What is Vaginal Breech Delivery?
Vaginal breech delivery refers to the process of delivering a baby vaginally when the baby is in a breech position. A breech position means that the baby’s buttocks or feet are positioned to be delivered first rather than the head. This is contrary to the more common cephalic (head-first) presentation.
Types of Breech Presentation
There are three main types of breech presentations: Frank Breech: The baby’s buttocks are aimed toward the birth canal, with legs sticking straight up in front of the body and feet near the head.
Complete Breech: The baby’s buttocks are pointed downwards with legs folded at the knees and feet near the buttocks.
Footling Breech: One or both of the baby's feet are positioned to deliver first.
Risks Associated with Vaginal Breech Delivery
Vaginal breech delivery carries higher risks compared to a cephalic delivery. Some of the primary risks include:Criteria for Vaginal Breech Delivery
Not all cases of breech presentation are suitable for vaginal delivery. Here are some criteria that may support a decision for a vaginal breech delivery: The baby is full-term, generally between 37 and 42 weeks of gestation.
The baby is estimated to be of a normal size, neither too large nor too small.
The mother has a normal-sized pelvis, assessed through clinical examination or imaging.
The healthcare team is experienced in managing vaginal breech deliveries.
The baby is in a frank or complete breech position.
Preparation and Monitoring
Preparation for vaginal breech delivery includes: Thorough prenatal counseling about the risks and benefits.
Continuous fetal monitoring during labor to detect any signs of distress.
Availability of a skilled obstetrician and a surgical team prepared for an emergency C-section if needed.
Procedure of Vaginal Breech Delivery
During a vaginal breech delivery, the process is as follows: The mother is closely monitored for signs of labor progression and fetal well-being.
Labor is typically managed without the use of
epidural anesthesia to allow the mother to push effectively.
Special maneuvers, such as the
Bracht maneuver or the
Mauriceau-Smellie-Veit maneuver, may be employed to assist in the safe delivery of the baby.
Immediate neonatal care is provided to address any complications.
Large baby size, which increases the risk of complications during vaginal delivery.
Fetal distress or abnormal fetal heart rate patterns.
Maternal health conditions that complicate vaginal delivery.
Lack of experience or expertise in the healthcare team for managing vaginal breech delivery.
Conclusion
Vaginal breech delivery involves delivering a baby in a breech position through the birth canal. While it can be a viable option under certain conditions, it carries higher risks compared to cephalic delivery. A thorough assessment and proper preparation are crucial to ensure the safety of both the mother and the baby. In many cases, a C-section may be the preferred method of delivery to minimize risks and complications.
