Diagnostics

First and foremost, the position of the child can be checked by ultrasound examination of the pregnant woman (sonography). A pelvic end position can thus already be detected in the preventive examinations during pregnancy. Furthermore, various hand movements (Leopold’s hand movements) are also possible in order to palpate the child’s head and breech and thus assess the position of the child. However, this method must be well mastered, otherwise misjudgements regarding the position of the child are possible.

What to do in case of breech presentation?

Depending on how high the risks for mother and child are, a natural birth can be performed in addition to a caesarean section. This should always be considered in conjunction with a doctor, as there are certain requirements for a natural birth in the final pelvic position. If these are not fulfilled, a Caesarean section should be performed.

Furthermore, a natural birth with breech presentation should be performed at a birth centre that is technically designed for high-risk births and has experience with births with breech presentation, as a natural birth from breech presentation is associated with additional risks. A birth in a birth centre or even a home birth is therefore not advisable due to the lack of medical equipment. Another possibility would be to perform an external rotation to bring the child into a normal birth position and thus avoid the complications of a breech birth.

After a detailed examination of the pregnant woman, the attending physician should make a recommendation as to which type of delivery seems most suitable. In order to avoid a caesarean section and the risks of a natural birth in the breech presentation, an external turn of the child can be performed at the end of the pregnancy. In principle, this is only carried out from the 36th week of pregnancy onwards in order to avoid the risks of premature birth.

Normally, the outer turn is carried out 2 to 4 weeks before the planned date of birth. In the external turn, the child is turned from a pelvic end position into a cranial position from the outside. There are various procedures for this, which are carried out by one or two obstetricians.

The child is monitored before, during and also after the attempt to turn the baby using CTG (computer tomography). After the successful turn, an ultrasound check is performed. Furthermore, the mother is given contraceptive medication before the start of the turn.

However, it must be remembered that the turn may not be successful. Only in about 50% of the cases the turn is successful. A second attempt should only be made in exceptional cases.

Furthermore, complications can occur during the external turn. For example, in rare cases, a premature detachment of the placenta is possible, but this can be registered via the applied CTG. Furthermore, umbilical cord complications or a premature rupture of the bladder are possible.

The most serious complication can be the intrauterine death of the child during, but also days after the attempt to turn the baby. However, this is only very rarely observed. If complications occur, a caesarean section is performed immediately to deliver the child. Whether an external turn is possible has to be clarified with the treating doctor beforehand, as there are special requirements for this as well. In some cases, the outer turn may not be performed, for example in case of premature rupture of the bladder or if the child is not developing well.