'>"And if it is breech?". Here is another of the fears that expect expectant mothers: the fear that the baby they carry in their womb does not "put itself in position" upside down, but shows up with the bottom, knees or a foot, forcing you to undergo a caesarean section. Rest assured: it could turn around even at the last moment, when you think that the possibility of a natural birth has vanished. The gynecologist talks about it in detail Gabriella Pottocar.
Dr.ssa Gabriella Pottocar
Doctor Pottocar, let's start by giving a definition of breech presentation of the fetus ...
“By breech presentation of the fetus we mean the position of the fetus with the podium (bottom of the puppy) at the bottom, as if sitting cross-legged, with the head up (under the ribs of the woman) in a longitudinal position. Some variants are distinguished: buttock varieties with thighs bent over the abdomen and legs extended over the trunk, so that only the buttocks are distinguished at the pelvic entrance; variety of knees with thighs extended over the trunk and legs bent over the thighs, so that the knees are the first parts that arise; foot variety, when the thighs and legs are partially extended, so that the first parts that arise are the feet; mixed varieties, when a foot, a knee or a buttock and a foot occur at the pelvic entrance. Complete 'typical' breech presentation is the most frequent ”.
What are the causes?
“The causes seem to be attributable to prematurity of the fetus, but in reality they are still completely unknown now. The fetus changes positions by means of spontaneous movements even several times, during the last weeks of pregnancy, finally assumes the definitive orientation just before the onset of labor. The global frequency of breech presentation at term of pregnancy is about 4% of the total births with a certain prevalence in the pluriparous compared to the nulliparous ".
Up to what week can a child typically turn around?
“In theory, the baby can turn around until the last week of gestation, in reality, until the 39th week. The variables depend on the size of the puppy, the length of the umbilical cord and apparently also on the amount of amniotic fluid ".
How does the gynecologist or midwife notice the breech position?
“The diagnosis of breech presentation is easily carried out through ultrasound (by now no gynecologist is without this means), but the obstetrician can evaluate and diagnose a presentation of the fetus simply with the maneuvers of palpation and mobilization of the various parts. When there was no ultrasound device, the diagnosis of presentation of the fetus was carried out manually and, often, with the same precision ".
Are there any methods for spinning the baby before delivery? What are the pros and cons of each of them?
“To 'convince' the fetus to turn around, in the West, manual turning was used, a technique of manipulating the woman's abdomen aimed at manually moving the fetus and making it rotate, usually clockwise. This happened 50 years ago, even if the technique was taken up by osteopaths who, in a more gentle way and listening to the movement of the small body, still manage to do so now. The osteopathic technique, therefore, being endowed with 'listening' to the fetus, allows the operator to choose whether to insist on turning or not. As you can imagine, 50 years ago, manual upheaval was not without its rather serious consequences ranging from rupture of the uterus to death of the fetus. The study of the acupuncture meridians allows us to use the stimulation of the gall bladder point, placed bilaterally on the little finger of the foot, in the outer corner of the nail. Stimulation, in general, is carried out using the Moxa technique, an mugwort cigar which, lit by a slow and gradual combustion, is brought closer to the point, warms it and sends energy to the child who, if he can do it, turns around in a few sessions. This technique is normally used in China, but also in Del Paese it has several supporters. Risk-free and with an efficacy of 67%, it can also be performed by the patient's partner, if properly trained. In 96 in JAMA, an authoritative international medical journal, a group from Verona published a study on a considerable number of pregnant women with breech presentation who, when subjected to Moxa, had a physiological upheaval of the fetus and in a much higher percentage than 'chance'. The heating technique of the aforementioned acupuncture point should be performed every day from the 2004th week to the end. The orientation of the Paeseno is to carry it out until the 30th / 34th week, but having already booked and planned a caesarean section. In China they continue until the end and, I must say, I too have had cases of upheaval through Moxa in the 37th week ".
Does a breech baby always and in any case mean Caesarean delivery?
“In any case, breech birth can be assisted like a cephalic presentation, with extreme attention and competence on the part of the delivery room staff. Personally, I believe that taking risks is not correct and, in my experience I know that if I practice Moxa and the fetus does not turn, it is good to continue until the end, but to organize the birth through a calmly planned cesarean. What is certain is that the risks of a woman and especially of the baby in the breech position during the expulsion, especially if it is the first birth, are definitely to be avoided. If I again bring up my experience of almost 30 years, I must say that a breech birth of a multiparous girl is very feasible and not very risky. If it is the first child, I prefer to perform the Moxa every day but recommend a caesarean that must be booked and planned, without making it urgent. Certainly, women who move and have a normal pregnancy period have a spontaneous change even in the last few weeks ".
We send a message to mothers who are at the end of their pregnancy and have a baby in the breech position ...
"If I have to turn to women who have a baby in the breech position and have a near deadline, I feel like reassuring them both for a possible upheaval attempted with osteopathic technique or with Moxa, but also for a caesarean section which fortunately, now being conservative, does not preclude the possibility of having other children even in a natural way ".
