Breech delivery occurs when the fetus presents its buttocks or feet first instead of the normal head-first position. This positioning poses mechanical challenges during delivery, as the feet or buttocks may not provide sufficient pressure to effectively dilate the cervix. It also increases the risk of complications such as umbilical cord prolapse and the head becoming trapped during delivery.
There are three main presentations of breech positioning:
1. Frank Breech: The fetus’s hips are flexed while the knees are extended.
2. Complete Breech: Both the hips and knees are flexed.
3. Incomplete Breech: The feet or knees are positioned lowermost during delivery, either both feet (double footling) or one foot (single footling).
By around 8 months of pregnancy, most babies naturally position themselves with their head downward in preparation for birth. However, in some cases, the baby may remain in a breech position. Your healthcare provider should inform you about your baby’s position by the start of the third trimester, typically by feeling for the baby’s head, back, and bottom.
For women approaching full term whose baby’s position is uncertain, a healthcare provider may suggest an external cephalic version (ECV). This involves manually applying pressure to the abdomen to attempt to turn the baby from a breech position to a head-down position. The success rate of ECV is approximately 58% for turning breech babies and 90% for babies in a transverse lie position (where the shoulder or arms present first). However, this method is more successful in women who have had previous pregnancies.
ECV may not be suitable for women carrying twins, experiencing complications such as bleeding or excessive amniotic fluid, or if a cesarean section (C-section) is planned. In such cases, alternative delivery options will be considered.