In a breech presentation, the unborn baby lies in the mother's abdomen with its bottom pointing towards the pelvic outlet. Normally, the baby should have turned so that its head is pointing towards the pelvic outlet by around the 32nd week of pregnancy. A natural birth is then usually possible.
Below you will find further information and selected specialists for breech presentation
A breech presentation is one of the so-called positional anomalies. A baby is usually born head first. This is also referred to as a cephalic position. A transverse position occurs when the baby lies transversely in the mother's abdomen. However, if the head is up in the womb and the feet or bottom are correspondingly down, the baby is in a pelvic presentation. Depending on the position of the unborn baby, different forms of breech presentation can be distinguished:
In around half of all cases, there is no cause for the baby's positional anomaly. However, breech presentation is particularly common in women giving birth to their first child. Studies also show that women who give birth from a breech presentation are also more likely to give birth from a breech presentation.
Many babies do not turn until around the 30th week of pregnancy. Premature babies born before this time have often not yet turned. Pelvic presentation therefore occurs more frequently in premature babies.
Another risk factor for a breech presentation is a multiple pregnancy. In this case, one or both twins or multiples lack the space to turn. There is also too little space in normal pregnancies with too little amniotic fluid (oligohydramnios). If there is too much amniotic fluid (polyhydramnios), there tends to be too much space, which means that the position can often change within a short period of time - the so-called "alternating fetal positions". This also increases the risk of a breech presentation.
Other causes of breech presentation are
Many women do not realize that their child is in a breech position. Pregnant women may notice increased kicking of the baby in the abdomen. Pressure on the bladder from the feet can trigger an increased urge to urinate. In some cases, the head also presses against the ribs from below. This is perceived as extremely uncomfortable or can be associated with pain.
In contrast to the transverse position, the breech presentation does not necessarily require a caesarean section. There are clinics that accompany the natural delivery of a baby in the breech position. As the breech presentation has other complications during birth than the cephalic presentation, support from experienced midwives and doctors is important for a positive birth process. The conditions are then in place for a complication-free birth, even with a breech presentation. Nevertheless, breech presentation is considered a sufficient factor for a high-risk birth.
The breech presentation does not usually affect the development of the unborn child. It is only referred to as breech presentation if the child has not turned by the end of the pregnancy. Malformations and deformities occur in earlier stages of pregnancy and are not caused by a breech presentation. The care of the unborn child is also not normally endangered by a breech presentation.
Most women are diagnosed with breech presentation as part of normal prenatal care. The gynaecologist can use ultrasound to see exactly how the baby is positioned in the womb. At each check-up, the doctor records the exact position of the baby in the maternity record. The gynecologist speaks of a breech presentation if the fetus has not yet turned by the 32nd week of pregnancy. In principle, however, rotation is still possible until around the 37th week of pregnancy.
© fotoduets | AdobeStock
Experienced obstetricians can perform what is known as an external turn in the event of a breech presentation. This involves turning the baby from the breech position to the cephalic position with careful and targeted maneuvers from the outside through the abdominal wall. The success rate for this procedure is around 50 - 70 %.
Complications occur in less than 3 % of all cases. These include, for example, premature detachment of the placenta and a drop in the baby's heart rate. For this reason, a surgical team ready to perform a caesarean section (cesarean section) should be available at every external turn.
The care of pregnant women who give birth from the breech position or who undergo an external delivery is usually carried out in perinatal centers. Obstetrics specialists are specialized in the care of premature and newborn babies.
An external delivery after the 37th week of pregnancy can reduce the number of caesarean sections and at the same time increase the probability of a natural birth. However, if there are no particular risk factors, pregnant women can also give birth vaginally from the breech position. The birth can be more strenuous for both the baby and the pregnant woman than a birth from the cephalic position.
If there is a mismatch between the size of the baby's head and the mother's pelvis, this can lead to delays during the birth. For this reason, an ultrasound or MRI is often performed before a birth from the breech position to assess this ratio. If there are any abnormalities, a caesarean section may be necessary.
The Leading Medicine Guide's quality assurance is ensured by the following acceptance prerequisites.
