The breech presentation occurs during delivery when the baby’s buttocks, feet, or both emerge first from the birth canal. The birth position may increase the risk of birth defects or congenital malformations. Breech babies’ birth defects may vary from physical issues to genetic disorders. Babies born breech do not move their heads down towards the birth canal as the due date approaches to be born with vertex presentation. About 3-4% of full-term infants are born with breech presentation (1). Despite the presence of a breech presentation, not all babies born with it may develop birth defects.
Types Of Breech Babies
There are three types of breech positions (2).
Frank breech: This is the most common breech position where buttocks are delivered first. Legs are positioned up in front of the body and feet near the head.
Complete breech: The buttocks are presented near the birth canal. The knees are bent, and the feet are placed near the buttocks.
Incomplete breech: Baby’s buttocks and a foot are presented in the birth canal. The other leg stays up towards the body like seen in the frank breech. If one foot and buttocks emerge first, it is called footling breech. If both feet appear first since both legs are extended, it is called double footling breech.
What Rate Of Breech Babies Have Birth Defects?
There may be a slight increase in the number of birth defects among breech babies. A study noted that 11.7% of infants born breech had at least one congenital anomaly. In comparison, only 5.1% of babies born with vertex presentation had any congenital anomaly (3). This occurred regardless of the term of pregnancy. The study established that breech presentation at birth may indicate congenital anomalies. Congenital defects could prevent the baby from moving to a cephalic position (head down) before delivery. Although the breech position may indicate a possible congenital anomaly, it may not be noted in all breech babies.
What Birth Defects Are Associated With Breech Babies?
Studies have shown that the following birth defects are commonly seen in babies born breech (4). Studies have shown that various malformations are associated with breech birth except for digestive system problems. Malformations may primarily cause the baby to fail to rotate to the cephalic presentation before birth.
Complications Of Breech Presentation
Umbilical cord prolapse and head entrapment are significant problems of breech delivery (5). If the umbilical cord is compressed during breech birth, it could restrict the blood and oxygen flow to the fetus. Breech birth can be associated with fetal distress in many cases. Delay in delivery and meconium-stained amniotic fluid can be a reason for it. There is also an increased risk of hip dislocation during a breech delivery.
How To Prevent Problems Of Breech Births?
There is no way to prevent birth defects in breech babies. However, problems associated with breech birth could be prevented by changing the position of the fetus before the delivery. The following procedures or techniques may help to avoid breech birth.
1. External cephalic version
It is a procedure that turns the fetus from breech or side-lying (transverse) position to head-down or vertex position before the labor. This is usually done at 37 weeks of gestation before the labor begins but rarely done during the labor before the amniotic sac ruptures (6). Doctors may give tocolytic injections before the procedure to prevent uterine contractions and relax the uterus. After visualizing the baby’s position, placental location, and amniotic fluid volume, the doctor may gently push the abdomen to change the position. The fetus is closely monitored with fetal ultrasound and electronic fetal heart monitoring. If the first attempt fails, the second attempt may be made under epidural anesthesia. Although complications are rare in the external cephalic version, there is always a possibility. Therefore, the procedure is always done in a hospital where women can have emergency C-sections. It is possible to have a vaginal birth after a successful external cephalic version. If there is no complication after an unsuccessful version, a scheduled cesarean section is done. ECV may not be tried if there more than one fetus, known fetal anomalies, abnormalities of the reproductive system, wrong placement of the placenta, or placental abruption (11).
2. Chiropractic care
The Webster technique is a chiropractic method to move the fetus from breech position to normal position. This technique focuses on relaxing the uterus and ligaments, reducing stress on the pelvis. This technique is based on the theory that a more relaxed uterus lets the breech baby turn naturally. Although it is attempted in chiropractic care, a few existing scientific studies backing the techniques are weak in conclusion (7).
