He was extremely distressed when he rushed his wife, E, to the hospital. She was groaning in pain at the backseat of his car and was in an advanced stage of labour. He almost freaked out in the delivery suite when he witnessed his baby being delivered in a breech position: butt first, rather than head first.
E, a 35-year-old mum had 2 previous normal deliveries. Her babies weighed around 3.3 kg each at birth. She was from a neighbouring country and came for her first consult only at 32 weeks of gestation. Her prior visits to the obstetrician in her native country were apparently uneventful.
Ultrasound examination revealed that her baby was in a breech (butt- first) position. External cephalic version (ECV) without general anaesthesia was attempted to correct the breech position on her second visit 2 weeks later. But it failed. E began to try all sorts of methods, including acupuncture, yoga and eating a spicy meal, to get her baby to change its position. At her subsequent visit at 35 weeks gestation, the baby was still in a breech presentation. As ECV again failed, I advised her to deliver the baby by lower segment caesarean section (LSCS) to avoid complications to the baby. She agreed. This was scheduled at 38 weeks of gestation.
However, she started to have labour pains a week before the scheduled operation. By the time she was admitted to the labour ward, her cervix was fully dilated and the water bag had burst. The baby’s butt could be seen emerging from the birth passage. With further contractions, the baby’s legs emerged and part of the body was hanging outside the mother. It was too late for Caesarean section. I immediately performed an assisted vaginal breech delivery which went on smoothly. A baby girl weighing 3kg was finally delivered in a healthy condition.
About 3 -4% of all births present as breech at term. Many studies have demonstrated that planned Caesarean delivery is safer than planned vaginal delivery in terms of infant deaths and injuries.
This is because in a breech presentation, the baby’s head comes out last. His or her body may not stretch the cervix enough to allow room for the head to come out easily. As a result, the head or shoulders may be jammed against the bones of the mother’s pelvis. Delivery under such situations may result in serious injuries such as cerebral palsy or nerve injuries to the baby.
Another risk is that the umbilical cord may slip into the vagina before the baby is delivered. If this happens, suffocation and death to the baby may occur.
As Caesarean section itself also carries risks like infection and bleeding, the obstetrician may perform a manoeuvre called ECV in the antenatal period to turn the baby to the head down position. This procedure is usually done without anaesthesia after 32 weeks and involves applying gradual pressure to the abdomen to turn the baby from the outside. The baby’s heart rate is monitored closely before and after the procedure.
In E’s case, ECV failed. Vaginal birth was imminent as she was admitted to the labour ward in the late stage of birth. Fortunately, the baby was not too big and the delivery went well without complications.
I saw E and her husband the next day. They had just recovered from the “shock” the day before.
“Doc, we are amazed by the calmness you showed at delivery. Kudos to you.” E exclaimed.