A key concern to birth doctors during labor and delivery is that the baby is in the correct fetal position. The ideal cephalic position is head-down. During the pregnancy, the fetus will move around in the uterus. As the months pass and the fetus grows, the baby will have less room to move around. By the end of the third trimester, your baby will reach a final position.
According to Very Well Health, the mother’s physician should start checking around Week 36 of the pregnancy to determine if the fetus is in the cephalic position. The cephalic position means that “the baby presenting in the womb is head down, facing your back, with the chin tucked, and the back of the head ready to enter the birth canal.”
The reason that birth doctors prefer that a fetus be in the cephalic position is because that position is the safest and easiest for the baby to pass through the birth canal. The birth canal stretches due to the contractions – for that very reason – to help the baby have enough room to exit the birth canal.
If the fetus is not in the cephalic position, then the delivery becomes much more difficult. Different positions present different difficulties.
The risks of a non-cephalic position
Nearly 96% of babies are in the correct cephalic position by the time they are ready to enter the world. The other 4%, though, are either in a breech position or another position. Breech means the fetus’ bottom is down, not the head. The difficulty with a breech birth is that it’s more complicated than a vaginal delivery. A vaginal delivery is risky for many babies who are in a breech position, because the fetus’ head is bigger than the fetus’ bottom. This creates a danger that the head may become entrapped in the uterus, which makes the delivery challenging and risky.
While some birth doctors may be Ok with performing a vaginal delivery if the baby is doing well, most birth doctors perform a cesarean, or a C-section, delivery.
What are the types of breech positions?
According to the Very Well Health article (which references the Cleveland Clinic), breech positions include:
- Frank breech. In this type of breach, the legs of the baby are up and the feet are near the head. “This position raises the chance of forming an umbilical cord loop that could come out through the cervix before the head.” This type of breech can injure the baby if a vaginal delivery is performed.
- Footling breech. Here, one or both legs are “lowered over the cervix.” A footling breech creates an increased danger that the umbilical cord may slide “down into the mouth of the womb, cutting off the baby’s blood supply.”
- Complete breech. In this type of breech, the baby is bottom-first, with knees bent. This type of breech also creates umbilical cord loop complications which can endanger the baby if a vaginal delivery is performed.
What factors increase the risk of a breech baby?
The odds a mother may have a breech baby increase if:
- You go into labor before you reach full term
- You are pregnant with more than one baby
- “Have an abnormally shaped uterus, fibroids, or too much amniotic fluid”
- Have a condition called placenta previa, where the cervix is covered by the placenta
Another birth position risk is called a transverse lie position. This position may occur at the end of the third trimester. Here, the baby is “presenting sideways across the uterus rather than vertically.”
With a transverse lie, your child may be positioned:
- “Down, with the back facing the birth canal
- With one shoulder pointing toward the birth canal
- Up, with the hands and feet facing the birth canal”
A C-section will be used if the transverse lie position isn’t corrected before the mother goes into labor.
Other dangerous positions include an occiput or cephalic posterior position, which means the “baby is positioned head down, but they are facing the abdomen instead of the back.” A common name for this position is the “sunny-side-up” position.
Why is a breech birth dangerous?
If the baby gets stuck in the birth canal, the baby may die or suffer a birth injury. If the umbilical cord is in the wrong position, the oxygen supply the baby needs may be reduced.
Diagnosis of your baby’s position
Your birth physician will determine your baby’s position through a physical examination and an ultrasound. The doctor, in the last weeks of your pregnancy, will palpate the lower abdomen with his or her hands to check the baby’s posting, including the position of the head, bottom, and back. If the doctor (or health provider) suspects a breech position, then an ultrasound will be used.
How do physicians treat a non-cephalic position?
While most babies do turn over into the cephalic position, if the baby still hasn’t moved into the correct position by the delivery date, there are several steps your physician can try. None are guaranteed to be successful. Some have better odds of success than others.
The most common non-invasive procedure is called the external cephalic version. This procedure, performed by an obstetrician, aims to move a baby from a breech position to a cephalic position while the fetus is in the uterus. The procedure involves pressure on the stomach to help rotate the baby into the correct position. Ultrasound may be used.
The ECV procedure is normally done about 37 weeks into the pregnancy. “ECV has a 50 to 60% success rate. However, even if it does work, there is still a chance the baby will return to the breech position before birth.”
Other treatments to reposition the baby include having the mother try specific movements, such as getting on her hands and knees and gently rocking back and forth, or using stimulating sounds to lure the baby out of the breech position and towards the music. Chiropractic treatments and acupuncture may also be considered.
Physicians are held to a standard of care that conforms to their type of practice – such as delivering babies. At Merkel & Cocke, P.A. our Mississippi birth injury lawyers work with obstetricians and other birth delivery professionals to show that your doctor failed to position your baby correctly or caused a birth injury for any reason due to medical malpractice. To assert your right to hold birth doctors liable for medical errors, call us at 662-627-9641 or use our contact form to schedule a free consultation. We represent parents and children in Jackson, Clarksdale, Oxford, Tupelo, and across the Gulf Coast Region.
After graduating from the University of Virginia Law School in 1975, Mr. Cocke and Mr. Merkel established Merkel & Cocke, P.A. in 1982. Since that time the emphasis of Mr. Cocke’s practice has progressed toward medical malpractice. At the present time his practice is exclusively devoted to handling medical negligence cases for the plaintiff, either as a result of direct contact by the client or on referral from other attorneys who are not familiar with the handling of medical negligence cases. Mr. Cocke was selected Best Lawyer of the year for 2012 and 2014 in The Memphis area in the field of Medical Malpractice and has been selected a Best Lawyer and Super Lawyer every year since 2006. Learn more about John Hartwell Cocke here.