Breech Birth | Michigan Birth Injury Attorneys

Normally, children are born head-first. In the breech presentation, the baby is turned around so that the feet or buttocks enter the birth canal first. When this happens, the baby is at risk for complications such as head trauma, brain bleeds, umbilical cord problems, hypoxic ischemic encephalopathy, cerebral palsy, seizures and birth asphyxia. Often, the best way to deliver a breech-positioned baby is via C-Section.


Breech Birth: An Overview

Under normal circumstances, a baby is born head first. This position allows the infant to easily pass through the birth canal without injury to the head or limbs. Breech Birth: Breech presentation vs. vertex presentation - medical illustration of fetal presentationSometimes, however, the baby is in a breech position, where either the feet or buttocks are positioned to descend the birth canal first.  Breech presentation occurs in about 3-4% of all deliveries in the United States. Serious complications and potential birth injuries can result from a breech presentation.

It is the physician’s responsibility to identify a breech baby, make appropriate attempts at turning the child, and safely deliver the baby by C-section when necessary.  In fact, research shows that a C-section delivery is the safest way to deliver a baby who is in breech position. A breech presentation is associated with numerous complications, including head trauma and brain bleeds as well as umbilical cord problems and birth asphyxia.  Failure to safely and quickly deliver a baby who is in a breech presentation can cause the baby to experience a lack of oxygen in her brain and resultant hypoxic ischemic encephalopathy (HIE), cerebral palsy and seizures.

Types of Breech Presentations

There are three types of breech presentations:

  • Frank breech: This position occurs in about 50-70% of the breech cases. It resembles a pike position where the baby’s buttocks are pointed toward the birth canal and the knees are extended.
  • Complete breech: This position is similar to a cannonball position where the baby’s buttocks are pointed down toward the birth canal and the legs are folded at the knees. A complete breech occurs in about 5-10% of the breech cases.
  • Incomplete or footling breech: As the name implies, this is where a foot presents first and one or both of the baby’s hips are extended. It occurs in about 10-30% of breech presentations.

Causes of Breech Presentation

Although the causes of breech presentations are not fully understood, there are predisposing factors that appear to make breech more likely in some cases. These include:

  • Premature births or a history of premature delivery
  • Previous breech presentation
  • Multiples pregnancy
  • Amniotic fluid levels: Too much amniotic fluid (polyhydramnios) or too little amniotic fluid (oligohydramnios)
  • Uterine anomalies such as an unusual shape or fibroids
  • Placenta previa (the placenta grows in the lowest part of the uterus and covers all or part of the opening to the cervix)
  • Small pelvis or uterus
  • Fetal abnormalities

Diagnosing and Managing a Breech Birth

When a breech position is diagnosed, the physician may try to turn the baby into the proper head first position.  Physicians use manual techniques to push the baby into place from outside the mother’s abdomen.  If the baby cannot be turned, then the physician must assess whether the conditions exist that will allow a vaginal birth (eg: baby is full-term and in the frank position; baby does not show signs of distress while her heart rate is closely monitored; x-rays and ultrasound show the size of the mother’s pelvis would allow a safe vaginal birth; a stat C-section is possible on short notice).

However, today, most health care providers and the current medical literature recommend C-sections as they are the safest method of breech delivery to avoid potential birth injuries.

Breech Birth Injuries

Injuries associated with breech deliveries include:

  • Umbilical cord prolapse: This is an obstetrical emergency that occurs when the cord becomes compressed by the baby’s body as the infant moves through the birth canal cutting off the baby’s oxygen (hypoxic ischemic encephalopathy) and blood supply. The baby must be delivered immediately to avoid brain damage or death.
  • Nuchal cord (cord wrapped around baby’s neck): This is also an obstetrical emergency. If not corrected, oxygen to the baby may be diminished.
  • Fetal distress: Sometimes the stress and pressure of a breech delivery causes heart rate changes in the infant that can lead to hypoxic ischemic encephalopathy (HIE).
  • Nerve damage: If a baby’s head gets caught in the birth canal or if one or both of the arms are wrapped around the back of the neck, there is a risk for nerve damage.  A doctor’s attempt to dislodge the baby (excessive twisting or pulling) can cause brachial plexus injuries and Erb’s palsy (injury to the shoulder nerves that cause weekness and paralysis of arm).
  • Head trauma: This is also a result of the head becoming caught in the birth canal. This is estimated to occur in up to 8.5% of vaginal breech deliveries. Types of injuries include bruising, lacerations, hemorrhages (brain bleeds), and brain damage.
  • Cervical spine injury: This can occur if the fetus has a hyperextended head prior to delivery.
  • Low Apgar scores

Award-Winning Birth Injury Attorneys Helping Children with Birth Injuries from Breech Birth

Reiter & Walsh, P.C. was established to focus exclusively on birth injury cases. Our attorneys and in-house medical staff determine the causes of our clients’ injuries, the prognoses of birth injured children and areas of medical negligence. Our specific focus on birth injury allows our attorneys to provide unparalleled legal service to our clients, who hale from states across the United States. We’ve assisted families in Michigan, Ohio, Pennsylvania, Texas, Tennessee, Wisconsin, Arkansas, Mississippi, Washington D.C., and other states. Our team receives prestigious legal awards and memberships including involvement in, ratings by and reviews from the Birth Trauma Litigation Group (BTLG), Avvo, the MAJ, and AAJ, Best LawyersSuper Lawyers and many other sources, and we have extensive experience litigating birth trauma cases.

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Video: Birth Injury Attorney Jesse Reiter Discusses Breech Birth and Its Complications

In this video, Jesse talks about the importance of C-section delivery when a baby is in distress and / or is experiencing a high-risk condition, such as breech presentation and breech birth.


SOURCES:

  • Wiley. (2014, August 11). Breech babies have higher risk of death from vaginal delivery compared to C-section. ScienceDaily. Retrieved October 22, 2014 from www.sciencedaily.com/releases/2014/08/140811124531.htm
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  • Vlemmix F, Bergenhenegouwen L, Schaaf JM, et al. Term breech deliveries in the Netherlands: did the increased cesarean rate affect neonatal outcome? A population-based cohort study. Acta Obstet Gynecol Scand 2014; 93:888.
  • Hannah ME, Hannah WJ, Hewson SA, et al. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Term Breech Trial Collaborative Group. Lancet 2000; 356:1375.
  • Hartnack Tharin JE, Rasmussen S, Krebs L. Consequences of the Term Breech Trial in Denmark. Acta Obstet Gynecol Scand 2011; 90:767.
  • Goffinet F, Carayol M, Foidart JM, et al. Is planned vaginal delivery for breech presentation at term still an option? Results of an observational prospective survey in France and Belgium. Am J Obstet Gynecol 2006; 194:1002.
  • Toivonen E, Palomäki O, Huhtala H, Uotila J. Selective vaginal breech delivery at term – still an option. Acta Obstet Gynecol Scand 2012; 91:1177.
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