4% of babies present by the breech. What does this expression mean? What are the consequences on childbirth? What you need to know about presentation by seat.

Babies come for delivery upside down in the vast majority of cases. In 4% of pregnancies, the baby presents his buttocks below: this is the breech presentation (podalic presentation). If the baby is sitting cross-legged (legs bent under the baby’s bottom), it is called a full seat. If the baby presents his buttocks first with the legs extended towards the bust, the breech is said to be incomplete.

Breech presentation is diagnosed during the 8th month examination, by palpation of the uterus, and confirmed by ultrasound.

The breech presentation can be explained by a malformation of the uterus, a bad position of the placenta but most often no particular cause is found.

Several solutions may be offered to you to try to turn the baby over: alternative methods, such as acupuncture or osteopathy, or an attempt to turn the baby over in a hospital environment.

An attempt to turn the baby over (version by external maneuvers) can be carried out during the 8th month. It consists of trying to put the baby upside down by gentle pressure in the abdomen under ultrasound control. It is not very pleasant for the mother!

This maneuver is contraindicated in the event of a malformed uterus, placenta previa (insertion of the placenta at the level of the uterine cervix) or intrauterine growth retardation (IUGR).

The success rate of this technique is only 50 to 60%. A second version attempt by external maneuvers can be proposed. In case of failure, the question arises of the mode of delivery.

The perspectives of the mode of delivery for a breech presentation different depending on whether it is a complete breech or a complete breech (if it is a full breech, a cesarean section is scheduled), if it is a first pregnancy or not. The chosen delivery method (vaginal or cesarean delivery) also depends on your morphology, the estimated size and weight of the baby.

Two examinations provide the information necessary for the choice of the mode of delivery:

• Fetal ultrasound: it gives the measurements of the diameter of the baby’s head and makes sure that his head is flexed.
• Radiopelvimetry: this pelvic X-ray gives the exact dimensions of the different internal diameters of the maternal pelvis.

These measurements make it possible to ensure that the head measurements are compatible with the inner diameters of the mother’s pelvis, if the flexion of the head is correct but also to see what is the orientation of the baby’s head in the pelvis. .

Other elements are taken into account when deciding on the mode of delivery: the mother’s age which may or may not promote pelvic plasticity, her previous deliveries if it is not a first baby (course, weight and size babies…).

If all the elements are favorable and the parents agree for a vaginal birth, a natural birth is possible in some maternities for a complete breech. Some centers automatically schedule a Caesarean section for all presentations at the seat.

Note: in some cases, an emergency caesarean is necessary during labor.

The epidural is very strongly recommended for breech birth: obstetric maneuvers may be necessary to facilitate the birth and a caesarean section may be decided upon at any time. It also allows better relaxation of the perineum.

Breech birth is more laborious because it takes place upside down. The largest diameter (the head) indeed comes last!

The stages of breech birth

• The baby’s feet come out first. The head and the arms must be clear
• Then an arm emerges
• Lower limbs, thorax and both arms come out
• The head comes out last.

It is necessary that the expulsive maternal efforts be effective so that the baby is released in a progressive way and without help. Obstetric maneuvers may be necessary if this is not the case, only when the baby’s navel is at the level of the vulva.

Forceps are used if the baby’s head is stuck.

The breech delivery through the vagina is much more at risk for the baby, this because the risks of fetal asphyxia (baby lacking oxygen) are increased: the baby can get stuck during the progression in the pelvis.

When the delivery is not progressing well or the baby shows signs of distress, a cesarean section is performed urgently.

During a breech birth, the entire medical team is present: anesthesiologists, obstetricians, midwives, pediatricians.