Breech baby: everything you need to know.

What week does the baby turn in the womb?

“Usually the fetus turns to place itself in a head position – head down – around the 26th week of amenorrhea », Indicates the obstetrician-gynaecologist.
At 28 weeks of amenorrhea (SA) only 20% of the babies are breech and at 33 SA, ie at the time of the 3rd ultrasound, only 10 to 15% have not yet rolled over. It is then estimated that between the 33rd and 35th week of amenorrhea, a third of these latter refractories will eventually return spontaneously before delivery.

Causes: Why do some stay put?

While the exact reasons that prevent a baby from rolling over are often unknown, several physiological causes have been identified:

– A malformation of the uterus – such as a uterine septum – or a placenta that is placed too low
– A uterus too narrowwhich can force the baby to limit his movements
– Conversely, a very large uterus, swollen from several previous pregnancies, causing the baby to turn constantly
– A hypercontractile uterus, which hardens with every movement of the fetus and can prevent it from rolling over
– An amount insufficient amniotic fluid

Until when can a baby turn around in the womb?

If it is more difficult for him from the 37th SA, the baby will still probably turn around until the last minute before delivery, provided he has the opportunity. It is for this reason that we can try, in a more or less natural way, to help the fetus position itself upside down before delivery.

The VME, version by external maneuver

If the baby is still in a breech position around the 37th SA and the mother wants to give birth vaginally, but prefers to avoid vaginal delivery in a breech position, we can offer her the version via external maneuver (VME).

dr. Maticot-Baptista: The VME is not a light gesture, it is an exercise done in the obstetric block, by an obstetrician doctor, under supervision, ultrasound and perfusion. Not all midwives offer it and the mother’s consent is required.

Furthermore, the chance of success is not very high, because it is between 40 and 63% alone. Success increases when the baby is in a full breech position and when there is a significant amount of amniotic fluid. Conversely, it decreases in incomplete breech presentation, in primiparous mothers, and in mothers with an anterior placenta.
“The risks of VME are the breakage of the bag of water and an emergency cesarean section,” says the gynecologist.
Also be careful, this maneuver has a certain number contraindications : scarred uterus, uterine malformation, abnormal placental placement, fetal distress, etc.

What about acupuncture to turn the baby?

l’acupuncture may be suggested to the mother-to-be to try to return the baby in utero, although this discipline has not really proven its effectiveness and is therefore not recommended by the National Obstetrical College of France (CNOF). “On the other hand, it’s a risk-free methodwidely appreciated and requested by patients,” adds Dr. Maticot Baptista.
It consists of stimulate point BL67, on the outside of the nail of the big toe.

Can an Osteopath or Chiropractor Help the Baby Roll Over?

As the osteopaths and the chiropractors are by no means qualified to manipulate the fetus through the mother-to-be’s abdomen, instead they may work on the adjacent structures to try to free up space to allow for the turning of the fetus. In particular, they act on the mobility of the muscles and ligaments of the pelvis, lumbar region and psoas.
These manipulations have not proven their effectiveness, but can be tested without fear by the future mother.

The Indian Bridge

From the 32nd week of pregnancy, the expectant mother can also try to encourage the baby to turn around using a simple pose, which is performed for about 15 minutes daily. This pose, derived from hatha yoga, is known in Sanskrit as the half bridge or “Ardha-setu-bandhâsana”.
It consists of lying on your back, legs bent and raising your pelvis about 1 foot above the ground. This position is intended to allow the baby’s buttocks to slide out of the mother’s pelvis. If the position is difficult to maintain, the expectant mother can place a pillow or support under her buttocks.

Complete chair or unfinished chair: what’s the difference?

When the baby is sitting cross-legged, with his legs under his buttocks, he is fully breech. When his legs are up and his feet are level with his head, we speak of an unfinished chair. Finally, it happens that he has one foot under his buttocks and the other up, we say that he is sitting on a half-finished chair.

Baby in a transverse position: mandatory caesarean section

In rare cases, the baby does not lie head up or down, but lies horizontally in the womb. It is then the baby’s shoulder that presents itself first in the birth canal, which is definitely unfavorable. These babies, which are called transverse, are therefore systematically born by cesarean section.

Baby still breech: is vaginal delivery possible?

If “breech baby” has long been synonymous with “cesarean section”, most maternity hospitals now offer vaginal deliveries to mothers-to-be whose babies have not been turned over. Although more delicate than the cephalic presentation, thepod delivery is no more risky than a cesarean section, which remains a major operation and is prone to complications for both the baby and the mother.

dr. Maticot-Baptista: From the 8th month, ie the 35th week of amenorrhea, the mother is asked whether or not she consents to vaginal delivery. It is always the mother who has the last word on health personnel.

If she refuses, she will be offered a cesarean section on SA 39, two weeks before the expected delivery date.

“If the mother agrees, we do a pelvic scan to make sure the patient can give birth vaginally in a breech position,” says the specialist. The baby should not be too big compared to the mother’s pelvis.
Once the green light has been given, an attempt at vaginal delivery is made, systematically under an epidural. “On the other hand, there is no systematic episiotomy, as we sometimes hear it said,” assures Dr. Maticot-Baptista.

All preparatory precautions are taken to ensure a perfect vaginal delivery. “The breech delivery must be ‘brilliant’: it is necessary that the dilation goes well and that there is no stagnation; if not, it’s a caesarean section,” sums up the midwife. Tweezers should be present on the table during a breech delivery, as their use is more frequent than in cephalic presentation.
In addition, the presence of an obstetrician, anesthetist and a pediatrician is required in case of final head retention.

There are several obstetric maneuvers that facilitate the passage of the baby in a breech position:
– The Lovset maneuver, which helps free the baby’s arms
– The maneuvers of Mauriceau or Bracht, which help to get your head out.

At the slightest abnormality in the heart rate or the slightest suspicion of fetal distress, the doctor may decide to perform an emergency cesarean section.

In short, for two-thirds of babies in breech presentation, the decision in principle is to cesarean sectionand for the remaining third, the low road is attempted, with about 70% success.

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