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Breech Birth

It often sends chills down an expectant mother's back if she hears the word breech. This doesn't have to be as scary as it sounds. When labor begins, 96 percent of babies have assumed the head down or "vertex position" with only a few (about 3.5 percent) in the bottom first or breech position. Most babies settle into birthing position by the eighth month of pregnancy, but some babies will keep mothers and doctors guessing up until only a few days before birth.

If you are near term and your baby is breech, your doctor or midwife may try to turn the baby by manipulating your uterus manually. The procedure is called an external cephalic version (ECV). Many times this technique works, but other times, the baby is just to big to budge, or it may rotate back into a breech position.

Just because your baby is breech does not mean that you will have to have a cesarean section. One third to one half of all breech babies are born vaginally. However, studies have shown that breech babies have a lower risk of birth injury and newborn complications if delivered via c-section rather than vaginally. Many doctors speculate if the statistical rise in complications of a vaginal breech birth are due simply to the breech presentation rather than the method of delivery. The best advice to take when you're told your baby is in a breech position is to stay flexible and be as well informed as possible.

Another factor that can determine if there is the option of a vaginal delivery is the type of breech presentation your baby has settled into. If your baby is in the more common frank breech position (bottom down with legs extended up toward the face), vaginal delivery is a better possibility. The deciding factors with a frank breech vaginal delivery will depend on the baby's estimated weight and your doctor or midwife's experience. If your baby is in the incomplete breech position (one or both of your baby's knees or legs is the part of him closest to your vagina) or complete breech positions (the baby is sitting cross-legged) it will make vaginal delivery all but impossible. You will probably have to undergo a c-section. If your baby is breech and you go into pre-term labor, your doctor or midwife is more likely to opt for a c-section. Although pre-term babies weigh less and have smaller bodies than full-term babies, their heads are quite large and their bodies are small; these combined factors can make a vaginal delivery difficult.

Doctors and midwives without a lot of experience with breech births may be uncomfortable with a vaginal delivery. If you have delivered vaginally before, don't have a history of giving birth to big babies, and your baby isn't in the incomplete or complete breech position, your doctor or midwife may be more likely to give a vaginal birth the go ahead. Before making a final decision, you and your doctor or midwife should evaluate your situation and discuss the possible risks and benefits of both a c-section and a vaginal birth so you can choose what is best for you and your baby.

When a vaginal delivery is to be attempted, labor is carefully monitored in a surgically equipped delivery room. If all goes well, the labor and delivery is allowed to continue. If the cervix dilates too slowly or if other complications arise, your doctor and his surgical team will be ready to perform a c-section in a matter of minutes. Because of the potential for complications, continuous electronic fetal monitoring is absolutely necessary.


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