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A fetus is said to be in a breech presentation when the
buttocks of the baby are presenting first at the bottom of the uterus, and
the head is in the upper part, or fundus of the uterus.
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In some cases, a baby in the breech position can be delivered vaginally; when
the legs and lower half of the body are out, the doctor when completes the
delivery of the shoulders and head, sometimes using forceps. Because of
the potential risk of complications in a vaginal delivery of a baby in a breech
position, many doctors now regularly deliver such babies by cesarean. If a
vaginal delivery is done, electronic fetal monitoring and
episiotomy are usually used.
Situations that make a breech presentation at the time of labor more likely
include:
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Preterm
labor and birth - if labor starts when the baby is still small enough to move
rather freely in the uterus.
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A placenta in the fundus - the placenta takes up some of the space in the
top of the uterus.
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An unusual shape of the mother's
uterus, or fibroids in the lower part of the uterus.
-
More than one fetus (such as
twins)
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A very relaxed uterus from many
previous children
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Too much or too little amniotic
fluid
A vaginal delivery may be attempted for a baby in the breech position
if:
-
The baby is in a frank breech
position its hips are bent and its l
egs
extend up.
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The baby is small enough (usually under 8 pounds) to pass easily through
the vagina.
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The pregnant woman has no obstetrical problems, such as placenta previa, that might complicate the delivery.
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The pregnant woman's pelvis is a normal or above average size.
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The baby has already descended well into the pelvis as labor begins.
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The baby's head is tucked down toward its chest - not extended.
In some cases of breech presentation, a doctor can try to r
eposition the baby
(called external version) late in pregnancy. Usually guided by ultrasound, the doctor uses his or her hands on the outside of the woman's
abdomen to try to manipulate the baby inside the uterus into the normal birth
position, with head down. Although this procedure can be uncomfortable for
the woman, it is sometimes a viable alternative to cesarean delivery. Because of the slight possibility of rupturing the membranes or causing labor to
begin, external version is attempted only when the baby is mature enough or
delivery.
Anything I can do to make him turn?
There has been a suggestion that spending 15 minutes every 2 hours of the
waking day in the knee-chest position will help the baby to turn (Elkin's
manoeuvre). Although the first report of this was very encouraging, subsequent
studies have not found it to be useful. There is some evidence that hypnotherapy
may be useful, though only one study has looked at this. Acupuncture has been
suggested and the results of a more formal study are awaited.
NOTE: Babies who are delivered after a breech presentation should have
their hips checked carefully for potential hip dislocation.
3-4% are
found to be breech. Before term, which is defined as 37 weeks, it doesn't
matter if the baby is breech, as there is always a good chance that she will
turn spontaneously. 
There are three types of breech presentations, frank, complete, and
incomplete. With a frank breech the legs are flexed at the hips and extended
at the knees so the feet are up by the head. With a complete breech presentation
one or both of the legs are