Pelvic end presentation is a position of the unborn child in the womb that deviates from the norm beyond the 34th week of pregnancy. In this position, the baby lies head up instead of down as in the normal cranial position. The rump or legs are at the bottom of the uterus. About five percent of all infants lie in a breech presentation at birth.
Forms of breech presentation
Until the 34th week of pregnancy, all unborn babies lie head up in the uterus. Then, with increasing lack of space, they turn on their own, head down, into the cranial position. If this rotation does not take place, it is referred to as a final pelvic position. There are different variants of this birth position. The most common form is the complete breech presentation, which accounts for more than 60 percent of all births. It is not uncommon for only one leg to be pointing upward. It is also possible that both legs of the child are pointing upward and the breech is at the bottom. In the complete breech-foot position, both legs are crouched. In the mixed forms, there are the knee positions (one or both knees down), the foot positions (one or both feet down).
Causes
About half of pelvic end positions have no medically identifiable cause. In more than 50 percent, the mother is a first-time mother, and a familial cluster can also be detected. Women and men who have themselves given birth as a pelvic end presentation are up to three times more likely to have a pelvic end presentation child. Multiples are also more likely than average to be born in breech presentation in the womb. In twins, the incidence is about one-third. Other risk factors for this deviation are head malformations, an umbilical cord that is too short or entangled, and too little or too much amniotic fluid. Uterine malformations and certain pelvic shapes of the mother also favor the occurrence of a breech presentation.
Risks of breech presentation
The risks of breech presentation include an undersupply of oxygen to the baby and injury during the birth itself. Folding the arms over in the birth process can prevent the head from passing through. Obstetricians must then manually release the arms from this position. This can result in arm fractures and muscle injuries. The umbilical cord is also compressed more quickly in the breech presentation than in a normal birth. This can lead to an undersupply of oxygen to the baby and, in the worst case, brain damage. In up to 70 percent of breech deliveries, there is also torticollis due to muscle tension. For the mother-to-be, a breech delivery is more strenuous because it often takes longer than a normal birth. The particularly stressful pushing phase can also take longer than in a cranial presentation birth because the baby’s large head does not come until the end.
Vaginal birth or cesarean section?
Vaginal birth is generally possible in breech presentation, but it is rarely recommended these days. It requires an experienced team of obstetricians. Relatively few hospitals offer the option of spontaneous delivery for breech presentation. In the case of a simple breech presentation, a birth age of more than 34 weeks and if there are no illnesses of the mother or the child, there is basically nothing to prevent a spontaneous birth. The quadruped position is recommended as a birthing position, since the child can be born largely independently in this position. Normally, no additional assistance is required from the obstetricians. In the case of an estimated birth weight of more than 3500 grams, premature rupture of the membranes, illnesses of the mother or the child, and a stretched head position of the child, a cesarean section is recommended for the mother. This also applies to a relatively high birth age of the mother as well as a larger than average head circumference of the child.
External turn in breech presentation
External turning in the case of a breech presentation of the child is a possibility to bring the child into the cranial position after all. This is possible from the 36th week of pregnancy. An experienced obstetrician applies external pressure to the unborn child and turns it into the cranial position. This procedure comes with risks: there may be complications of the umbilical cord, vaginal bleeding and premature detachment of the placenta. The success rate is about 60 percent, and the risk of complications is reported to be about three percent.There should always be a surgical team ready to perform a cesarean section immediately in the event of a complication. Because an external turning is possible only in the late stage of pregnancy, the children are already mature enough for birth in such a cesarean section. Acupuncture and moxibustion (heating of specific body points) are also discussed as methods for a turn. These are procedures from traditional Chinese medicine. However, they have not been scientifically proven.
All will be well!
Many women worry unnecessarily early on because of a breech presentation. Most of the time, however, the children spontaneously turn into the cranial position. In the case of a breech presentation, the decision to have a vaginal birth or a cesarean section always rests with the mother. This also applies to the decision to have an external turn. It is important to have a detailed medical consultation that provides detailed information about the options and risks. Regardless of whether cesarean section or spontaneous birth, pelvic end presentation infants do not differ in their development from cranial end presentation infants. Regardless of the type of delivery, pain and fear are usually quickly forgotten and the joy of the miracle of new life prevails.
