Your baby’s position or ‘presentation’ refers to which part of the baby’s body will be born first. Although most babies are born head first, sometimes they are in breech presentation. Some babies who come head first are in the posterior position.
This means your baby is lying head up in the uterus. Her bottom (or, occasionally her foot) is probably the part that will be born first – the ‘presenting’ part. Babies may lie with their legs bent at the knees, almost cross-legged, or with their knees pointing up towards the face – this is known as ‘frank breech’.
How common is breech?
At 30 weeks of pregnancy, about 20% of babies are in the breech position. By the end of pregnancy only about 3% are breech. Many babies move into a head-down (vertex) position by themselves.
Babies who are still breech by about 37 weeks of pregnancy may not turn by themselves. Some doctors try to turn them by ‘external cephalic version’ (ECV). ECV is not usually done before 37 weeks or the end of term. If it is needed, your midwife will explain this procedure to you and answer any questions you may have.
Delivering a breech baby
Almost all doctors prefer to deliver breech babies by Caesarean section, as research shows this is less likely to harm the baby. If your baby is expected to be born breech, some options for where to give birth may not be available to you – you will not be able to have a home birth for example. You can talk about this with your midwife.
The posterior position refers to when your baby’s back is lying against your back. It doesn’t matter earlier on, but once you are ready to go into labour, your baby has to turn all the way around to the front. While in the posterior position your baby’s head presses against your sacrum (your lower back) and can cause backache which can be worse in labour.
What you can do
There are some things you can do before your baby is born which may help your baby turn. From about 36 weeks you can try leaning forward whenever you can. This may help your baby to turn so that her back is toward your front, before her head becomes engaged in your pelvis in preparation for the birth.
What is a Caesarean birth?
A Caesarean birth means your baby is born by an operation. The obstetrician makes an opening in your abdomen and then the uterus. In your notes, you may see it as LSCS or LUSCS, which is the abbreviation for lower segment Caesarean section or lower uterine segment Caesarean section, or simply as CS (Caesarean section).
Why it’s done
A Caesarean section may be planned in advance. This is called an ‘elective section’. Your appointment will probably be before the date your baby is due (your expected date of delivery) so you won’t go into labour before the operation.
You may go into labour and expect to give birth vaginally, but then find you need a Caesarean section. This is called an emergency Caesarean section, although often it isn’t as dramatic or last-minute as the name suggests.
Anaesthesia and Caesarean section
If you have a Caesarean section, you will need total pain relief. Some women have a general anaesthetic, which works rapidly and means you are unconscious during the operation. Most women have an epidural or spinal anaesthetic. This will allow you to remain awake during the operation but be numb from the bust downwards. You will also have heavy legs. Although there should be no pain, there is sometimes pressure or discomfort during the operation. A good description is ‘like someone doing the washing up in my tummy’. If there is any pain the anaesthetist can give you additional anaesthetic such as gas and air or an other form of pain relief. But a general anaesthetic can also be given if necessary.
You are more likely to need a general anaesthetic for an emergency Caesarean section if the baby is in distress and the doctor has to get him/her out as quickly as possible. It takes time to recover from the effects of a general anaesthetic and there are more risks to the mother’s health, so that is why an epidural or spinal anaesthesia will usually be given if there is time. In some units, doctors administer a combined spinal -epidural anaesthetic and which allows a top-up of anaesthetic if necessary. You will receive help and support to make sure you are able to breastfeed comfortably after a Caesarean section if you wish.
What happens next
The obstetrician first makes a cut at the base of your abdomen and then through the uterus, in a line called a bikini incision. You may feel some tugging when the baby is lifted out, sometimes by hand, sometimes with a pair of forceps. The baby’s umbilical cord is clamped and cut, and then she will be quickly checked over. If all is well you will be given your baby to hold as soon as possible. The placenta and membranes are delivered next, and then your uterus and abdomen are stitched. It only takes about ten minutes to deliver the baby and about 30 minutes to stitch you afterwards.
Why you may need an elective Caesarean section
- you have a very low-lying placenta (called placenta praevia) which blocks your baby’s way out
- multiple pregnancy – for some twins and almost always for triplets or more
- other complications, such as previous vaginal surgery
- malpresentation – your baby is in a position which makes vaginal birth difficult or impossible.
Why you may need an emergency Caesarean section
- eclampsia or severe pre-eclampsia in the mother which means the baby should be delivered urgently
- onset of severe illness, such as kidney disease, or very high blood pressure
- your baby is suffering from fetal distress (lack of oxygen) and labour hasn’t gone far enough for a forceps or a ventouse delivery to be carried out safely
- your baby’s head is too big for your pelvis (disproportion), or your pelvic shape or size won’t allow the baby to be born without major difficulty or risk
- lack of progress in labour, your contractions are weak and your cervix doesn’t dilate.