the same pattern

Next, the baby will rotate to face the mother’s back

Baby’s Head should now help the head emerge.

Bruising may be found on hips, legs, and genitalia [This will resolve within a few days]

Complications:

1.)    Umbilical cord problems such as compression
2.)    Cesarean section may be required
3.)    Loss of oxygen
4.)    Head entrapment
5.)    Neurological problems due to loss of oxygen
6.)    Injury [brain, arms, legs, hip, etc]
7.)    Abdominal injury
8.)    Others

Important factors

-    Type of breech
-    Fetal size
-    Maturity
-    Stage of Labor
-    Second twin – if first twin has passed – improved chances for the second
-    Skull size
-    etc

Manual attempts in turning baby

External cephalic version
-    Good results
-    Complications are rare
-    Fetal heart is monitored

Importance of C-section

-    When complications arise due to breech, c-section is often a logical choice.
-    Several risks are associated with a surgery
-    Risks include – internal injury, hysterectomy required, infertility, injury to baby, bleeding, others