Breech position: causes, risks and maneuvers

The breech position of the fetus is a rare eventuality, but not so remote: it happens to just under 4% of mothers to find themselves with the baby ready to come into the world “in the wrong direction”.

In these cases, it is not the head that appears first, but the legs or pelvis, which makes vaginal delivery very complex and can lead to a caesarean.

However, there are techniques and maneuvers that can “encourage” the child to return to the encephalic position, the most common one.

But if these are not successful, the birth will be done in the safest possible way to avoid even serious damage to the mother and, above all, to the baby.

When you see the breech position

Generally, after the thirtieth week, an ultrasound is performed that detects, in addition to the general health conditions of the child, the possibility of a breech position.

If this is detected, weekly monitoring will be recommended (by palpation or further ultrasound examination if necessary).

In general, between weeks twenty-eight and thirty-two there is still the possibility that the baby still changes position spontaneously, while beyond the thirty-second week the possibility of a non-induced change becomes remote.

Many possible causes, no certainty

The causes of the breech position have not yet been defined with absolute certainty, but there are several concomitant factors reported.

In particular, this possibility has been detected more frequently in the presence of polyhydramnios (excess fluid in the amniotic sac) and placental problems (defects of adherence of the placenta, or insertion anomalies). Structural abnormalities of the baby’s skull would also be affected, as well as a too narrow pelvis in the mother, but also excessive weight gain, congenital uterine anomalies, too short umbilical cord or tumors in the pelvic area.

In premature births it is less severe

It can also happen, in the case of preterm births, that the baby is breech because it has not yet had time to turn around: this position is in fact quite frequent in the case of premature births and involves less risk, so much so that it is also rarer to resort to caesarean. This, of course, because the smaller size of the unborn child makes its “unorthodox” passage much more manageable and less dangerous.

The risks of vaginal delivery with breech position

Although a fetus positioned with its feet or buttocks in a prominent position does not necessarily run risks, it is true that the breech position can lead to complications, some of which are very serious.

For example, if the baby begins its descent into the birth canal from the lower extremities, it may happen that by the time the head has to pass the dilatation is not yet sufficient to allow it: in this case the baby would run a serious risk of asphyxiation.

Or there may be prolapse of the umbilical cord, part of which is expelled along with the infant’s pelvis or lower limbs, compressing the birth canal and, again, risking oxygen loss.

A precious but delicate manoeuvre

To induce a change of position in the breech baby still inside the mother’s womb, what is called “Cephalic version from the outside” (ECV) or, more commonly, “Turning maneuver” can be practiced between the thirty-sixth and thirty-seventh weeks.

The maneuver consists of a delicate but precise external manipulation on the mother’s belly, a series of small pressures lasting a few minutes which, from the outside, would stimulate the baby’s head, trying to orient it in the right direction, until it makes a sort of half a somersault.

It should be emphasized that this is a delicate manoeuvre, which requires maximum attention and specific training on the part of the gynecologist or obstetrician who performs it, which must be done in the operating room and with constant ultrasound monitoring.

In addition to being effective only in about one out of two cases, in fact, the reversal maneuver can cause damage to the cord or rupture of the placenta, with the need for an emergency caesarean section . Other possible risks of the maneuver, borne by the mother, are the rupture of the uterus or the appearance of hemorrhage.

In which cases it is not possible to perform the maneuver

ECV, or turning maneuver, is not allowed in all cases of breech position.

The circumstances and clinical conditions in which it is not possible to carry out a cephalic version are in fact numerous: anomalies in the placental insertion, oligohydramnios (reduced amniotic fluid, which therefore, despite the maneuver, would not allow the child’s turning), twin pregnancy with both breech babies (otherwise it is possible to give birth to the encephalic twin first and then rotate the second), vaginal bleeding, previous cesarean delivery, presence of fibroids.

Natural and alternative techniques

Always and strictly with the advice and under the supervision of the doctor, it is possible to try to gently induce the breech child to rotate in the right position before or as an alternative to the maneuver.

Experienced staff can suggest some postural techniques, or the adoption for a few minutes of specific positions (which, supine or prone, tend to place the mother’s abdomen and pelvis above the head, but which is not the case to improvise without the detailed explanation of a specialist on the subject), sometimes making small oscillations, possibly even in water.

Other times it is suggested a course of acupuncture or moxibustion, or moxa, always strictly with the consent of the doctor.

Katherine Johnson, M.D., is a board-certified obstetrician-gynecologist with clinical expertise in general obstetrics and gynecology, family planning, women’s health, and gynecology.

She is affiliated with the Obstetrics and Gynecology division at an undisclosed healthcare institution and the online platform,

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