At the time of delivery, the position of an unborn child in a woman’s uterus is considered normal only if it presents itself head-first and face down (known as the occiput anterior position). If the baby presents itself in any other position such as feet first, buttocks first or sideways, it is termed a breech presentation or breech birth and considered abnormal. If a woman’s doctor misdiagnoses a breech delivery or fails to respond appropriately, injury to the baby, including brain damage and cerebral palsy, may occur.

Determining the Position of the Fetus

Throughout a pregnancy, the fetus can change positions many times, but between week 32 and week 38 (accepted full term), the percentage of fetuses in breech position reduces naturally from 25% down to approximately 3%. A number of factors can contribute to a fetus remaining in breech: a multiple pregnancy (two or more fetuses), prior Cesarean sections (C-section), an unusual volume of amniotic fluid (too much or too little), as well as any abnormalities of the uterus, placenta or fetus.

Whether premature or full-term, it is the health care provider’s responsibility to determine the fetal position at the time of labor and delivery. He or she may accomplish this by feeling the baby’s positioning through the abdomen using a procedure known as Leopold’s Maneuvers or by performing a vaginal exam in which they feel for the suture lines along the baby’s skull. In some situations, an ultrasound may be performed late in the pregnancy or even during early labor to determine the baby’s positioning.

Delivery Options for Breeched Babies

In the event of a breech, there are options for delivery. Because breech presentations make it very difficult, if not impossible, for the baby to safely pass through the birth canal, many result in C-sections. If the fetus is known to be in breech, the health care provider may first attempt to rotate the baby into the occiput anterior position by pushing on the mother’s abdomen (a procedure known as External Cephalic Version or gently twisting the baby through the vaginal opening and cervix using their hands and/or forceps (Internal Cephalic Version). When attempting either or both Versions, it is imperative that the baby’s vital signs be closely monitored through ultrasound and fetal heart monitoring. If at any point during the procedure the fetus appears in distress, such as a sudden drop in heart rate, the procedure is terminated until the fetus is stabilized. If the fetus does not stabilize, an emergency C-section may be performed.

Risks of Breech Deliveries

Attempts at vaginal deliveries of breech presentations are not uncommon but can be difficult and present a higher risk of fetal distress, birth defects or suppression of the umbilical cord. “Fetal distress” is a term the OBGYN community is moving away from, preferring practitioners now use terminology more specific to the situation. Historically, however, “fetal distress” has referred to any situation in which the baby is not coping well with the demands of labor. While occurrences of “fetal distress” are considered rare, any number of contributing factors could be in play, including the mother’s medical history, her health and lifestyle during pregnancy or circumstances specific to labor and delivery. A “birth defect” refers to any physical, mental or biochemical abnormality present at birth. “Umbilical cord suppression” refers to cutting off the flow of the oxygenated, nutrient-rich blood prior to the baby drawing its first actual breath. Any of these complications can lead to temporary or even permanent health problems for the newborn.

Advice for Expectant Parents

For all we don’t know about the causes of cerebral palsy, we do know that it reflects an abnormality or disruption in brain development, often during pregnancy or childbirth. Misdiagnosing the fetal position or attempting a risky vaginal birth increases the possibility that something can go wrong.

The key to protecting the health of your child is to get regular prenatal care which should include conversations with your doctor about the positioning of your unborn child and a game plan in the event of a breech presentation.