Breech baby labor and birth
The number of babies presenting as breech ( bottom first) is closely related to their gestational age. At 28 weeks some 25 % of all babies are breech, but most of them turn of their own according during the third trimester to become cephalic ( head down) presentations.
If your baby is breech it will be in one of three positions:
-a complete breech: the bottom is still lowest but the thighs are extended upward and the knees are flexed so that the legs are folded against the baby's body
-a frank breech: the bottom presents to the cervix and the legs are extended upward along the baby's body
-a footling breech: the legs are presented below the baby's bottom
Vaginal breech deliveries are more prone to risks and complications, the most important being that the largest diameter of the baby, the head, is the last to deliver. The breech doesn't fit into the mother's pelvis as well as a head, so there is always the risk that the umbilical cord will prolapse or fall through the cervix along the bottom or the legs. A prolapsed cord results in acute fetal distress because when the umbilical cord is exposed to air, it constricts or closed down, cutting off the oxygen supply to the baby.
LABOR: A vaginal breech birth is most likely to be considered if your baby is in a frank breech position. It is always considered to be a trial of labor and will be allowed to continue only if no problem develop.
Breech labor are often slower than cephalic labors because the presenting part, the baby's bottom, is softer and does not exert the same downward pressure on the cervix.
DELIVERY: assuming that all has gone well and you have now reached full dilation. The buttocks will be delivered first with the help of your contractions and pushing efforts. The OB will gently rotate the baby's buttocks to the left or right to allow the doctor to insert a finger into the vagina and hook it around the first and then the second leg. The shoulders usually need to be rotated to one side and then the other, so that once again the OB can insert a finger into the vagina and hook a finger around the upper limbs to aid delivery of the arms.
The baby's head is the largest part of its body and when the neck is extended an even wider diameter is presenting to the cervix, which may not yet have been fully dilated by the delivery of the buttocks, trunk, and shoulders.
The key to a successful vaginal breech delivery is that it should not be hurried and there should never be any pulling or tugging of the baby, just guidance and gentle rotation as baby emerges.