Full or incomplete seat?
On the day of delivery, 4-5% of babies are breech-presented, but not all are in the same position. The full seat corresponds to the case where the baby is sitting cross-legged. Seated is when the baby has his legs up, with his feet at head height. And there is also the semi-completed seat, when the baby has one leg down and one leg up. Most often, the legs go up along the body, the feet reaching the level of the face. This is the siege unfulfilled. If the birth is vaginal, the infant’s buttocks appear first. The baby can also be sitting with bent legs in front of him. When crossing the pelvis, he unfolds his legs and presents his feet. By vaginal route, this childbirth is more delicate.
The testimony of Flora, mother of Amédée, 11 months:
«It was on the 3rd month ultrasound that we knew that the baby was presenting siege unfulfilled (buttocks down, legs outstretched and feet next to the head). On the advice of the ultrasound machine, I did acupuncture, osteopathy and an attempt at a manual version, but he did not want to turn around. In my case, a cesarean was scheduled because of the narrowness of my pelvis but vaginal birth is quite possible if certain conditions are met. We continued the childbirth preparation course in case baby turns around at the last moment. The midwife who was preparing us was great. She explained to us the specificities of these deliveries: the presence of a reinforced medical team, difficulties for the caregivers to perform certain maneuvers to help the expulsion, etc.
The midwife warned us
Above all, the midwife informed us of these little things that have no medical impact and that no one had told us about. She was the one who warned us that our baby would be born with his feet next to his head. It helped us, my partner and I, to project ourselves. Even knowing it, I was very surprised when I took the hand of my little end before realizing that it was his foot! At the end of 30 minutes his legs had come down well but he remained “in frog” several days. Our baby was born healthy and there were no complications. Despite everything, we saw an osteopath two weeks after the birth. We also had an ultrasound on his hips at one month and he had no problems. My partner and I were very well supported, all the caregivers we met always explained everything to us. We really appreciated this follow-up ”.
See our expert’s answer: Seat complete or incomplete, what’s the difference?
Baby is in seat: what can we do?
When the child is still in seat presentation at the end of the 8th month, the doctor may try to help him turn around. If there is sufficient amniotic fluid and the fetus is not too small, the doctor will perform an external maneuver, called a version.
In the maternity ward, the mother-to-be is placed under monitoring to ensure that she has no contractions and to control the baby’s heart rate. The gynecologist then exerts a strong pressure of the hand above the pubis, to bring up the buttocks of the baby. The other hand presses firmly on the top of the uterus at the child’s head to help it turn. The results are mixed. The baby only turns around in 30 to 40% of cases for a first pregnancy and this manipulation is very impressive for the mother-to-be who may fear that her baby will be hurt. Wrong of course, but it is not always easy to control your fears. You can also schedule an acupuncture session, with an acupuncturist midwife, or a professional who is used to pregnant women. A baby in a seat is one of the indications for the acupuncture consultation.
If the version fails, the doctor will assess the possibilities of a natural childbirth or the need to schedule a cesarean. The doctor goes take basin measurements in particular to make sure that it is wide enough so that the baby’s head engages it. This x-ray, called radiopelvimetry, will also allow her to check that the baby’s head is flexed. Because if the chin is raised, it would risk catching the pelvis during the expulsion. In view of the pictures, the obstetrician recommends whether or not to give birth vaginally.
How will the delivery go?
As a precaution, the Caesarean is often offered to women with a breech baby. However, except in cases of absolute contraindication, the final decision rests with the mother-to-be. And whether she gives birth vaginally or by cesarean section, she will be accompanied by an anesthetist, a midwife, but also an obstetrician and a pediatrician, ready to intervene in the event of complications.
If the pelvis allows it and if the baby is not too big, vaginal birth is totally possible. It will probably be longer than if the baby is upside down, because the buttocks are softer than the skull. They therefore exert less pressure on the cervix and dilation is slower. The head being larger than the buttocks, it can also get stuck in the uterine cervix, which requires the use of forceps.
If the baby is in a full seat, that the pelvis is not wide enough, a Caesarean will be scheduled between the 38th and 39th week of pregnancy, under epidural. But it can also be a choice because the mother-to-be does not want to take risks, neither for herself nor for her baby. However, knowing that this technique is never trivial: it is a surgical intervention with the risks that this entails. The convalescence is also longer.
Baby in seat: special cases
Can twins both be in seat? All positions are possible. But if the one closest to the exit is in the breech, the obstetrician will have to perform a cesarean section. Even if the second is upside down. Quite simply to prevent the head of the first from remaining in the pelvis and preventing the second from coming out.
Can some babies lie down with their backs first? The fetus can be in a transverse position, we also say “transverse”. That is, the baby is lying across the uterus, head to the side, his back or one shoulder facing the “exit”. In this case, the delivery will also have to be done by cesarean section.
In video: Why and when to perform pelvimetry, x-ray of the pelvis, during pregnancy?
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