Delivery when the baby is sitting or breech

The gestation period extends over 40 weeks from the beginning of the last menstruation. The three major stages of gestation are: the germinal period, during the first three weeks; the embryonic period, from week 4 to 12 and the fetal period, from week 12 to birth.

The fetus will take different positions throughout the pregnancy, as it will be possible to verify in the different ultrasounds that the mother will perform. But one of these movements will be especially important for the delivery and how it will occur.

WHEN AND HOW IS THE FETUS POSITIONED IN THE MOST SUITABLE WAY FOR THE FUTURE DELIVERY?

Between weeks 28 and 32, the baby will be placed in a cephalic position , the most suitable for delivery, that is, with the head down, looking back and with the spine following the same direction as the mother’s. Thus, when the phase known as fetal descent begins , the baby descends a little more, flexes its head, and snaps into place. Afterwards, it performs several rotations and extensions until the head comes out, and then the rest of the body.

Although as we say it is common for the baby to turn between weeks 28 and 32, it can still turn later if at that time it has not already done so. If they are large fetuses or with little amniotic fluid, it may be more difficult to position with the head down naturally.

WHAT IS THE BREECH POSITION LIKE?

It is possible that, despite all the previous exercises, at the time of delivery the baby will continue in breech presentation. If so, you may have taken different positions:

– The full breech presentation : The baby is actually sitting on the mother’s uterus. The buttocks supported down, the legs bent with the knees at chest level and the feet low, next to the buttocks. Similar to the classic fetal position, but in reverse.

– The frank breech presentation: As in the previous case, the baby is sitting, but the legs are not flexed as before, but are more stretched and the feet are raised above the head.

– Incomplete or breech breech presentation: With one leg positioned as in the complete breech and the other as in the frank breech. That is, with one of the legs (or both), the baby supports the foot on the uterus.

IN WHICH CASES IS THE BABY MORE LIKELY TO BE BREECH?

Although in any pregnancy the fetus may find it difficult to turn head down, there are some conditions that increase the likelihood of this happening:

– If labor starts prematurely, the fetus may not have turned yet.

– If it is a multiple birth, with two or more babies.

– If the mother has any abnormal shape of the uterus, presence of fibroids or too much amniotic fluid.

– If there is a placenta previa , when it is in the lower part of the uterine wall, blocking the cervix.

EXERCISES TO PROMOTE CEPHALIC PRESENTATION

There are a number of exercises or strategies to help the baby roll over and lie head down. In any case, the gynecologist or midwife should individually indicate the most appropriate for each woman , since there may be specific conditions or characteristics that favor or contraindicate these exercises:

– Swimming: Swimming calmly, upside down or simply floating in this position, seems to stimulate the baby to roll over.

– Yoga: Some typical Yoga postures , such as the “Mohammedan Posture”, or the “Cat Posture”, can also help the fetus to take the correct position.

– Exercises such as raising the hips, either lying on the floor, raising the legs in line with the wall taking a 90 degree angle or placing cushions and pillows in order to have the hips higher, can also help the baby to stop appear seated.

– Get on all fours and crawl for a few minutes a day.

– External cephalic version:Unlike the previous strategies, this maneuver must be carried out by a qualified professional. It is a non-surgical technique to try to turn the baby by manipulating the mother’s abdomen. Although it is not surgical, it must be performed in the hospital context, since an ultrasound must first be done to verify the exact position of the baby, monitor it to control it during the maneuver and probably provide the mother with medication to help relax the uterine muscles. It is a safe technique as long as it is carried out in the correct way and in the indicated cases. One of the risks that exist is that childbirth is triggered, so it will be the specialists who determine if the necessary conditions are in place to practice it.

In general, if delivery is approaching and the baby is still breech, it is very important for the mother to remain calm. Nerves and anxiety are never good companions .

WHAT IS DELIVERY LIKE IF THE BABY IS IN THE BREECH POSITION?

The moment of delivery arrives and the baby is still sitting on the uterus. It is time to decide how the delivery will take place and this may be different from one case to another.

Perhaps the doctors consider that it is not necessary to arrive at that moment and consider a planned cesarean section . In most cases, doctors opt for caesarean sections in cases of breech presentation, to avoid the main risks. These are that the baby gets stuck in the birth canal as the head is the largest and last part to emerge or that the umbilical cord becomes blocked or damaged during delivery, depriving the baby of oxygen.

That is why there are some cases in which it is especially contraindicated to try vaginal delivery :

– The baby is going to be premature .

– It weighs more than 4 kilos .

– It’s a multiple pregnancy.

– There is a placenta previa .

– There is fetal distress.

For these reasons, the first option is usually a cesarean section . However, if the doctors consider that the necessary favorable conditions are in place and the mother is willing, the option of vaginal delivery can be chosen. The frank breech position is the most favorable for attempting natural childbirth.