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Breech - series |
Breech Birth And Other Positions
In most pregnancies, your baby will be head down and face down in your uterus. A small percentage of babies assume different positions, some of which make vaginal birth risky and require medical intervention. Here are some abnormal delivery positions you should be aware of:
- Breech: The most common alternate delivery position is breech, in which the baby's rear end comes out before the head. In a complete breech position, he is butt-first with knees bent; in a frank breech, the legs are extended up, with feet near the head; if one leg is lowered over the cervix it is a footling breech. Approximately 3 in 100 babies approach their delivery date in a breech position.
- Occiput posterior: This position is similar to occiput anterior (the normal position), except that the baby faces the mother's front, instead of her back. About 1 in 50 babies are positioned this way.
- Transverse: A baby in the transverse position is sideways, usually with his shoulders or back over the cervix. Sometimes referred to as a shoulder or oblique position, a transverse position occurs in 1 in 2,500 births.
Rare abnormal delivery positions include face-first, brow-first, and compound, in which a hand or foot emerges from the birth canal with the head or buttocks.
Symptoms And Diagnosis
Your doctor will usually know the position of the baby before you go into labor by feeling your uterus. A suspected abnormal position can be confirmed with ultrasound, and you and your doctor can discuss the safest delivery options.
A few abnormal positions are more likely to occur under specific circumstances:
- Breech: You are more likely to have a breech baby if you go into labor prematurely or have an abnormally developed uterus, fibroids, excessive amniotic fluid, more than one baby in the womb, or placenta previa. Placenta previa is a condition in which the placenta is positioned in the low portion of the uterine wall, partially or completely blocking the cervix.
- Transverse: The risk for having a baby in the transverse position increases if you go into labor prematurely, have given birth four or more times, or have placenta previa.
Treatment
- Breech: If your baby is in a breech position after 36 weeks gestation, your doctor may attempt to guide the baby into the correct position by pushing gently on your tummy while viewing fetal movement with ultrasound (external cephalic version). If the baby is still breech when labor begins, your doctor usually delivers the baby by cesarean section. In some cases, vaginal birth may be possible. However, an infant who arrives feet- or butt-first can get his head stuck in the birth canal. The infant's body does not stretch the birth canal wide enough for the head to pass through, and the baby's skull cannot compress or mold to the birth canal as it does during a headfirst passage. This can cause a prolonged labor and fetal distress. Discuss your particular situation with your doctor.
- Occiput posterior: In this position, vaginal delivery is possible but more difficult for you and the baby. Labor is often prolonged. Sometimes the doctor uses forceps to help out the baby. Your doctor may opt to deliver the baby by cesarean section, depending on the risks.
- Transverse: Your doctor will deliver the baby by cesarean section, either right when you start labor, or a little earlier. A vaginal birth would be too risky for you and the baby. If there is a long labor period before the cesarean is performed, there is an increased risk of uterine rupture and umbilical cord damage.
With all abnormal positions, there is additional risk to the mother and fetus. In many cases a damaged or obstructed umbilical cord threatens the baby's oxygen supply. If the baby goes without oxygen for too long, he can develop brain damage or even die. There is also an increased risk of cervical or vaginal tears with abnormal positions.
Frequently Asked Questions
Q: If I had a pregnancy with an abnormal position, what are the chances it will happen again?
A: If the baby was positioned abnormally because of a maternal physical imperfection, such as an abnormally developed uterus, your chances of having an abnormal position in your next pregnancy are increased. Sometimes the position is associated with a condition such as premature labor or placenta previa, so if your subsequent pregnancy is not affected by the related condition, your chances are not increased.
Reviewed By: Peter Chen, M.D., Obstetrics and Gynecology, University of Pennsylvania School of Medicine. Review provided by VeriMed Healthcare Network.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2001 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
