Feet First—Breech Presentation

Managing Breech Presentation

Cesarean delivery is currently the most popular approach to seeking the best outcome for these babies. We must consider, however, the increased risks to the mother that come with Cesarean section. It's true that the complication rate in private practice is low, but it's still higher than with vaginal delivery.

So the answer seems to lie with convincing these little babies to assume a head-first presentation. That sort of diplomacy is called external cephalic version, a technique in which the baby is physically turned to the head-first position. This can be a rather forceful procedure involving two physicians, one pushing against the mother's abdomen, the other doing a pelvic exam to exert pressure there.

This technique fell into disfavor because mothers really weren't crazy about it, and there seemed to be a feeling that there was probably a pretty good reason for the baby to be breech in the first place.

In the past, this procedure didn't fare well (not to mention it being rather uncomfortable for the mother-to-be). Perinatologist Dr. Steve Fortunata, MD, espouses the newer thinking on the subject. The reason version failed often in the past was that the patients who were scheduled for version may not have been selected very well (and chances are, for these women versions should have been passed over in favor of a C-section).

Now, criteria are in place to help doctors decipher just who's the best (and safest) candidate for a version. Doctors consider points such as how low the breech baby is and where the back is placed in the womb, making versions safer and frequently successful. Ultrasonographic guidance and gentle manipulation while a drug that relaxes the womb is used have made the procedure desirable once again. Add to that the need to bring down C-section rates and suddenly it begins to make a lot of sense.