Breech babies during pregnancy: identify the causes, types and the best solution

Approaching the day of birth, the baby's body will continue to move and change positions in the womb. Normally, the position of the baby's head is down close to the vaginal opening. In some cases, however, instead of being in the right position before birth, the baby can be in a breech position which makes it difficult to be born. Let's look at the full review of the position of breech babies until later in labor.

What is a breech baby position?

During pregnancy, the baby is usually in the head-up and feet-down position.

When entering the end of the third trimester of pregnancy at around 36 weeks, or to be precise before the time of delivery arrives, the position of the baby in the womb will change.

From what had been the head above, it became the other way around. Ideally, your baby's head should be on the bottom with the chin tucked into the chest, and the feet on top.

Launching from the American College of Obstetricians and Gynecologists, this condition is called vertex presentationoranterior occiput vertex.

The head down position is the safest position for normal delivery.

This change in the position of the baby's body that seems upside down is a normal condition. This aims to facilitate the birth process in the future as well as to provide encouragement to open the birth canal.

So, the position of the baby's head near the cervix (cervix) can first come out through the vagina. Only then was followed by his body, hands and feet.

Unfortunately, sometimes babies can be in a breech position, where the baby's head is not below but remains above.

If depicted, the position of the baby that does not change will make the buttocks and legs of the baby to be born out first.

This condition which can last until delivery is known asbreech birth or the baby's breech position.

What are the types of breech baby positions?

There are 3 types of breech baby positions in the womb, even before delivery, including:

1. Frank breech (frank breech)

Position frank breech (Frank's breech) when the baby's feet in the womb point straight up, right in front of the face and body. This leaves only the bottom part of the buttocks.

Frank breech is a type of breech position that is most common in babies in the womb before delivery.

2. Complete breech (complete breech)

Complete breech is a breech position when the knees and feet of the baby in the womb bend like they are squatting.

In this breech position, the baby's buttocks and feet will first enter the path when it is born through vaginal delivery.

3. Incomplete breech (incomplete breech)

Incomplete breech is a combination breech position of frank breech and complete breech. This condition occurs when one of the baby's legs is up towards his head while the other is bent under the buttocks.

Babies in this breech position before delivery sometimes make you feel like someone is kicking your lower abdomen.

If the fetus is in a complete breech position (complete) or incomplete (incomplete), doctors can usually take action during delivery.

The doctor may try to turn the baby's head while placing his hand on the abdomen, or so calledexternal cephalic version.

Before the time of delivery arrives, the doctor will usually check the health and condition of you and the baby in a breech position first.

If you feel the condition is unsafe and allows for normal vaginal delivery, doctors and the medical team will not recommend actionexternal cephalic version for breech babies.

What causes breech baby position?

The position of the breech baby can usually be seen when you undergo an ultrasound examination (USG) before the day of delivery.

Although the position of the baby in general will immediately rotate as normal, but there are also some fetuses who remain in the breech position until the day of delivery arrives.

The main cause of this breech position in the womb is not yet certain.

However, the American Pregnancy Association mentions various possible causes behind the position of breech babies, such as:

• Have been pregnant several times before
• Are pregnant with twins, triplets, or more
• Have had a premature birth in a previous pregnancy
• The amount of amniotic fluid in the womb is too much, so the baby has more room to move. Or too little amount of amniotic fluid, making it difficult for the baby to move
• If the shape of the mother's uterus is abnormal or has complications in childbirth, such as fibroids in the uterus
• If the mother has placenta previa during pregnancy

How do you know the position of a breech baby?

The baby's normal position during pregnancy will indeed be in a straight line, with his head up and his feet down close to the birth canal.

Before reaching 35 or 36 weeks of gestation, the position of the baby in the womb is not said to be breech.

Because after the gestational age is more than 36 weeks or when the day of delivery arrives, the position of the body and head will rotate the other way around.

This is useful in preparation for a normal vaginal delivery.

If until 36 weeks of gestation the baby's position does not change, it will be even more difficult for him to change positions.

This is because the baby's body size is getting bigger, making it more difficult for him to move and move into the correct position towards the day of delivery.

Now, to find out whether the baby in your womb is in the right position or even breech, the doctor will perform a physical examination.

The way the doctor does is by placing his hand at several specific points on your stomach.

Here, the doctor tries to find and feel the position of the baby's head, body, back, and buttocks.

In addition, to be more sure, doctors generally will carry out further examinations using ultrasound.

That is one of the reasons it is important to have regular prenatal checks even before your due date.

What are the doctor's actions to correct the breech baby's position?

Babies who are in a breech position usually don't show signs before delivery, so it can be difficult to tell.

This is where the ultrasound examination plays a role in clearly knowing the condition of the baby in the womb.

The doctor may recommend a caesarean delivery procedure if your baby is in this position.

But before that, doctors can try to change the position of the breech baby's head and body with medical measures, such as:

1. Doing external cephalic version (ECV)

If your gestational age is between 36-38 weeks, your doctor may recommendexternal cephalic version (ECV). Unfortunately, ECV is not recommended for certain conditions.

Some of these conditions are undergoing multiple pregnancies, vaginal bleeding, abnormal fetal heart rate, premature rupture of membranes, or placenta blocking the birth canal.

The ECV procedure is done by manually changing the baby to the correct position, aka using the hand that is placed on your stomach.

Ultrasound can be used to guide the course of this ECV procedure. During this procedure, the baby's heart rate will be monitored through ultrasound.

So, if suddenly there is a problem in the baby, the ECV procedure can be stopped immediately. The chances of success for ECV are usually greater if a sufficient amount of amniotic fluid is available.

But sometimes, ECV can also fail and even cause complications. Whether it's the amniotic sac rupture too quickly, changes in the baby's heart rate, placental abruption, and preterm birth.

2. Doing chiropractic

Chiropractic care is usually performed to help treat problems in the neck, spine and back.

In fact, according to Larry Webster, D.C. from the International Chiropractic Pediatric Association, chiropractic can be applied to help relax the pelvis of pregnant women.

That way, this more relaxed pelvis will affect the condition of the uterus, muscles, and ligaments around it.

Over time, this condition will trigger the movement of the breech baby to change its position naturally during labor.

This action or technique is known by the nameWebster Breech, which is usually recommended to be done in the 8th month of pregnancy.

Are there any natural exercises to improve the position of a breech baby?

In addition to medical action from the doctor, you can also try to change the position of the baby on your own before labor arrives.

You can do some exercise to help change the position of the breech baby.

However, it would be better to consult with a doctor first before trying to do this method.

Some sports movements that you can do to deal with the position of a breech baby before childbirth, namely:

1. Breech tilt

Perform this movement by lying on the floor and resting your feet on a chair. Next, place a pillow under your butt.

This will allow your body to form a 45 degree angle to the floor.

Hold it in this position for a maximum of 15 minutes or at least until you feel discomfort.

2. Increase walking

Walking is the easiest exercise to do during pregnancy. Walking can also help your baby to move to find the right position.

Therefore, try to take time to walk for 30 minutes every day during pregnancy.

3. Perform knee-chest movements

This movement is done by kneeling on the floor, then placing your head or forehead on the floor (facing the floor, in a prostrate position).

If necessary, you can place pillows on your knees and head to make it more comfortable.

Maintain this position for 15 minutes and do this movement 3 times a day.

If you have made various efforts as above but your baby's position is still breech, immediately consult your doctor again.

The doctor will usually recommend a caesarean section to make labor easier for you and the baby in the womb.

Is it possible that babies can still be born normally in a breech position?

Delivery by caesarean section is usually preferable to vaginal delivery, if the baby is still in the breech position.

However, a normal vaginal delivery when the baby is in a breech position can still be done by a doctor with the following conditions:

• The age of the baby is ideal for birth and the type of breech position, namely frank breech.
• The baby's heart rate is normal when monitored.
• The beginning of the labor process is smooth and stable, marked by dilation of the cervix (cervix).
• The baby's body size is not too big.
• The size of the mother's pelvis is wide enough or not too narrow to facilitate the process of delivering the baby.

Even so, delivering a breech baby normally vaginally can still carry risks and complications.

If enforced with conditions that do not allow, the baby's head can get stuck in the vagina because it comes out the last.

Another potential problem is umbilical cord prolapse. This occurs because the baby's umbilical cord is pinched during the birth process, thus blocking the supply of oxygen and blood for the baby.

When should a breech baby be born by caesarean section?

Most cases of breech baby position in the womb should be delivered by caesarean section as the safest step.

Even if the normal delivery method is chosen, usually the baby's heart rate will always be monitored during labor.

If there are signs of heart rate problems or the baby's overall condition, a cesarean delivery will be done immediately.

This aims to prevent and reduce the possibility of complications for you and your baby with a breech position.

Not only that, babies who will be born prematurely in a breech position are also strongly advised to undergo a cesarean delivery.

The reason is because the body size of premature babies is usually smaller than babies born at normal gestational age.

The proportion of the head of premature babies is also relatively bigger than the body size. That is why, it is difficult for premature babies to stretch the cervix if they are born vaginally.

Since there may be little space for the baby to escape, a caesarean delivery is the best way to position a premature baby who is breech.

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