Breech
What is breech?
Breech means your baby is lying bottom first in the womb. Normally, the baby lies with head first position.
Figure 1 Baby in breech position
What are my options if my baby is breech?
- External cephalic version (ECV). This is a procedure that could be done to manually turn the baby which is in breech position into head first position.
- Caesarean section. A surgical procedure where a cut is made on your abdomen to deliver the baby.
- Vaginal breech delivery. This is where you deliver your baby vaginally but your baby’s bottom will be delivered first before the head
When is vaginal breech delivery not advisable?
Only suitable patients should opt for vaginal breech delivery as it is a more complicated vaginal birth as the largest part of the baby i.e its head is the last to be delivered and in some cases this may be difficult. A vaginal breech delivery may not be advisable in:
- Your baby is in footling breech
- Your baby is large i.e more than 3.5kg for Asians
- You baby is small i.e less than 2kg
- You had a previous caesarean section
- You have a narrow pelvis
- You have other medical condition that complicates your pregnancy e.g diabetes or high blood pressure.
- The baby’s neck is tilted backwards (hyperextended neck)
What could I expect during labour if my baby is breech if I have opted for vaginal breech delivery?
- You could have the same choice of pain relief as other woman in normal labour.
- Your baby’s heart will need to be monitored continuously during labour.
- In some circumstances, you may need an emergency caesarean section.
- Your baby will be delivered by an experienced obstetrician skilled in vaginal breech delivery and the baby’s doctor will standby.
- Forceps may need to be used to assist delivering your baby’s head.
Figure 2 Using forceps for delivery of baby’s head
What are the possible complications associated with vaginal breech delivery?
- Cord prolapsed especially in those with footling or complete breech.
- Injury to the baby e.g fracture of the baby’s thigh or upper arm bones and trauma to the nerves at the neck. (brachial plexus)
- Delay in delivery of the baby leading to reduced oxygen to the brain.(asphyxia)
- Rapid compression and decompression of the baby’s head during delivery leading the bleeding inside the head. (intracranial hemorrhage)
Hence, if you have opted for a vaginal breech delivery, an experienced doctor or nurse will have to deliver you to minimize the complications above.
REFERENCES:
A breech baby at the end of pregnancy. Patient information. Royal College of Obstetricians and Gynaecologist United Kingdom. Feb 2008.
