Breech and other unusual deliveriesBBreech and other unusual deliveriesBreech and other unusual deliveriesEnglishPregnancyAdult (19+)Body;UterusReproductive systemNAPrenatal Adult (19+)NA2009-09-11T04:00:00ZNicolette Caccia, MEd, MD, FRCSCRory Windrim, MB, MSc, FRCSC11.000000000000046.00000000000001459.00000000000Flat ContentHealth A-Z<p>Learn about breech delivery and the delivery of babies in other unusual positions in the uterus, such as posterior position and transverse position.</p><p>Usually, toward the end of pregnancy, the baby positions themselves head-down, facing their mother’s back, and the top of their head comes through the birth canal first. Sometimes though, the baby may assume another position, which can make vaginal delivery more complicated. The baby may be head-down but facing their mother’s tummy or another direction. Or they may be feet-down, or knees or buttocks down, in what is called a breech position. </p><h2>Key points</h2> <ul><li>In some cases, the baby may position themselves in a breech, posterior, face or transverse position.</li> <li>Depending on the position of the baby, a vaginal birth may be attempted but sometimes a C-section is required.</li></ul>
Accouchement par le siège et autres accouchements inhabituelsAAccouchement par le siège et autres accouchements inhabituelsBreech and other unusual deliveriesFrenchPregnancyAdult (19+)Body;UterusReproductive systemNAPrenatal Adult (19+)NA2009-09-11T04:00:00ZNicolette Caccia, MEd, MD, FRCSCRory Windrim, MB, MSc, FRCSC11.000000000000046.00000000000001459.00000000000Flat ContentHealth A-Z<p>Apprenez-en davantage sur les accouchements par le siège et les accouchements où le bébé adopte une position inhabituelle dans l'utérus, comme la position postérieure et la position transverse.</p><p>Habituellement, vers la fin de la grossesse, le bébé se place tête vers le bas, face au dos de la mère et la couronne de sa tête passe dans le canal génital en premier. Cependant, le bébé peut parfois prendre une autre position, ce qui peut compliquer l'accouchement vaginal. Le bébé pourrait se positionner avec la tête vers le bas mais face au ventre de sa mère ou dans une autre direction. Il pourrait également se présenter par les pieds, les genoux ou les fesses, ce que l'on qualifie de « présentation par le siège ».</p><h2>À retenir</h2> <ul><li>Dans certains cas, le bébé pourrait se présenter par le siège, en position postérieure, de face ou en position transverse.</li> <li>En fonction de la position du bébé, on peut tenter un accouchement vaginal, mais parfois une césarienne est nécessaire. </li></ul>

 

 

Breech and other unusual deliveries412.000000000000Breech and other unusual deliveriesBreech and other unusual deliveriesBEnglishPregnancyAdult (19+)Body;UterusReproductive systemNAPrenatal Adult (19+)NA2009-09-11T04:00:00ZNicolette Caccia, MEd, MD, FRCSCRory Windrim, MB, MSc, FRCSC11.000000000000046.00000000000001459.00000000000Flat ContentHealth A-Z<p>Learn about breech delivery and the delivery of babies in other unusual positions in the uterus, such as posterior position and transverse position.</p><p>Usually, toward the end of pregnancy, the baby positions themselves head-down, facing their mother’s back, and the top of their head comes through the birth canal first. Sometimes though, the baby may assume another position, which can make vaginal delivery more complicated. The baby may be head-down but facing their mother’s tummy or another direction. Or they may be feet-down, or knees or buttocks down, in what is called a breech position. </p><h2>Key points</h2> <ul><li>In some cases, the baby may position themselves in a breech, posterior, face or transverse position.</li> <li>Depending on the position of the baby, a vaginal birth may be attempted but sometimes a C-section is required.</li></ul><h2>Breech position</h2> <p>In most vaginal deliveries, the baby’s head passes through the birth canal first and the rest of the baby’s body follows. In a breech delivery, the baby’s feet, knees, or buttocks appear first. Fifty to 70% of breech babies have their legs extended up along their body in a pike position where the feet are by the ears. Some have both legs pulled up in a cannonball position. Others have at least one leg extended downward. </p> <p>A breech position during pregnancy is not necessarily a cause for concern. Many times a baby may assume the breech position during pregnancy, but then will flip into the traditional head-down position shortly before delivery. However, in about 3% to 5% of deliveries, a baby will assume the breech position shortly before childbirth and stay in that position until delivery. </p> <p>Breech delivery is a complication during childbirth because the largest part of the baby’s body, the head, is last to pass through the birth canal. Sometimes in a vaginal breech delivery, the body can fit through the birth canal but the head becomes stuck. Also, in a breech delivery, the umbilical cord can become compressed, cutting off oxygen flow to the baby. </p> <h3>Delivery by caesarean section</h3> <p>Because of the complications associated with vaginal breech delivery, many health-care providers prefer to deliver these babies by caesarean section. In fact, about 90% to 95% of all babies who are in breech position are delivered in this way. About 10% to 15% of all caesarean sections are done because the baby is in a breech position. The chances of having a caesarean section for a breech baby are highest in the following circumstances: </p> <ul> <li>if the baby is large </li> <li>if there is a problem with the shape of the mother’s pelvis, or if the pelvis is determined to be small </li> <li>if the mother has pregnancy-induced hypertension requiring immediate delivery </li> <li>if the fetal membranes have ruptured and labour has not started within 12 hours </li> <li>if there are problems with the mother’s uterus </li> <li>if the baby has one or more feet extended downward below their body </li> <li>if the baby is healthy but premature at a gestation of 25 weeks or more </li> <li>if there is severe fetal growth restriction </li> <li>if the mother has had previous babies who suffered or died from birth trauma </li> <li>if the mother wishes to have her tubes tied </li></ul> <h3>Vaginal breech delivery</h3> <p>If a baby is in the breech position, it may still be possible to plan to have a vaginal birth. The baby should be full-term. Women pregnant with a baby in the breech position who wish to deliver vaginally should have a pre- or early-labour ultrasound to assess the position of the baby, size, weight, and position of the head. If no ultrasound is available, a caesarean section is recommended. A woman should not plan to have a vaginal delivery if the baby is unusually small or large, if the baby has any type of birth defect, if there is a problem with the umbilical cord, if the mother's pelvis is unusually small compared to the baby's head, or if the baby is in an unusual breech position. </p> <p>Alternately, if a woman arrives at the hospital fully dilated and there is no time for a caesarean section, she may need to deliver vaginally. </p> <p>There are three types of vaginal breech deliveries:</p> <ul> <li>spontaneous breech delivery, commonly used in premature births, where the baby is not manipulated in any way during childbirth </li> <li>assisted breech delivery, the most common type of vaginal breech delivery, where the baby is allowed to come out without intervention until their umbilical cord emerges, after which the doctor uses special maneuvers to deliver the body, arms, and legs </li> <li>total breech extraction, where the feet are grasped and the entire baby is extracted through the birth canal, only used for the delivery of a second twin, since the cervix is already dilated from the delivery of the first twin </li></ul> <p>An anaesthetist should be available at all times during a vaginal breech delivery in case complications develop during labour and delivery. If complications do arise, the mother may need general anaesthesia and/or a caesarean section. A paediatrician should also be on hand for when the baby is born. </p> <h3>External cephalic version</h3> <p>External cephalic version (ECV) is when the doctor places their hands on the outside of the mother’s abdomen and uses a series of maneuvers to rotate the unborn baby into the head-down position. The procedure may be done under a regional anaesthetic such as an epidural or spinal block. An ultrasound is usually used to monitor the baby’s position in the womb and the baby’s well being. After moving the baby into place, the doctor may induce labour right away or wait for labour to begin on its own. </p> <p>The success rate of ECV varies widely from 35% to 85%. Women who have given birth to previous babies tend to have a higher success rate with ECV. Success rates also vary depending on the type of breech position. </p> <p>There are some women with breech babies who should not have ECV:</p> <ul> <li>women who should not give birth vaginally, such as those with placenta previa or herpes simplex virus </li> <li>women with problems with the volume of amniotic fluid in the womb </li> <li>women with an abnormality in their uterus </li> <li>women carrying babies with fetal growth restriction or birth defects </li></ul> <h2>Posterior presentation</h2> <p>Sometimes the baby is in the head-down position but faces their mother’s front instead of her back. This is called the posterior presentation. In 90% of cases, the baby will rotate to face their mother’s back at some time before delivery. However, in the 10% of cases where this does not happen, the baby’s head does not fit as well into the mother’s pelvis. </p> <p>When the baby is in a posterior position, the bony part of the baby’s head presses against the mother’s bony pelvis. As each contraction pushes the baby’s head into the pelvis, the mother can experience severe back pain. The birth of a baby in posterior position can be especially long and exhausting for the mother. Regional blocks such as epidurals can help relieve the pain but do not always block the pain entirely. The doctor can try to rotate the baby into an anterior position, either with their hands or with forceps, but these attempts are not always successful. Sometimes a caesarean section is required. </p> <h2>Face presentation</h2> <p>Face presentation is when the baby is head-down and their head is arched backward. The back of their head touches their back. The baby’s face, usually their chin, appears first through the birth canal. This type of position occurs in about 0.2% of births. </p> <p>There are a number of causes of face presentation. The mother’s pelvis may be too small, or the baby too big. The baby may have their umbilical cord wrapped around their neck, causing the head to arch backwards. Birth defects such as anencephaly, where the baby’s brain has not developed, can also lead to face presentation. The diagnosis of face presentation can be confirmed by ultrasound if necessary. </p> <p>Sometimes during vaginal delivery, the baby’s face converts naturally to a more favourable position. The doctor should not try to manually rotate the baby’s face into a better position. The careful use of forceps may be needed to deliver the baby’s head. The success rate of vaginal delivery in face presentation is quite good at 60% to 70%. Babies in face presentation who are born vaginally often have swelling on their face once they are born. </p> <p>About 12% to 20% of babies in face presentation will require a caesarean section. A caesarean section is done if labour stops or if the baby has a nonreassuring heart rate as measured on a fetal monitor. </p> <h2>Transverse lie</h2> <p>Transverse lie is when the baby’s body lies across the mother’s uterus. In a transverse lie position, the baby’s shoulder presents to the birth canal first. Transverse lie occurs in about 0.3% of births. This position is sometimes called shoulder presentation. It is often an easy position to diagnose, because the mother’s abdomen appears unusually wide. </p> <p>If the baby is in a transverse lie position, a vaginal delivery should not be attempted. This is because, if a vaginal delivery is allowed to happen, the baby’s shoulder can become tightly wedged in the birth canal and their arm can fall through the mother’s vagina. The shoulder can then become stuck in the pelvis and the mother’s uterus will contract vigorously to overcome this obstacle. Eventually the uterus will rupture. Because of the risks associated with vaginal delivery, babies in the transverse lie position are delivered by caesarean section. </p>https://assets.aboutkidshealth.ca/AKHAssets/breech_and_other_unusual_deliveries.jpgBreech and other unusual deliveries

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