Breech position

Eva Rudolf-Müller is a freelance writer in the medical team. She studied human medicine and newspaper sciences and has repeatedly worked in both areas - as a doctor in the clinic, as a reviewer, and as a medical journalist for various specialist journals. She is currently working in online journalism, where a wide range of medicine is offered to everyone.

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At the end of pregnancy, a baby in breech position (breech position) does not lie with its head down in the womb, but with its pelvis. This is the case in around five percent of all births. The breech position can cause problems during vaginal birth, which is why the expectant mother is often advised to have a caesarean section. Read everything you need to know about the causes and risks of breeches here!

Breech position: Different shapes

There are different variations of breeches. In all of them, the child's head lies above and the pelvis below in the womb. However, the position of the legs is variable:

• Pure breech position: The baby has turned up its legs so that the feet are in front of its face. So the rump goes first at birth.
• Perfect rump-foot position: both legs are crouched, that is, the knees are drawn towards the stomach.
• Imperfect breech-foot position: one leg is crouched, the other is turned up as in the breech position.
• Perfect foot position: both legs are stretched out downwards; so the feet go first at birth.
• Imperfect foot position: one leg is stretched down, the other is turned up.
• Perfect knee position: The baby is "kneeling", so both legs have been bent backwards.
• Imperfect knee position: The baby only "kneels" with one leg while the second is turned up.

The breech position is the most common form of breech position. Foot and rump-foot positions follow in second and third place. The knee position is very rare.

All breech variants are considered to be high-risk births that require special monitoring. The children may have to be delivered by caesarean section.

Causes of breech position

There can be very different reasons if a baby has not turned in such a way by the due date that the head is down and the previous part emerges first at birth:

For example, breech can occur in a premature birth if the fetus has not yet turned at all at the time of the premature birth.

In multiple pregnancies, the two twins are twisted to each other in about a third of the cases, that is, one twin lies in the skull position, i.e. has the head down, and the other twin lies in the breech position, i.e. has the bottom down.

Even if the child is very big and therefore cannot turn so well, the breech position often results. The same applies if the child moves very little or too much in general or does not have enough room to turn due to an abnormality in the uterus or a narrowed pelvis.

An unfavorably positioned placenta and an umbilical cord that is too short are other possible reasons: They can prevent the child from turning from the breech position into the skull position in good time.

Breeching poses risks

A breech position of the child poses a problem in a vaginal birth. If the buttocks (or if the feet are in position, the feet / feet) emerges first as the preceding part of the child, the cervix will not open as well as in the case of the smaller circumference of the rump Passage of the head. As the birth progresses, the umbilical cord lies between the last head to emerge and the mother's birth canal. Since the head is the largest part of the child, the umbilical cord is pinched and the baby is briefly undersupplied with oxygen. If this period of undersupply is only short, this is not a problem for the child. If it is longer, however, damage to the child can be expected.

External turn in breech position

Three to four weeks before the calculated delivery date, the doctor can still attempt an external turn if the child is in the breech position. The doctor tries to turn the child from the outside with gentle, pushing movements in the uterus so that it does a somersault, so to speak, and the head comes to rest on the bottom. During this process, the child is monitored with the contraceptive chart (CTG).

The outer twist success rate is 50 to 70 percent. In the event that the attempt fails, everything should be prepared for an emergency caesarean section.

Prerequisite for a vaginal birth from breech position

If the baby meets a few requirements, a vaginal birth will be attempted in the clinic despite the breech position. The child should not be heavier than 3500 grams. In addition, the baby's waist circumference should not be significantly smaller than the head size, so that the birth canal is stretched when the abdomen emerges so that the head does not take too long to be born afterwards. The head should then emerge within 20 to 60 seconds. The expectant mother should receive epidural anesthesia (PDA) for better relaxation and faster delivery.

Caesarean section in breech position

If a vaginal birth is too risky for the mother and / or child for various reasons (for example, if the child has a large head circumference or fetal growth retardation), the doctor will always recommend a caesarean section for breeches - even if the risk for the woman is one Caesarean section is ten times larger than a vaginal delivery.

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