Elevate Your Health Colorado How does a Breech baby come out?

Today was a great day.  I was working on Labor and Delivery and got to deliver babies.  After 15+ years and countless babies, it is still the funnest gig around.

One of my deliveries was by Cesarean Section for a breech baby.

The resident asked me if I had done many vaginal breech deliveries, since nowadays, virtually all breech babies are delivered by C-section. 

Since a breech baby is upside down, the head is the last thing to come out, and it can get stuck. 

Obviously before C-sections, this was the only way for a breech baby to come out.  

Even when I was a resident, which wasn’t that long ago, there were still some vaginal breech deliveries.  We tried to plan for them.  We would recommend the patient get a CT scan of her pelvis so we could measure her bones and then compare that to the measurement of the baby’s head and have some reasonable assurance that there was room for the head to come out. 

And the breech baby had to be in certain kind of breech position; pike position is best, with the baby’s bottom coming out first.  Footling breech, with the feet hanging out, isn’t good, because the feet are small, and maybe the cervix won’t be open enough to let the rest of the baby out-especially that big ole’ after-coming head.

I told the resident about an attending I had, who was old back when I was an intern-so almost older than time itself, as my kids would say.  He said that his attending would teach the residents how to do breech deliveries by telling them to kneel on the floor with their hands behind their backs-in other words, don’t interfere, let the natural expulsive forces of the uterus push the baby out and let the baby position itself as best it could.

I think most of the time this worked fairly well.  Except every once in a while it didn’t, a baby would get stuck, and that’s just not good.

For a while we would deliver 2nd twins who were breech vaginally. If the first baby was head down and came out through the vagina, the rationale was that a second baby could come out too, as long as it wasn’t too much bigger, even if it was upside down.  Now even these breech deliveries aren’t done too often.  

I did get to do some vaginal breech deliveries as a resident.  They always scared the poo out of me because one of the first deliveries I saw as a medical student was a stuck breech.  That really is not something you ever want to see.

With the rise in C-section rates, one of the culprits (there are many) is the abandonment of the vaginal breech delivery.  Its too bad, because those deliveries usually did go ok, but no one wants to take the risk any more, and that is maybe ok.

Thoughts????