Is Breech Extraction Safe?

The safety of breech extraction depends in large part on the experience of the obstetrician.

A breech baby means that the baby is in a bottom-down position inside the uterus. The baby generally has enough room inside the uterus to change position. By 36, most babies are in the head-down position (vertex presentation), which is the best and safest position for delivery. In around 4 out of 100 births, the baby stays in the breech position even after 36 weeks of pregnancy. Non-vertex presentation in a baby means any position other than the head-down position inside the uterus. Non-vertex positions, including breech, are more common in twin pregnancies where one baby may be in a vertex presentation whereas the other baby is in a different presentation (such as breech or lying transversely in the uterus).

A breech presentation may be of different types. These include

• Complete breech: In this breech position, the baby’s buttocks are down near the birth canal and the knees are bent so that the feet are near the buttocks.
• Frank breech: This is the common type of breech position. In this type of breech, the baby’s legs are stretched up so that the feet are near the head, whereas the buttocks are the presenting part and come out first during the delivery.
• Footling breech: This means that the baby has one leg or both legs stretched out below the buttocks. One or both the legs are in place to come out first during delivery.

Breech extraction is a procedure in which the obstetrician grasps the baby’s feet so that the baby is delivered (extracted) from the womb through the vagina. This procedure is performed for the delivery of the second twin in a vertex (head-down) or non-vertex presentation (such as a breech baby or a baby lying obliquely in the uterus). It is not recommended for the delivery of a single fetus. After the delivery of the first twin, the second twin often changes its position. If the second twin is in a vertex presentation, the baby is allowed to descend through the pelvis. In a non-vertex position, however, breech extraction is preferred. The procedure is generally performed with adequate pain control (analgesia) under epidural anesthesia. 

The safety and success of the breech extraction procedure largely depend upon a well-trained and experienced obstetrician. Although several studies have revealed that breech extraction gives a good outcome, some complications can occur. These include

• The head of the second twin may get entrapped if the cervix is not fully dilated or if the second twin is significantly larger than the first twin.
• Injuries to the baby
• Injury to the mother
• The baby’s hip socket and thigh bone may get separated during the delivery.
• Abruptio placentae (a condition in which the placenta separates from the womb before delivery) leading to excessive bleeding
• Postpartum hemorrhage or PPH (excessive blood loss after the delivery), which most commonly occurs due to uterine atony (inability of the uterus to sufficiently contract after delivery)
• There may be problems with the umbilical cord such as compression or flattening of the umbilical during delivery, which can cause nerve and brain damage in the baby due to lack of oxygen.