Maturity of the baby – Premature babies appear to be at higher risk of complications if delivered vaginally than if delivered by caesarean section. Progress of labor – A spontaneous, normally progressing, straightforward labor requiring no intervention is a favorable sign. Second twins – If a first twin is born head down and the second twin is breech, the chances are good that the second twin can have a safe breech birth. Management
As in labour with a baby in a normal head-down position, uterine contractions typically occur at regular intervals and gradually the cervix begins to thin and open. In the more common breech presentations, the babys bottom (rather than feet or knees) is what is first to descend through the maternal pelvis and emerge from the vagina.At the beginning of labour, the baby is generally in an oblique position, facing either the right or left side. The babys bottom is the same size in the term baby as the babys head. Descent is thus as for the presenting fetal head and delay in descent is a cardinal sign of possible problems with the delivery of the head. In order to begin the birth, descent of podalic pole along with compaction and internal rotation needs to occur. This happens when the mothers pelvic floor muscles cause the baby to turn so that it can be born with one hip directly in front of the other. At this point the baby is facing one of the mothers inner thighs.
A frank breech (otherwise known as an extended breech) is where the babys legs are up next to its abdomen, with its knees straight and its feet next to its ears. This is the most common type of breech. A complete breech (or flexed breech) is when the baby appears as though it is sitting crossed-legged with its legs bent at the hips and knees. A footling breech is when one or both of the babys feet are born first instead of the pelvis. This is more common in babies born prematurely or before their due date. A kneeling breech is when the baby is born knees first.In addition to the above, breech births in which the sacrum is the fetal denominator can be classified by the position of a fetus. Thus sacro-anterior, sacro-transverse and sacro-posterior positions all exist, but left sacro-anterior is the most common presentation. Sacro-anterior indicates an easier delivery compared to other forms. Complications
Umbilical cord prolapse may occur, particularly in the complete, footling, or kneeling breech. This is caused by the lowermost parts of the baby not completely filling the space of the dilated cervix. When the waters break the amniotic sac, it is possible for the umbilical cord to drop down and become compressed. This complication severely diminishes oxygen flow to the baby, so the baby must be delivered immediately (usually by Caesarean section) so that he or she can breathe. If there is a delay in delivery, the brain can be damaged.