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Is there special advice for labour in breech presentation?
Breech labour is managed actively. Labour is expected to proceed smoothly without any undue delay or other problems.
The special advice advocated by most is epidural analgesia. This facilitates the smooth progress of labour by preventing the severe backache which tends to characterise breech labours. More importantly, it prevents premature maternal efforts (pushing), an urge to which these mothers are prone.
The risk associated with this is that if the mother feels these strong urges to push, the lower limbs and body of the fetus could be pushed through an incompletely dilated cervix, leading to head entrapment. This is a serious but fortunately rare complication.
Effective epidural analgesia virtually eliminates this risk.
What proportion of those who attempt breech vaginal delivery actually succeed?
About a third to half of those embarking on breech labour end up having a caesarean section. There are various reasons for this. The most common is unsatisfactory labour progress (velocity). This means over half of breech labours have a successful conclusion.
What about breech presentation in twin pregnancy?
This is common, especially for the second twin. Vaginal delivery of a breech-presenting second twin does not normally pose a problem.
If the first twin is breech presenting while the second is cephalic (head down), most obstetricians will advocate a caesarean section.
If both twins are breech-presenting, again it is usually a caesarean delivery.
If there is to be a vaginal delivery of a breech presenting baby in any situation, the overriding factor that underpins that plan is availability of the appropriate skills.
It is said, in breech vaginal delivery, the use of forceps is necessary. Is this so?
It is certainly common but by no means necessary. There are various methods of delivering a breech vaginally and not all of them involve the use of forceps. If the mother has a particular antipathy to forceps, she should feel free to express her reservation to the doctor assisting the delivery. In such a case, the doctor will try to avoid the use of forceps unless this becomes necessary.
In some cases - such as premature delivery - forceps have an additional important function, which is to protect the still-delicate head (that is, the brain). The doctor is duty-bound to explain all this well in advance.
Is breech presentation recurrent?
No, unless there is an unchanging predisposing feature, such as uterine abnormality, where breech or another form of abnormal lie of the fetus may feature in every pregnancy.
Last update: February 23, 2013