Breech Delivery

The diagnosis of breech is the third most common reason for cesarean section in our country. Any strategy to bring down overall cesarean section must deal with this issue. Somewhere between 2 and 4% of all babies are born in the breech position (butt first). At the present time virtually 100% of these babies are delivered by cesarean section in the outdated belief that it is the safest way for the baby; none will say cesarean is the safest way for the mother.

However, recent studies have called this entrenched idea into question. Many experts in the field now recognize that vaginal delivery is as safe as cesarean section for the baby as well as safer for the mother. In fact, our current strategy eliminates cesarean 75% of the time when the diagnosis of breech is made. . .

Here’s how we do it. If by our physical examination, any time past 36 weeks, we believe that the baby is breech, we order a sonogram. This helps us decide if this baby is a good candidate for external cephalic version . Opinions vary as to what makes a good candidate, but the amount of fluid around the baby, the position of the limbs, the general size of the baby as well as the mother, and location of the placenta all help us decide who to offer version. If the mother accepts our offer we schedule a birthing room at the hospital approximately three weeks before the due date. We generally administer an asthma medicine that relaxes the uterine muscles just as it relaxes bronchial muscle. Then after we apply some body oil (it cuts down on the chafing from my hands), I simply turn the baby head over heals. Sound elegantly simple? It is. I just catch the baby by the back of the head (by pressing on the mom's tummy) and the butt and do what is called a "forward roll maneuver". And that is why it is successful 50% of the time.

Once verted the baby seldom returns to the former breech position. Babies that aren’t breech don’t carry the high risk for cesarean- neat! But what if it’s still butt first? Some say that the vaginal delivery of a breech is a dead art and/ or foolish in this day and age. I am reasonably sure I’m not dead and I hope Iam not foolish, but I was trained by OB’s in the mid 1970’s who believed that vaginal breech delivery was at the highest level of their expertise. They took great pride in those skills and I still do. Here again it is almost unbelievably simple.

We let the patient labor. If the butt appears we catch the baby, if it doesn’t we do a cesarean. Honestly when we do it this way, 50% of the time the baby jumps right out. So there you have it, using our management we reduce section for breech by about 75%. Any questions ? E-mail us or give us a call. Some times simple really is best.