Types of breech presentation
The type of presentation directly determines whether natural childbirth is possible. With a purely breech presentation, the legs are extended along the body, and the buttocks are tightly adjacent to the entrance to the pelvis - this is the most favorable option. With a mixed buttock, the child seems to be squatting. Leg options, when the feet or knees come first, are considered the least convenient for natural childbirth, since there is a higher risk of umbilical cord prolapse. The exact type is determined by ultrasound closer to the due date, and not in the middle of pregnancy.
- Pure gluteal - legs extended upward
- Mixed glute – buttocks and feet together
- Full footed - both feet point downwards
- Incomplete leg - one leg below
- Knee - a rare option
Why doesn't the baby roll over?
Most often, a specific reason cannot be found, and this is simply an accident. But there are conditions that prevent the baby from turning his head down or, conversely, allow him to rotate freely until birth. The amount of amniotic fluid, the shape of the uterus, the location of the placenta and the duration of pregnancy matter: the earlier labor begins, the higher the proportion of breech presentations. Repeated breech presentation in the next pregnancy is somewhat more common than in women with a previous cephalic presentation.
- Premature birth and short term
- Polyhydramnios or, conversely, oligohydramnios
- Abnormalities in the shape of the uterus, large myomatous nodes
- Low position or placenta previa
- Short umbilical cord, entanglement
- Multiple pregnancy
How to make a diagnosis
At the appointment, the doctor palpates the abdomen and determines that there is a soft, large part below, and a dense, rounded head at the bottom of the uterus. The baby's heartbeat can be heard above the navel. However, the final conclusion is given by ultrasound: it shows the type of presentation, the position of the legs, the estimated weight of the fetus, the amount of water, the location of the placenta and the position of the head. There is no point in fixing the position before 32 weeks, because the baby is still actively moving. Major decisions are made after 34–36 weeks.
- External obstetric examination
- Listening to the heartbeat above the navel
- Ultrasound with determination of the type of presentation
- Estimation of estimated fetal weight and water volume
- Assessing the position of the head and umbilical cord
- Dopplerography according to indications
External rotation of the fetus onto the head
This is a procedure in which the doctor carefully moves the child to the head position through the anterior abdominal wall under ultrasound guidance. It is usually performed after 36–37 weeks, in a hospital, where, if necessary, a caesarean section can be quickly performed. Before turning, the amount of water, the condition of the fetus and the location of the placenta are assessed, and drugs that relax the uterus are often used. The procedure is not successful for everyone, and sometimes the child returns to the previous position, but if successful, it allows one to avoid surgery. Home exercises and postures do not replace turning.
- Performed only by a doctor in a hospital setting
- The optimal period is after 36–37 weeks
- Monitoring ultrasound and fetal heartbeat is mandatory
- Contraindicated in cases of uterine scar, placenta previa, oligohydramnios.
- After the procedure, the condition of the fetus is monitored
- Trying to turn on your own is dangerous.
How childbirth is planned
A planned caesarean section is the most common choice for breech presentation, especially with a pedunculated version, a large baby, a narrow pelvis or a uterine scar. Natural birth is possible with a pure breech presentation, normal pelvic size, average fetal weight and the presence of a doctor who knows how to use a pelvic birth manual. The decision is made individually after 36 weeks and must be discussed with the woman. With a breech presentation, it is especially important to immediately contact the maternity hospital when your water breaks, without waiting for contractions.
- Tactics are determined after 36 weeks and recorded in the exchange card
- Planned caesarean section - with leg presentation and large fetus
- Natural birth - with a purely breech presentation and an experienced team
- Hospitalization in advance according to the doctor’s decision
- If your water breaks, go immediately to the maternity hospital
- Births in a hospital only, home births excluded
