Birth from a breech position

introduction

In the uterus, the child can assume various positions in relation to the maternal pelvis and the uterus. First, the child lies upside down in the uterus. Normally, at the end of the pregnancy, the child turns so that the child's head comes to rest at the pelvic outlet and the rump points upwards. This birth position, in which most children are born, is also called the position of the skull. The head can be born first during the birth process. A natural birth has the fewest complications in the position of the skull.
However, at the end of the pregnancy the child can also assume other positions. These are then referred to as a positional anomaly.

Please also read: Childbirth complications

Definition of breech position

In the Breech position is it a Situation anomalybecause it differs from the normal birth position of the child. The breech position only comes at approximately 5% of births in front. At Premature babies Breech position is observed much more frequently because the child has not yet rotated at the time of birth.

The breech position can in turn be broken down into different forms. The breech position is most common. The buttocks, i.e. the rump, of the child are at the mother's pelvic outlet. The feet are turned up and the head comes to rest on the upper edge of the uterus, the fundus uteri. So the child takes a kind Sitting posture a. This form of breech position is the most common and at the same time harbors the fewest complications in natural birth.
Then come the Foot position (The child's legs are stretched out and are therefore at the pelvic exit), the Rump-foot position (here the feet precede the rump at birth - "squatting position of the child") and the Knee position as the rarest form. Furthermore one differentiates one perfect locationwith the legs down, so the child assumes a kind of crouching position, from one imperfect locationwith one leg of the child pointing up towards the head and resting against the child's torso.

Causes of breech position

Up to the 20th week of pregnancy, about half of the children still have a breech position, but this number then decreases as the pregnancy progresses due to the physiological rotation of the child Birth position. There can be various reasons for remaining in breech position until the end of pregnancy, which sometimes also interact. However, the exact cause often remains unclear.

Breeches occur more often Premature babies because the child would not rotate until later in the pregnancy. Furthermore, breeches are often found Multiple pregnanciesbecause there is not enough space in the uterus for the children to turn, the children therefore remain in breeches. In addition, a low weight, Developmental delays or Malformations of the child play a role. But also a narrowed or small pelvis of the mother, as well as malformations or myomas of the uterus, or a very deep-seated placenta (Placenta previa) can contribute to breeches in the child.

Furthermore, an increased amount of Amniotic fluid (Polyhydramnios) or too little amniotic fluid (Oligohydramnios) play a role. Due to the increased fluid, the child has more freedom to move, but at the same time there is no abutment to be able to turn. If the amount of amniotic fluid is too low, however, the child lacks the freedom of movement that would be necessary for the rotation.

Diagnosis

First and foremost, the child's location may be about the Ultrasound examination of pregnant women (Sonography) to be controlled. A breech position can already be in the Check-ups during pregnancy getting discovered. Furthermore, there are also various Handles (Leopold handles) possible to feel the head and rump of the child and thus assess the child's position. However, this method must be mastered well, as otherwise incorrect assessments of the child's position are possible.

What to do with breeches?

Depending on how high the Risks for mother and child can be next to one Caesarean section natural birth can also occur. This should always be weighed up in conjunction with a doctor, as there are certain requirements for a natural birth with breeches. If these are not met, a caesarean section should be performed. Furthermore, for a natural birth in breech position one should be Birth center be visited, which is technically for Risk births is designed and has experience with breech births, as a natural breech birth with additional risks connected is. From a birth in Birthplace or even one Home birth is therefore not advisable due to the lack of medical equipment.
Another option would be to do a outer twistto get the child into a normal birth position and avoid the complications of breech birth. After a detailed examination of the pregnant woman, the attending physician should do a recommendation indicate which type of delivery seems most suitable.

Outside twist

To one Caesarean section and to avoid the risks of natural breech birth, an outward turn of the child can be performed at the end of the pregnancy. Basically, this is only from 36th week of pregnancy done to reduce the risks of a Premature birth to bypass. Usually the exterior takes a turn 2 to 4 weeks before the planned due date instead of.
With the outer turn, the child is moved from the outside from a breech position to a Skull position turned. There are different procedures for doing this, through one or two Obstetrician are executed. The child will be over before, during and even after the attempt at turning CTG control (Computer documentography) supervised. After the successful turn, a check is carried out by Ultrasonic. Continue to be the mother before the start of the turn Contractions given. It should be noted, however, that the twist may not be successful. The turn is only successful in about 50% of the cases. A second attempt should only be carried out in exceptional cases.

Furthermore, complications can arise with the outer turn. So in rare cases is one premature detachment of the placenta possible, which can however be registered via the created CTG. Furthermore are Umbilical cord complications or a premature rupture of the bladder possible.
The most serious complication can occur during, but also days after, the attempt to turn the intrauterine death of the child come. However, this is very rarely observed.
Should any complications arise, one is notified immediately Caesarean section carried out to bring the child into the world. Whether an external twist is possible must first be clarified with the treating doctor, as there are special requirements for this too.
In some cases, the outward turning may not be carried out, for example in the case of premature rupture of the bladder or in the case of a poor development of the child.

Is Natural Birth Possible?

A natural birth is also possible with breeches. Since the natural birth in breech position, however more difficult designed as with skull location, it is important to look at one experienced birth center to apply that is well versed in breech births. Good care and organization of natural birthing in breeches are crucial and important.
Furthermore, for a natural breech birth, some requirements be fulfilled: the birth may only after the 34th week of pregnancy take place, it may no pure foot position or knee position of the child, the child must still be a normal birth weight exhibit (not too heavy and not too easy either), too Malformations and other factors that would prolong the labor process must be ruled out beforehand.
Finally, no additional risks, such as a Diabetes mellitusare available.
Continuous monitoring of the child is required during the birth process CTG important. In addition, a Local anesthesia (epidural or Epidural anesthesia) Help the mother against pain and during childbirth by relaxing the muscles.

Risks

Performing the natural breech birth carries some risks. First of all, there may be a prolonged birth come (protracted birth)which carries further risks for the child and also for the mother. The stress can lead to acidification (Acidosis) of the child as well as further deterioration Blood gas levels of the child (pO2, pCO2). A quick birth is therefore important in order not to endanger the child during this phase. Furthermore, it can become a Incident of the umbilical cord or an extended one Compression of the umbilical cord result from lack of oxygen. In the event of an umbilical cord incident, the birth must be stopped immediately; if this is not possible, it is immediate Caesarean section indexed.
In addition, a prolapse of the arms or feet can occur. The arms or feet are thrown upwards and must be released again by the obstetricians using certain hand movements. If the birth of the head is difficult, there are seldom damages to the child, such as damage to the arm and nerve plexus (Brachial plexus), Head injuries, fractures or bruises are possible.
In addition to the risks for the child, the risks for the mother should not be underestimated. Therefore, in some cases, the natural breech birth is still a secondary caesarean section necessary, for example in the case of premature birth arrest, which can be observed more frequently in births from breeches. Therefore, the Complications of a caesarean section. Other risks are above all pelvic floor trauma Dam cracks or other vaginal injuries at birth.

Complications

In contrast to birth from cranial position, infant mortality during birth from breech position (BEL) is increased by 4%, but this is mainly due to the fact that the proportion of Premature births in BEL is greater. Furthermore, the birth process can be delayed and even lead to a birth arrest, since the head and thus the largest part of the body are born at the end and the rump does not stretch the birth canal sufficiently. Umbilical cord incidents occur much more frequently than normal because the rump does not adequately seal the birth canal. This can lead to a lack of oxygen in the child. The umbilical cord can also be pinched between the head and the pelvic wall when the head is born. In this case, the child should be born within 3-5 minutes to prevent suffocation.

Another serious complication are Cerebral hemorrhage (intracranial hemorrhage) through a crack in the roof of the cerebellum (Tentorium cerebelli) and can be fatal depending on the size and severity of the bleeding.

There is also the risk of Plexus paralysis, a paralysis of the shoulders and arms, which is mainly caused when the arms are folded up during the birth process. Other injuries too, like one Dislocation of the hip (Hip dislocation) or Fractures in the collarbone or poor can occur.

The mother can develop wounds in the vaginal area or torn perineum during childbirth. A dreaded complication of foot positions is the rupture of the cervix during the birth of the head, which is life-threatening.

Caesarean section in breech position

If the risk for the child is too high or the conditions for a natural birth are not met, a caesarean section is indicated in the case of breeches. Furthermore, the caesarean section can also occur Mother's wish to be preferred to natural birth. For example, if the child is born too early before the 36th week of pregnancy, if the child is too low, if the child is too big or if there is a disproportion between the child and the mother's pelvis, a caesarean section is mandatory.
As there is an increased risk for the mother with a caesarean section, the implementation should always be carefully considered as with any operation. In general, the following risks should be considered during a caesarean section: bleeding complications, infections or Wound healing disorders are typical postoperative risks. Adhesion of the surrounding tissue can also occur.

Baby's head shape after birth in breech position

The baby's head can be in breech position before birth a little bigger as growth is not hindered by the mother's pelvis. The differences to children in skull position are small. Immediately after birth, the head is more elongated and egg-shaped because it deforms during birth. This is due to the fact that the head has to pass through the mother's relatively narrow pelvis and the skull plates in small children have not yet grown together and can therefore overlap. After birth, however, the skull usually forms back within a few days and becomes rounder again.