Bump and breech

What does breech condition mean?

Breech condition means that your baby is in the uterus with the buttocks facing down. This is not an unusual and usually temporary position at the beginning of the third trimester.

When your baby is in this breech, you may have an uncomfortable feeling under your ribs and are quickly out of breath as your baby's head presses down on your diaphragm from below. You may also experience some painful kicks against your bladder.

Your first baby is likely to turn her head down after 36 weeks of pregnancy at the latest (RCOG 2006a). Only three percent of babies are still in breech at the end of the pregnancy. (RCOG 2006a, 2008a).

What if my baby is still in a rump position at the end of the pregnancy?

Most breech-born babies are born with a caesarean section (HSCIC 2012, ISD Scotland 2013), but before that happens, there's a chance to turn your baby around. There are pregnant women who try natural methods to encourage their baby to turn around. Your doctor or midwife may arrange an appointment with you at the maternity ward to try and turn your baby (NCCWCH 2008, RCOG 2008a). This manual procedure is called outer turn.

The treatment is not recommended for all women. If you recently had vaginal bleeding or you expect multiple births, there is a great deal of risk to an external turn (RCOG 2006b, 2008b).

An outer turn is more likely to succeed if you have already given birth or amniotic fluid (RCOG 2006b). But sometimes it happens that a baby does not want to be turned or rotates back into the breech posture after treatment (persistent breech position). Why are the doctors going to suggest a Caesarean section?

In Germany, most babies are delivered to the breech by caesarean section (HSCIC 2012, ISD Scotland 2013), as most experts believe this is the safest way (NCCWCH 2011, RCOG 2006a, 2008a).

Whether to advise you to Caesarean section depends on the following factors:

Whether you are trying an outer turn and whether it is successful or not.

  • The exact location of your baby, if it stays in the rump and of course your own preferences.
  • The equipment and experience of doctors and midwives working at your maternity ward.
  • In addition, a caesarean section may be necessary if:

your baby is lying forward (foot position).

  • They expect twins and the first baby is in breech placement (NCCWCH 2011).
  • You have preeclampsia or other problems that endanger your or your baby's health. (RCOG 2006a, 2008a).
  • The estimated weight of your baby is more than 3800 grams (RCOG 2006a, 2008a).
  • Your baby is very small or his head circumference is very large relative to the waist circumference.
  • Your baby is in a certain position, such as a very long back of the neck, as this can make the birth of the head difficult (RCOG 2006a, 2008a).
  • You have been diagnosed with a narrow pelvis (RCOG 2006a, 2008a).
  • you have a low-lying placenta (RCOG 2006a, 2008a).
  • A caesarean section for your breech-child gives you time to plan the birth. Apart from his position, your baby is probably alive and kicking. The birth will probably be uncomplicated and relatively relaxed. This should give doctors and midwives time to look at their birth plan. It can include a selection of music for the birth or the option for your partner to announce the baby's gender - if you do not already know it. You may also ask the doctors to allow you to make skin contact while you are still in the operating room and to delay the umbilical, if you so choose. A planned caesarean section for breech placement is almost the same as a normal caesarean section, except that your baby is delivered with the buttocks or legs first and not head first.

What can increase my chances of having a vaginal delivery?

If you wish to have a vaginal delivery, your doctor will support this request if:

you have given birth vaginally.

  • A midwife or doctor is present at birth who is experienced and trained to perform a breech birth.
  • There are facilities for a cesarean section in the immediate vicinity.
  • There are not other reasons that speak against vaginal delivery (RCOG 2006a, 2008a).
  • You should discuss with your doctor and midwife the potential risks and benefits of Caesarean section and vaginal delivery. You should also talk about the different types of vaginal delivery and which ones are suitable for you, because there are different approaches (Evans 2012a, b).

The staff at most stations will have more experience with the woman lying on her back with the breech and her legs in headband (RCOG 2006a). But even a vaginal birth in a more upright position is possible. Once you know all the options, you can make a decision about what works best for you and the child.

What happens if my contractions start early?

If you have premature labor and your baby is in a breech, your doctor will decide with you whether a caesarean section or a vaginal delivery is better (RCOG 2006a).There is some evidence that it is safer for premature babies to be born by caesarean section. (Bergenhenegouwen et al 2014).

Many obstetricians prefer to give birth to premature cyst babies by caesarean section, although this is not recommended as a standard procedure (RCOG 2006a). If there are no other complications, vaginal delivery should always be a possibility for premature babies in breech. The final decision should be made by you, your midwife and the doctor (RCOG 2006a, MIDIRS 2008).

Where do I find experts for such a vaginal delivery in breech position?

It can be difficult to find a midwife or obstetrician who has the education and experience to deliver your breech baby vaginally (MIDIRS 2008). If your midwife does not agree, she might have at least one colleague willing to help you.

Talk to the primary midwife of your maternity ward when in doubt. It will ensure that you and your baby get the right treatment (NMC 2009).

If your local hospital does not have trained and experienced personnel, you should be referred to a hospital for a breech-only vaginal delivery (RCOG 2006a).

You could also try to find a midwife who has experience with breech vaginal births.

Can I have a home birth despite the breech?

Home births are not recommended in such a case. Vaginal breech births are associated with a higher risk of complications. If you have already given birth to a child without complications and have had no other problems in your current pregnancy, this could be an argument for you to enforce a home birth.

Again, it is advisable to talk to a midwife to get the best possible support.

What else do I need to know if my child is in breech?

Two things you should know. One

may pass before birth, though it's very unlikely the other should pass after birth. First, if your amniotic sac bursts with an effusion before your baby's buttocks are indented into the birth canal, there is a risk that the umbilical cord will be flushed into your vagina. But that rarely happens, in about one in a hundred bump births. Nevertheless, you should know (RCOG 2014).

If your amniotic sac bursts and you can feel or see the umbilical cord, immediately call an ambulance. Then walk on hands and knees, head down and buttocks up, waiting for the arrival of the emergency medical officer (RCOG 2014). Although this is not a very dignified position, it prevents your baby's weight from pressing on the umbilical cord.Your child will continue to get oxygen from the placenta.

The doctor or midwife will push up your baby's buttocks with his hand, preventing it from pressing on the cord. In this posture, you remain in the operating room until you arrive, as it is very likely that you will be taken to the hospital for a cesarean delivery (RCOG 2006a).

Second, all babies born of breech are ultrasonically examined for possible hip abnormalities during U2. In the case of all other babies, this examination takes place during U3 in the 4th to 6th week of life.

Sources

Alfirevic Z, Milan SJ, Livio p. 2013. Caesarean section versus vaginal delivery for preterm birth in singletons.

Cochrane Database of Systematic Reviews (9): CD000078. Bergenhenegouwen LA, Meertens LJ, Schaaf J, et al. 2014. Vaginal delivery versus caesarean section in preterm breech delivery: a systematic review.

Eur J Obstet Gynecol Reprod Biol 172: 1-6 Evans J. 2012a. Understanding physiological breech birth.

Essentially MIDIRS 3 (2): 17-21 Evans J. 2012b. The final piece of the breech birth jigsaw?

Essentially MIDIRS 3 (3): 46-9 Goffinet F, Carayol M, Foidart JM, et al. 2006. Is planned vaginal delivery for breech presentation at term silent at option? Results of an observational prospective survey in France and Belgium. Am J Obstet Gynecol

94: 1002-11 Hannah ME, Whyte H, Hannah WJ et al. 2004. Maternal outcomes at 2 years after planned caesarean section versus planned vaginal birth for breech presentation at term: the international randomized term breech trial. Am J Obstet Gynecol

191 (3): 917-927 HSCIC. 2012. NHS maternity statistics, 2011-12.

Health and Social Care Information Center, Hospital Episode Statistics. Independent Midwives UK. nd. Frequently Asked Questions.

ISD Scotland. 2014. Births in Scottish hospitals: year ending 31 March 2013.

Information Services Division Scotland, NHS National Services Scotland. Midir. 2008. Breech Presentation - options for care. MIDIRS Informed Choice - for professionals

9 NMC. 2009. Support for parents: how to supervise and supervisors of midwives can help you.

Nursing & Midwifery Council. London: NMC NCCWCH. 2008. Antenatal care: routine care for the healthy pregnant woman.

National Collaborating Center for Women's and Children's Health, Clinical Guideline. London: RCOG Press. NCCWCH. 2011. Caesarean section.

National Collaborating Center for Women's and Children's Health, Clinical Guideline. London: RCOG Press. NCT. nd. Hip dysplasia in babies.

RCOG. 2006a. The management of breech presentation.

Royal College of Obstetricians and Gynecologists, Green-top guideline, 20b. London: RCOG press. RCOG. 2006b. External cephalic version and reducing the incidence of breech presentation.

Reviewed 2010, Royal College of Obstetricians and Gynecologists, Green-top Guideline, 20a. London: RCOG press. RCOG. 2008a. Turning a breech baby in the womb (external cephalic version): information for you.

Royal College of Obstetricians and Gynecologists. RCOG. 2008b. A breech baby at the end of pregnancy: information for you.

Royal College of Obstetricians and Gynecologists. RCOG. 2014. umbilical cord prolapse.

Royal College of Obstetricians and Gynecologists, Green-top guideline, 50. London: RCOG press. Tidy C. 2013. Developmental dysplasia of the hip.

Toivonen E, Palomaki O, Huhtala H, et al. 2012. Selective vaginal breech delivery at term - silent at option. Acta Obstet Gynecol Scand

91 (10): 1177-83 Vendittelli F, Pons JC, Lemery D, et al. 2006. The term breech presentation: Neonatal results and obstetric practices in France. Eur J Obstet Gynecol Reprod Biol

125: 176-84 Show sources Hide sources

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