According to the Federation of Associations of Midwives of Spain, in almost four percent of full-term pregnancies the baby is breech . This news, which falls like a jug of cold water to the future mother, is usually communicated in the last ultrasound performed in pregnancy, and sometimes there is talk of a scheduled cesarean section if the baby is not turned in time.
But according to the latest published studies, vaginal delivery when the baby comes from the breech should be the first option to consider before the scheduled cesarean section, as long as a series of requirements are met.
Requirements for attempting a vaginal delivery with a breech baby
In 2011, the Spanish Society of Gynecology and Obstetrics (SEGO) published a Care Protocol for breech delivery at term , where we can read the following conditions that must be met for a safe delivery:
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Vaginal delivery can be attempted in cases of a fetus with adequate fetal intrauterine growth and an estimated weight less than 4 kg.
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Labor must progress adequately.
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The attitude of the fetal head should be flexed or indifferent (in no case can the baby be looking up). This is determined by ultrasound or x-ray once labor has started.
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The baby should be in a pure breech position (with the legs up, the butt wedged in the birth canal) or full breech (both feet in the birth canal).
If we assess the recommendations of the American Obstetric Association to opt for vaginal delivery in case of breech presentation, we find the following indications:
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The baby must be full-term and in a pure breech presentation.
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The baby shows no signs of fetal distress and his heart rate should be closely monitored.
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Labor must progress adequately.
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The baby should not be too big for the mother’s pelvis.
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It is important that anesthesia is available to be able to opt for an emergency cesarean section if it becomes necessary.
The respected childbirth association, “The birth is ours,” also published a detailed article on term pregnancies in which there is poor fetal position , and the recommendations to follow to opt for a natural delivery when the baby is breech.
In a fragment of this article we can read the following conditions that according to Dr. Emilio Santos must be met to opt for a safe breech delivery :
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The onset of labor must be spontaneous and unprovoked;
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You should not do the Hamilton maneuver (or rupture of membranes) to provoke it;
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If the woman does not dilate adequately when there are still no criteria for delivery, wait (as it should be done in any delivery);
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If the woman is clearly in labor but it is not progressing adequately, she should have a cesarean section;
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Minimize vaginal examinations to minimize the risk of ruptured membranes before the buttocks are supported, and consequently decrease the risk of cord prolapse;
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Perform a vaginal examination or adequate monitoring of the baby as soon as the bursa ruptures to rule out a prolapsed cord ;
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Encourage the woman to adopt a free posture, suggest squatting or all-fours, which favor the correct position of the baby’s back;
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Do not perform an episiotomy while everything is going well , with the philosophy of favoring the pressure of the fundus of the uterus that helps to avoid mispositions of the head and arms and that the baby is born by propulsion and never by traction “
For its part, in this article published by the American Obstetric Association we can read the following:
“Most doctors recommend a cesarean delivery for all breech babies, especially babies who are premature . Since premature babies are small and more fragile, and because a premature baby’s head is relatively large in proportion to its body, the baby is unlikely to stretch the cervix as much as a full-term baby. This means there may be less room for the head to come out. “
What can I do to help my baby roll over?
If you see that your pregnancy is progressing and your baby is not well positioned there are several exercises, techniques and positions that you can try to help him turn .
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Regular breaststroke swimming is an excellent exercise for your baby to get into a cephalic position as it helps relax the pelvis and abdominal muscles so that the baby can turn more easily.
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Control our posture throughout the day . For an optimal baby position, the ideal is to sit upright with the back slightly bent forward. It is also better to sleep on your side than on your back.
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Other recommended exercises are all those that disengage the baby from the pelvis so that he has more freedom to turn, such as kneeling on the floor and resting his head on the forearms on the ground, or doing a handstand with help in the pool.
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Finally, you can find a gynecologist with experience in performing an external cephalic version, a manual procedure in which the doctor attempts to turn the baby with a massage on your abdomen.
More information Strategy for Attention to Normal Delivery
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