Breech Birth and Delivery Issues

Jul 23 2009

It outlines the situations in which cesarean is the delivery of choice. Vaginal delivery of a breech baby is considered safe only when the baby is in a favorable position for vaginal delivery. The buttocks, rather than the feet, present and the breech is low in the pelvis at the onset of labor. The baby is neither too small nor too big. The fetal head is well flexed, making its birth following the birth of the buttocks and body more likely to succeed without problems. The flexion of the head usually can be ascertained with ultrasound. If this is inadequate, a computerized tomography scan(C-T scan) often can tell whether the head is flexed. As a last resort, because it exposes the fetus to more radiation, or in the absence of C- T scan equipment, an X ray can be done. Even with X ray, the radiation exposure is small.

Anytime labor is tried when the baby is in the breech presentation, the labor must be monitored carefully for progress and signs of cord prolapse. Careful attention must be paid when the membranes rupture as this is the time the cord may come down or prolapse.

For a vaginal breech birth, the birth attendant should be experienced in delivering a breech. Some midwives deliver breech babies, usually with assistance of an obstetrician. An anesthesiologist or nurse-anesthetist should be available as should a physician or neonatal nurse practitioner who can provide immediate infant resuscitation, if that becomes necessary. There are three types of vaginal breech deliveries:

In a spontaneous breech delivery, the fetus is born without assistance, except for support of its body .
In an assisted breech delivery(or partial breech extraction), the fetus is born without assistance until the umbilicus, or navel. The rest of the fetus is born with assistance of the birth attendant .
In a total breech extraction, the entire body of the fetus is taken out with assistance. Today, this is done rarely for a living fetus, except for a second twin .