Natural breech birth: when it is possible and what the risks are
There are conditions in which it is possible to offer a vaginal breech birth to women who request it. Here’s when you can choose, what are the risks and the video of a real case.
More and more often, we hear on the net about the so-called natural breech birth , i.e. the possibility of giving birth vaginally even if the fetus is in the breech position, avoiding a scheduled caesarean section .
In this article we will try to clarify the indications and risks of this procedure, which can only be performed in very specific situations and in specialized centers with expert operators.
Natural breech birth: why not done routinely?
When the fetus is not properly positioned head down at delivery, doctors typically schedule a cesarean section . For what reason?
The reason is easily understandable. When the baby is ready to be born, the baby’s head presses on the cervix and stimulates it to dilate . If the fetus is in the breech position , the pressure in the buttocks and legs is less and it cannot achieve the same dilation. As a result, the head may have difficulty passing where the rest of the body has exited without problems, with possible risks for the child .
On the other hand, cesarean delivery still requires surgery and, as such, presents its own risks.
This is why, unless there are contraindications, around the 37th week of pregnancy the gynecologist will suggest that the expectant mother perform some maneuvers to try to turn the breech fetus upside down.
In addition, the fetal position will be checked by ultrasound until the time of delivery. Sometimes, in fact, the baby can rotate spontaneously even at the end of pregnancy, making natural birth possible .
When can you choose a natural breech birth?
In some situations, natural breech birth is not a choice, but a necessity. In the case of a hasty delivery , for example, the mother could arrive at the hospital when the baby is practically ready to be born. In this case, doctors will take all measures to reduce possible risks.
There are also conditions in which it is possible to offer a vaginal breech birth to women who request it. Naturally, the gynecologist will assess whether this option is feasible, depending on the specific situation.
Among the selection criteria to be able to perform natural breech birth we find first of all the following conditions:
- there must be no contraindications to vaginal delivery (e.g. placenta previa );
- the woman must not have had a previous caesarean section ;
- there must be no fetal anomalies that could complicate the passage of the child;
- the estimated fetal weight must be between 2 and 4 kg (no IUGR, no macrosomia);
- delivery must take place after 36 weeks of pregnancy ;
- labor must occur spontaneously ( no induction);
- the fetus must not have head hyperextension (ie head tilted back at an angle greater than 90°);
- the breech presentation must be frank or complete (see image below, upper right and upper left figures);
- expert personnel must be present .
Furthermore, there must be no alterations in the heartbeat .
Finally, it is good to know that doctors are unlikely to propose vaginal breech birth to a woman in her first pregnancy . Usually, in fact, this option is reserved for those who have already given birth naturally and therefore have “less tonic” tissues, which will stretch more easily as the baby passes.
How does natural breech birth happen?
A natural breech birth may be slower than a cephalic birth.
Usually, the first phase is simple waiting. If everything goes in the right direction, the fetus will rotate and allow the spontaneous expulsion of the whole body. At most, the operator will support the body in the final stages of ejection of the head.
In some cases, once the buttocks have been expelled, the gynecologist may have to implement maneuvers to facilitate the baby’s exit (in this situation, we speak of breech birth assistance).
Among these we find:
- the Lovset maneuver , which consists in grasping the fetus at hip level and gently rotating it to disengage the shoulders and arms and make the head come out spontaneously;
- the Mauriceau maneuver , which can be used to help disengage the head. It consists of placing the forearm under the child’s bust and the fingers at mouth level, to induce him to bend his head forward.
Leakage of meconium (the baby’s first stool) is a fairly common occurrence, but it usually has mechanical causes and is not a sign of fetal distress .
Natural breech birth: what are the risks?
Even in the presence of favorable conditions for proceeding with a spontaneous birth, there is still the risk of complications , which appears to be greater for women in their first pregnancy .
In particular, the newborn could experience an oxygen deficit or injuries of a traumatic nature.
For this reason, natural breech birth is offered only in specialized centers and must only be performed by expert operators .
Kathryn Barlow is an OB/GYN doctor, which is the medical specialty that deals with the care of women's reproductive health, including pregnancy and childbirth.
Obstetricians provide care to women during pregnancy, labor, and delivery, while gynecologists focus on the health of the female reproductive system, including the ovaries, uterus, vagina, and breasts. OB/GYN doctors are trained to provide medical and surgical care for a wide range of conditions related to women's reproductive health.