NEW Bà bầu bị ngôi thai ngược có sinh thường được không hay phải sinh mổ?

Pregnant woman with breech position Can I have a normal birth? At around 32 weeks of gestation, about 25% of the fetus is still in the breech position. This percentage will gradually decrease in the following weeks. Because normally, the baby will feel free to move when turning his head down into the mother’s uterus, so he usually stays in that position. So, can a pregnant woman with a breech position give birth naturally?

What is an inverted pregnancy?

Thai butt, also known as upside down throne It is a phenomenon in which the bottom of the fetus turns down below the cervix. Therefore, when giving birth, the baby’s bottom and legs will come out first, the head will come back. This not only makes the labor process longer, but the pregnant mother is also at a high risk of umbilical cord prolapse. Currently, the exact cause of this condition is unknown. However, according to statistics, breech pregnancy is common in pregnant women who have factors that prevent the baby from turning the head down, such as uterine malformations, fibroids, pregnant mothers. multiple pregnancy, twins, malformed fetus, pregnant mother with polyhydramnios, lack of amniotic fluid, placenta previa, low placental attachment, short umbilical cord, pregnant mother with narrow pelvis, previous pregnancy, multiple births…

Normally, at birth, the baby’s head will come out first. If the legs and knees come forward, it is called an inverted position. Between weeks 29 and 32, about 15% of babies will begin to rotate their bottom downwards. This position is very common in the second trimester. Basically, the risk of breech is related to the baby’s gestational age. When you start labor, most babies lie on their side, with their face turned to the mother’s left or right. With a breech position, your baby’s head will be in the area below the diaphragm and rib cage. One of the signs to diagnose breech is palpating the flank area, which will touch a round and hard mass.

How many types of upside down thrones are there?

Normally, there are 3 types of breech position (breast pregnancy) as follows:

• Sufficient breech position: When the baby is born, the baby’s buttocks will be born first, the baby will be in the position of knees bent, thighs folded inward. This is the most common position of the breech position.
• Missing buttocks: The buttocks are born first, the baby is in the position of legs stretched straight up to the head.
• Legs upside down: Legs out before birth because the baby is in the position of the feet lower than the buttocks.

To identify the status of the fetus in the breech position, the pregnant mother can feel the upper rib cage above the navel, if there is a round, hard mass, it is likely that it is the baby’s head. However, this method is often uncertain, mothers should go for an ultrasound before the due date to know if the position of the fetus is breech.

Causes of breech position:

Only about 3% – 6% of fetuses have a breech position when they are due. The cause of this phenomenon has not been determined. Some explanations suggest that there are certain influences on the baby’s movements. During pregnancy, the baby will lie in the breech position, turning the bottom towards the mother’s uterus. However, starting from the 28th week, according to a natural process, the baby gradually moves the head downward so that it can be easier to come out. Therefore, cases of pregnant women having a breech pregnancy are not common.

• Mother’s Cause: If the mother has diabetes or gestational diabetes, the amniotic fluid becomes too much in the amniotic sac. This causes abnormal movements of the fetus because the baby does not have enough space to turn. Therefore, the position of the baby is not as standard as the usual cases. Conversely, if the amniotic fluid in the amniotic sac is too small, the fetus will have similar difficulties in movement. Pregnant women with twins or triplets also often experience breech pregnancy. In addition, pregnant women who are older, have abnormal uterine shape, smoke or abuse drugs often have difficulty giving birth because the fetus is not favorable.

• Causes of the fetus: For normal fetuses, the cause of the breech position is due to premature birth without time to turn the head, fetal malformation or short umbilical cord.

Premature birth is the most important factor leading to breech position. About 25% of babies have a breech position from week 32. And in the next 8 weeks, this rate drops to just 3%. This is because the head is heavier than the bottom, so the baby feels more comfortable when the head is below the mother’s pelvis. In the last weeks, your baby is growing up quite quickly, so he can’t turn around as easily as at first. Once the baby has turned its head, the baby will tend to stay in that position until birth.

Signs of breech position:

Although there are also some signs to recognize the position of the baby, but you will not be able to know it yourself. Your doctor will notify you. Because the fetal position of the baby is determined exactly right before birth. Some common signs of breech birth:

• See the legs or buttocks forward.
• Touching the upper abdomen of the pregnant woman will feel the baby’s head. It is a round, rigid and movable block. While the buttocks are usually soft, indistinct and not mobile.
• Pregnant women may complain of something hard right under their ribs and discomfort because of it.
• If your membranes have ruptured and you see meconium spilling out, that’s also a sign. Because meconium will appear at the baby’s first bowel movement. If your baby’s bottom is near the exit of the vagina, it’s easier for the doctor to see the meconium.
• Umbilical cord prolapse
• Abnormalities in contraction measurement chart – fetal heart rate
• The retrograde position is usually diagnosed by ultrasound, and sometimes by radiography.

What should a pregnant woman do when she has a breech position?

• This depends on the health status of the pregnant woman and the position of the baby. If your baby has a low breech position, for example, the doctor will still be able to give birth vaginally, although it can’t be 100% certain. Usually, the doctor will attach an electrode tip on the mother’s abdomen right where the baby’s bottom is and an electrode for the mother, and then monitor it with a machine. This will help to quickly recognize any changes in mother and baby. If necessary, a cesarean section may be required.

• There are also cases where pregnant women will choose the painless delivery method. In this method, pregnant women will be given an epidural to relieve pain and prevent the feeling of straining before the cervix is ​​completely open.

• When detecting that the fetus is reversed when the mother is in labor, doctors will use a number of measures to stimulate the fetus to turn its head during delivery. Often these measures cause discomfort and pain for the mother. It can also cause the umbilical cord to wrap around the neck in the unborn baby. Finally, if head rotation stimulation measures do not help, the doctor will recommend a cesarean section for pregnant women.

Can a pregnant woman with a breech position give birth naturally? Or do you have to have a caesarean section?

The breech pregnancy does not affect the development of the fetus and the mother’s health during pregnancy. However, the mother will be at risk for abnormalities during labor. When the fetus is breech, the pressure of the fetus’ buttocks on the uterus is not as much as the head area, so the labor time is often prolonged. In addition, during normal delivery in the case of a breech pregnancy, the mother is also at risk of prolapse of the umbilical cord. The umbilical cord slips out during birth, which will stop the supply of oxygen and nutrients to the fetus, making the fetus vulnerable to failure, even death.

Therefore, most cases of breech pregnancy are encouraged to have a cesarean section. But a mother can give birth naturally if the following conditions are met:

• Wide pelvis, no abnormalities.
• The pregnant woman’s health is good, no diseases such as high blood pressure, diabetes, etc.
• The fetal weight is not large (usually less than 3200g).
• The head of the fetus is not too supine.
• The fetus is growing healthy and stable.
• Favorable labor process: cervix dilated, no premature rupture of membranes, etc.

The best way is for the mother to go for a antenatal check-up before the due date so that the doctor can carefully check the fetal status and the mother’s condition, from which the doctor will give useful advice to the mother whether to give birth naturally or give birth. Caesarean section is based on the first factor to ensure safety for both mother and child.

Risks when pregnant with a breech pregnancy:

Risks to the mother:

• Uterine contractions are the same for all positions. However, the pressure exerted on the buttocks area will not be as much as the head area, so labor may take longer. Pregnant women will be more tired and weak, especially in the first stage. Some pregnant women will choose to have a caesarean section out of exhaustion, even though they desperately want a normal delivery.

• Umbilical cord prolapse is a common complication in a breech position. If it is a normal position, the baby’s head will fill the mother’s pelvis. While the buttocks and legs usually take up less volume, there is plenty of room for the umbilical cord to slide down and out. When the umbilical cord prolapses, the air and heat outside will cause the umbilical cord to contract. The process of providing oxygen and nutrients to the baby will be stopped.

• In addition, the umbilical cord can be compressed, preventing oxygen from reaching the fetus. This is the time for an obstetric emergency to save the baby immediately.

• Once the body is out, the baby’s head may get stuck. As a result, the baby can be deprived of oxygen and the delivery time is prolonged. In the worst case, surgery may be required to save the baby. If the baby’s head comes out first, the baby’s head will help the mother’s vagina expand as much as it needs to come out. In contrast, when the outlet is posterior, the vagina is not wide enough for the outlet. The head position at this time also does not have the effect of dilating the vagina. But the longer you wait, the more dangerous it will be for the baby.

Baby’s risk

• If everything is well controlled, your baby may be fine. Some pregnant women even only have a midwife to deliver at home and still have a normal baby. The most important thing is to have a contingency plan for the worst case scenario.

• Some babies will have bruises on their bottoms because their buttocks collide with the mother’s pelvis at birth. Your baby’s genital area may also be bruised and swollen. Boys may experience fluid retention in the testicles.

• Babies with a low breech position may hold their legs out for a few days afterward. The heads of babies upside down tend to be rounder.

• During normal delivery, the breech position is also common with hip dislocation complications. If the birth is too fast or the baby is born prematurely, there is a risk of damage to the baby’s head. As a result, it may sometimes be necessary to use forceps to facilitate the birth of the head. Alternatively, the doctor will use their own hands to control the baby’s head.

What is the rotation technique?

After 35 weeks, about 25% of babies born in an breech position will turn back on their own. If the doctor is confident that a vaginal birth has the least risk, and at the same time, the pregnant woman also insists on giving birth naturally even if it is the breech position, there is no need for any intervention. The doctor will have to be very careful when deciding to turn the fetus from the outside. First make sure the position of the umbilical cord and the placenta. Otherwise, the procedure may cut the umbilical cord or detach the placenta. Pregnant women may be prescribed a uterine relaxant before the procedure. The success rate is about 40-70% depending on the experience of the doctor.

Even when the procedure of turning the fetal position back to the head has been successful, the babies are completely capable of turning them back as usual. The risk of this happening is higher if it is performed too early than the due date. The ideal time to have this procedure is at 37 weeks of pregnancy.

Some pregnant women believe that special lying positions or special exercises will help the baby’s head turn down. As of now, there is no clear evidence. Therapies like burning scented candles and essential oils can’t even affect the way your baby is born.

Mother – Baby – Tags: experience giving birth