Reducing the Risk of Breech Delivery Through C-Section Delivery
Breech babies are significantly more likely to die during a vaginal delivery compared to breech babies delivered by C-section, according to a new study found by Michigan cerebral palsy lawyer Jesse Reiter. When a baby is in a breech presentation, his or her legs or buttocks are positioned to exit the birth canal first, as opposed to the normal, head-first position. This can pose many problems during delivery, and in most cases, a vaginal delivery should not even be attempted.
In this new study from the Netherlands, researchers reviewed more than 58,000 women who gave birth to breech babies between 1999 and 2007. The study showed that the risk of death was 10 times greater for babies in breech presentation delivered vaginally than for breech babies who had a C-section delivery.
Why Is Breech Delivery So Dangerous?
More complications can occur if a baby is in a breech presentation. When breech babies are delivered vaginally, they are more likely to be injured during or after delivery than babies in a head-first position. Very serious complications can occur in breech position, such as the umbilical cord being compressed during delivery, which can cause the baby to be partially or completely cut off from her supply of oxygen-rich blood. Umbilical cord compression is caused by a prolapsed cord, which occurs when the cord descends in front of the baby in the birth canal, or a nuchal cord, which is when the cord is wrapped around the baby’s neck.
A baby is also more likely to experience traumatic injury during a vaginal breech delivery. As the baby’s head passes through the birth canal, there is an increased risk of trauma to the skull due to the head’s position. The spine and spinal cord also can become injured if the physician does not properly position the baby during delivery. In addition, attempts to position the baby can cause brain bleeds and hemorrhages, especially if the head gets caught in the birth canal. These traumatic injuries can cause hypoxic ischemic encephalopathy (HIE), cerebral palsy, seizures and other birth injuries.
Sometimes forceps are used to help deliver the baby’s head. This is a risky delivery instrument that looks like a pair of salad tongs. If the forceps are not precisely placed on the baby’s head, the head can be compressed, spinal cord injury can occur, and vessels in the brain can be torn, causing brain bleeds, hemorrhages, clots and strokes.
Attempting to position and deliver the baby can cause labor to be prolonged. Prolonged labor increases the likelihood of the baby experiencing oxygen deprivation and hypoxic ischemic encephalopathy (HIE).
Most experts recommend a vaginal delivery for all types of breech presentations. However, a baby in a frank breech position, which is when her buttocks present first and her feet are both near her ears, may be delivered vaginally if the following conditions are present:
- The baby’s heart rate is being closely monitored and she is not in distress;
- X-rays and ultrasounds show that the size of the mother’s pelvis will allow a safe vaginal birth (cephalopelvic disproportion (CPD) is not present);
- The physician has the capacity to quickly perform an emergency C-section if fetal distress occurs.
The following types of breech presentations require a C-section delivery:
- Kneeling breech: In this position, the baby has one or both legs extended at her hips and flexed at the knees.
- Complete breech: In a complete breech, the baby’s hips and knees are flexed so that she is sitting cross-legged, with her feet beside the buttocks.
- Footling breech: In footling position, one or both feet present first, with the buttocks at a higher position.
A C-section delivery is often planned when a baby is in breech presentation. However, if the fetal heart rate monitor shows that the baby is in distress at any point during labor and delivery – which means she is being deprived of oxygen – a prompt C-section delivery must take place to get the baby out of the unsafe conditions so that the medical team can directly help her. Failure to quickly deliver a baby in distress can cause the baby to have hypoxic-ischemic encephalopathy (HIE), cerebral palsy, seizures and other birth injuries.
Protecting Babies in Breech Presentation
If a baby is in a breech position, the mother must see her physician on a regular basis. A thorough discussion should take place so that the mother and her physician can decide if it is the best option to schedule a C-section delivery. Some physicians give the mother exercises to do at home to help the baby turn into the head-first position. Before delivery, some physicians try to turn the baby in the mother’s womb by using a maneuver called external cephalic version. If this is successful and the baby remains in the head-first position, a normal vaginal delivery may take place if there are no other reasons that the baby might need a C-section.
What Is External Cephalic Version and When Is It Performed?
When a physician performs external cephalic version, she uses her hands on the outside of the mother’s abdomen to try and turn the baby. This is done towards the end of pregnancy, at approximately 37 weeks of gestation. The success rate of cephalic version is about 65%, and the risks of the procedure include the following:
- Premature labor;
- Premature rupture of the membranes (PROM);
- A small blood loss for either the baby or the mother;
- Fetal distress leading to an emergency C-section delivery;
- The baby might turn back to the breech position after the external cephalic version is performed.
Risk Factors for Breech Birth
Although the cause of breech presentation is not completely understood, there are certain predisposing factors that make breech position more likely in some cases. These include:
- Premature birth or a history of premature delivery
- Previous breech presentation
- Multiples pregnancy, such as twins or triplets
- Too much amniotic fluid (polyhydramnios) or too little amniotic fluid (oligohydramnios)
- Placenta previa
- Small pelvis or uterus
- Fetal abnormalities
Diagnosing Breech Presentation
Breech presentation is recognized on ultrasounds and x-rays that take place during regular prenatal visits. As discussed earlier, a baby in a breech position may only be delivered when certain conditions are present. Birth injuries are often due to the following:
- Failure to closely monitor the mother and baby when risk factors for breech presentation are present, or when breech presentation is known.
- Failure to obtain adequate informed consent, which includes advising the mother of the risks and alternatives of delivery methods, such as vaginal birth versus C-section and expectant management. It is imperative that the mother be promptly and fully informed of the risks of vaginal delivery.
- Failure to obtain adequate informed consent, which includes advising the mother of the risks and alternatives of forceps being used during vaginal delivery.
- Failure to quickly deliver the baby by emergency C-section when fetal distress is evident on the heart rate monitor.
Legal Help for Breech Delivery Injuries
It is imperative for physicians to properly evaluate a mother and baby in order to be aware of a breech position. Continuous fetal heart rate monitoring is essential so that physicians know when a baby is in distress. Standards of care for delivery must be followed, and the hospital and physician must be prepared for a delivery by emergency C-section in order to avoid oxygen deprivation, hypoxic ischemic encephalopathy (HIE) and cerebral palsy.
If your child was diagnosed with a birth injury, such as cerebral palsy, a seizure disorder or hypoxic ischemic encephalopathy (HIE), the award winning birth injury lawyers at ABC Law Centers can help. We have helped children throughout the country obtain compensation for lifelong treatment, therapy and a secure future, and we give personal attention to each child and family we represent. Our nationally recognized birth injury firm has numerous multi-million dollar verdicts and settlements that attest to our success and no fees are ever paid to our firm until we win your case. Email or call Reiter & Walsh ABC Law Centers at 888-419-2229 for a free case evaluation. Our firm’s award winning lawyers are available 24 / 7 to speak with you.