Patient information Breech presentation 1. Summary 2. What is breech presentation? At the end of the pregnancy, some In breech presentation, the head of the children lie in breech presentation: with child lies towards the top of the uterus. the buttocks down and the head up. If the buttocks lie by the exit of the Early in the pregnancy breech pelvis, it is referred to as frank breech. presentation is quite normal but at the The legs can also lie underneath the end of the pregnancy the child typically buttocks, which is referred to as lies with its head at the bottom. It is complete breech. usually unclear as to why a child remains in breech presentation at the end of a pregnancy. There are some situations with an increased chance of breech presentation: if you are pregnant with twins or more; if the uterus or pelvis has an unusual shape; if the placenta or a uterine fibroid lies in front of the exit; if the child has congenital abnormalities. Complete breech: with the knees bent so If your child still has breech presentation that the feet lie next to the buttocks. 36 weeks into the pregnancy, the gynaecologist or obstetrician can try to rotate the baby. In the event of a breech presentation at the end of the pregnancy you can choose between a caesarean section or a vaginal birth. A child with breech presentation can usually be born vaginally. The buttocks or feet of the baby will appear first. In the Netherlands, gynaecologists have agreed on a number of conditions under which a standard, vaginal birth is safe, also for a breech birth. Frank breech: with the legs upwards along the body. Bestelnummer: 3749 www.ziekenhuisamstelland.nl/en Versie: februari 2018 position of the placenta and potential uterine fibroids or other abnormalities that may block the entrance of the pelvis. 6. What happens if the baby is still in breech presentation at 36 weeks? If your child is still in breech presentation at 36 weeks or later there are three further options: the physician tries to “rotate” your child into cephalic presentation; a vaginal birth in which the buttocks Incomplete breech: one leg in frank or feet emerge first; breech, one leg in complete breech. a caesarean section 39 weeks into the pregnancy. 3. How often does breech presentation occur? Your physician will discuss with you Early in the pregnancy many children which options are realistic in your have breech presentation. Most children situation. rotate during the pregnancy themselves. Around the expected due date less than 7. Rotating a child in breech 3% of children have breech presentation. presentation 4. Why does a child have breech Why is a child in breech presentation presentation? rotated? In more than 85% of pregnancies, it is The risks for child and mother are the unknown as to why a child has breech lowest during a vaginal birth with presentation around the expected due cephalic presentation. date. There are some situations with an increased chance of breech presentation: When is a breech presentation rotated? Many children will rotate themselves into in a multiple pregnancy; cephalic presentation before 36 weeks if the uterus or pelvis has an unusual into the pregnancy. Therefore, it is shape; practical to rotate the child right after if the placenta or a uterine fibroid lies this period. Sometimes it is better to do at the entrance to the pelvis; it a bit sooner or later. This typically has if the child has congenital to do with the amount of amniotic fluid. abnormalities. It is almost always possible to try to rotate the child right up until the birth 5. Breech presentation examination In the event of breech presentation, your How is rotation performed? abdomen will be examined via In some hospitals, a child with breech ultrasound. The physician or ultrasound presentation is rotated at the outpatient technician observes whether your child clinic but it is also possible that you will has significant congenital abnormalities. be admitted for it. The gynaecologist, a This rarely occurs but such abnormalities resident or an obstetrician who works at can be the cause of breech presentation. the hospital will try to rotate the child. The physician or ultrasound technician You will lie on a bed or an examination also looks at the position of the baby’s table. Before one begins the rotation, the head, the amount of amniotic fluid, the physician will monitor the heart sounds (CTG, cardiotocogram) and the position The smaller and heavier you are the of the child. In some hospitals you will more difficult rotation becomes. receive an injection or tablet with a pain- During the first pregnancy, the suppressing medication to ensure that uterus is still firm and rotation has a the uterus does not contract. This can lower chance of success than in the cause your heartbeat to increase for a second or third pregnancy. few hours and you may suffer from heart palpitations. The average chance of success is approximately 40%. It is important that you lie as relaxed as possible so your abdominal muscles do During pregnancy with twins, it is not not tighten. A pillow under your knees possible to rotate either child and in the may feel better. When you find a event of high blood pressure or scarring comfortable position the obstetrician or in the uterus, the gynaecologist can physician will hold the child. One hand sometimes decide not to rotate the child. holds the buttocks of the child, just Possible consequences and complications above the pubic bone and tries to rotate from rotation them upwards. The other hand holds the There are no dangers for the mother. top of your abdomen and tries to push You may receive medication to relax the the head down. This way the child turns uterus. This medicine can cause side its head downwards. The length of the effects but these will always pass. The rotation varies from less than 30 seconds wall of the abdomen can be sensitive and to more than 5 minutes. Sometimes, if painful for a few days because of the the buttocks of the child have settled pushing. This is uncomfortable but does into the pelvis, the assistant pushes no real harm. them upwards via the vagina to facilitate the rotation. Afterwards, the heartbeat After the rotation the heartbeat of the of your child will be monitored again via baby sometimes slows a bit but it almost a CTG. always returns to normal. In very rare cases (less than 1%), the heart sounds How often is rotation of the child remain abnormal and a caesarean successful? section is immediately necessary. It is not predictable whether rotation of the child will be successful. In general: After the rotation the earlier in the pregnancy it is and the If the child is rotated successfully, you more amniotic fluid there is, the easier it can, in principle, give birth at home is to rotate the child. This also has a (unless you have another reason for a drawback: if it is easy to rotate the child hospital birth). The child can return to then the chance that child will return to breech presentation on its own. that position is also high. Your physician or obstetrician can In a number of situations rotation is consider another rotation, which usual more difficult: occurs after a week. If the child remains in breech presentation then you must In a far advanced pregnancy the stay at the hospital for monitoring of the amount of amniotic fluid is lower, pregnancy and the birth. which makes it more difficult to rotate the child. Women with rhesus negative blood If the placenta lies by the front wall groups receive an injection of anti-D of the uterus it is more difficult to after a rotation attempt, whether the grasp the child for rotation. rotation of the child is successful or not. For more information, see the pamphlets breech occurs the same way, but one or Pregnant, general information and Blood both of the legs exits first. group, rhesus factor and irregular antibodies. Monitoring of the heartbeat typically occurs, either externally, via the 8. Vaginal birth with breech abdomen, or internally, via an electrode presentation on the buttock of your child. How does a standard birth with breech Possible complications for the mother presentation progress? The chance of complications for the In many ways, a breech birth is similar mother is not greater during a breech to a birth with a child in cephalic birth than during a birth with cephalic presentation. There are also three presentation. There is, however, a phases: dilation, expulsion and the greater chance that the gynaecologist period after the birth. decides for a caesarean section. The dilation phase often progresses Possible complications for the child somewhat differently in a breech birth. Directly after the birth Children in breech The buttocks, legs and feet lie at the presentation who undergo a standard bottom and press on the cervix. These (vaginal) birth, are more often admitted are smaller than the head and can get to the incubator room shortly after the through the cervix more quickly. You birth than children born via caesarean may feel the need to push before section. After a standard birth after 38 complete dilation occurs because of this. weeks of pregnancy, approximately 1 in The physician or obstetrician will then 20 children require time in an incubator ask you to stop pushing. and that is ten times more frequent than after a caesarean section. There are Expulsion occurs exactly as with a child various reasons for admission.