by Ingrid Walter

Created on: September 01, 2009

For centuries women have delivered breech babies vaginally, and many still prefer this option regardless of the outcome of pregnancy. Some women would rather try vaginal delivery until it is established that vaginal delivery is impossible. For some, modern medicine techniques such as cesarean section are just not acceptable.

A breech baby is a baby whose buttocks are in the lower part of the uterus instead of the usual head first position. Breech babies are uncommon accounting for only 3% of the pregnancies at term. It is important that a breech presentation be recognized early in pregnancy so that the mother can be made aware of options for delivery and plan in advance. Often there is no identifiable cause of breech presentation but there are circumstances that favor the position. These include preterm labor, multiple pregnancy, polyhydramnios, hydrocephaly, uterine abnormalities, and placenta praevia.

Diagnosis can be made both during the antenatal period and during labor. Antenataly diagnosis is made by an abdominal examination, x-ray examination, and by ultra sound. During labor diagnosis can be made by doing a vaginal exam or by ultrasound.

Breech is usually not considered a complication during early pregnancy because at times the fetus may turn and position itself in the normal way.

Before 37 weeks gestation, a procedure known as external cephalic version (ECV) can be performed to try and turn the fetus. This procedure, however, does not reduce the incidence of breech babies or the rate of cesarean section because the fetus will most likely spontaneously turn itself back.

Most pregnant mothers panic when told that their baby is in breech position, especially during labor. But there is no need. Vaginal deliveries for breech babies are possible depending on the woman. However, most doctors would prefer to deliver a breech baby by cesarean section because of the complications involved during vaginal breech delivery. Generally, a woman with an adequate pelvis will be able to deliver, or a woman who has delivered previously (multiparous). However, it is almost impossible to deliver a breech in a primigravida (a woman delivering for the first time).

To deliver a woman vaginally an obstetrician should always be available (should complications arise), in addition to the midwife. When the baby is ready to be born, a generous episiotomy is always given to prevent the mother from having a serious vaginal tear. The baby's heart rate is monitored constantly to check for complications. Delivery of a breech baby can either be spontaneous or assisted. In spontaneous delivery, the baby comes out naturally without any assistant from the birth attendant. While an assisted breech delivery the buttocks are delivered spontaneously some assistance is needed to deliver the arms, legs and head.

What are the complications of vaginal breech deliveries? Delivering a breech baby vaginally can pose some serious problems to both the mother and the baby. Complications to the mother include prolonged labor and maternal distress, severe perineal lacerations, obstructed labor, and postpartum hemorrhage. Fetal complications include presentation and prolapse of the umbilical cord, fetal hypoxia and distress, asphyxia neonatarum, birth injuries, cerebral hemorrhage, and an increased mortality rate.

Delivering a breech baby per vagina and not by cesarean should be the woman's choice. Though, if there are serious medical implications a cesarean section should be considered as it will reduce the mortality and morbidity rate for both the mother and baby.

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