Is a natural birth possible?

A natural birth is also possible with the breech presentation. However, since natural birth is more difficult in the breech presentation than in the skull presentation, it is important to contact an experienced birth centre that is well versed in breech presentation. Good care and organisation of natural childbirth in the breech presentation are crucial and important.

Furthermore, some conditions must be fulfilled for a natural birth in the breech presentation: the birth must only take place after the 34th week of pregnancy, the child must not be in a pure foot or knee position, the child must have a normal birth weight (neither too heavy nor too light), and malformations and other factors that would prolong the birth process must be excluded beforehand. Finally, the mother must not have any additional risks, such as diabetes mellitus. During the birth process, permanent monitoring of the child via CTG is important.

In addition, a local anaesthetic (epidural or epidural) can help the mother against the pain and during the birth by relaxing the muscles. Performing natural childbirth from a breech presentation involves some risks. First of all, there may be a prolonged duration of the birth (protracted birth), which carries further risks for the baby and also for the mother.

The stress can lead to hyperacidity (acidosis) of the child, as well as to a deterioration of other blood gas values of the child (pO2, pCO2). Therefore a quick birth is important in order not to endanger the child in this phase. Furthermore, it can lead to a prolapse of the umbilical cord or prolonged compression of the umbilical cord resulting in a lack of oxygen.

In case of an umbilical cord prolapse, the birth must be terminated immediately, if this is not possible, an immediate caesarean section is indicated. In addition, a prolapse of the arms or feet may occur. In this case the arms or feet are pushed upwards and have to be released again by the obstetricians by certain hand movements.

If the birth of the head is difficult, damage to the child is rarely possible, such as damage to the brachial plexus, head injuries, fractures or bruising. In addition to the risks for the child, the risks for the mother should not be underestimated. Therefore, in some cases of natural birth from the breech presentation, a secondary caesarean section is nevertheless necessary, for example in the case of premature abortion, which is more frequently observed in births from the breech presentation. Therefore, the complications of a Caesarean section must always be explained. Further risks are mainly pelvic floor trauma due to perineal tears or other vaginal injuries during birth.

Complications

In contrast to birth from the cranial position, infant mortality during birth from the breech presentation (BEL) is increased by 4%, but this is mainly due to the fact that the proportion of premature births is higher in BEL. In addition, there may be a delayed birth process up to birth arrest because the head and thus the largest part of the body is born at the end and the breech does not stretch the birth canal sufficiently. Umbilical cord prolapses occur much more frequently than normal, because the rump does not seal the birth canal sufficiently.

This can lead to a lack of oxygen for the child. The umbilical cord can also be trapped between the head and the pelvic wall during birth of the head. In this case the child should be born within 3-5 minutes to prevent suffocation.

Another serious complication is cerebral haemorrhage (intracranial haemorrhage), which is caused by a tear in the cerebellar roof (tentorium cerebelli) and can be fatal depending on the size and strength of the haemorrhage. There is also the risk of plexus paralysis, a paralysis in the area of the shoulders and arms, which is mainly caused when the arms are raised during the birth process. Other injuries, such as a dislocation of the hip (hip luxation) or fractures of the collarbone or arms can also occur. The mother may have wounds in the vaginal area or perineal tears during birth. A dreaded complication in foot positions is a rupture of the cervix during birth of the head, which is life-threatening.