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Breech Presentation the situation in which, just prior to birth,
the buttocks, feet or knees of a baby are the presenting part
rather than the head.
A breech position is likely to cause
problems and a baby in this position is usually delivered by caesarian section to avoid the risks associated with a protracted
and difficult birth.
The incidence of breech presentation is about 20% at 28 weeks. Most of the fetuses turn spontaneously, so the incidence at term is 3-4%. It has been widely recognised that there is higher perinatal mortality and morbidity with breech presentation, due principally to prematurity, congenital malformations and birth asphyxia or trauma.
Breech presentation, whatever the mode of delivery, is a signal for potential fetal handicap and this should inform antenatal, intrapartum and neonatal management.
Caesarean section for breech presentation has been suggested as a way of reducing the associated fetal problems and in many countries in northern Europe and North America caesarean section has become the normal mode of delivery in this situation.
Why are some babies breech?
Actually, it is perfectly normal for babies to be breech frequently during pregnancy. As the child grows, the uterus gets more crowded and it is most common for him or her to assume the head down presentation.
The uterus is shaped rather like an upside-down pear, so the baby's head fits in the lower part, with more room at the top for movement of the extremities. Generally, the placenta is attached at the side of the uterus, which seems to encourage the head-down presentation, too.
Ninety-seven percent of full-term babies are born head first. Usually, by the time labor begins, a fetus will have chosen a head-down presentation, and will most likely stay there. If he or she is breech near the due date, turning around is still a possibility, although some medical studies find as much as 80% of breech babies stay breech until birth.
Mothers may not be aware much earlier than 36-37 weeks that their baby remaining in a breech position is a problem. The prevalence of breech presentation decreases from about 15% at 29-32 weeks gestation to between 3-4% at term.(1)
Many hospitals have a policy of elective caesarean section at 38 weeks gestation for all breech presentations. For many mothers, particularly those who have made great efforts to maximise the chances of 'as natural a birth as possible', such a position is extremely confidence-shattering and desperately upsetting - loss of control of, or involvement in, the delivery of her baby is often total.
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