Understanding Breech Presentation and Birth Injuries
Welcoming a new life into the world is a moment filled with joy, hope, and anticipation. For most families, childbirth is a beautiful experience that marks the beginning of a new chapter. However, for some, this moment can be marred by unexpected complications that may lead to birth injuries. One significant concern is breech presentation, which, if not managed properly, significantly increases the risk of birth asphyxia, a serious condition where a baby doesn’t receive enough oxygen before, during, or immediately after birth.
When these conditions are not managed properly due to medical negligence, the consequences can be life-altering for both the baby and the family. Birth injuries resulting from mishandled breech presentations or unaddressed birth asphyxia can lead to long-term health issues, developmental delays, and in severe cases, lifelong disabilities.
What Is Breech Presentation?
In a typical pregnancy, the baby is positioned head-down in the mother’s uterus as the due date approaches. This position allows for a smoother delivery through the birth canal. However, in some cases, the baby may be positioned with its buttocks or feet facing the birth canal. This is known as breech presentation. There are four different breech positions.
- Frank breech: This is when the baby’s buttocks present first, and her legs are flexed at the hip and extended at the knees, with the feet near the ears.
- Complete breech: In this position, the baby’s hips and knees are flexed so that the baby is sitting cross-legged, with feet beside the buttocks.
- Footling breech: In footling position, one or both feet come first, with the buttocks at a higher position than the feet.
- Kneeling breech: This is when the baby has one or both legs extended at the hips and flexed at the knees.
Managing the Delivery of a Baby in Breech Presentation
Sometimes a breech presentation resolves itself and the baby ends up in the head-first position. These babies still require close monitoring, however, because they are at an increased risk of going back into a breech position. When a baby is in a breech presentation, a C-section is the safest way to deliver them, and in most types of breech positions, a C-section delivery is required. A breech presentation puts the baby at risk of having numerous problems, including a compressed umbilical cord, head trauma, brain bleeds, birth asphyxia and conditions such as hypoxic ischemic encephalopathy (HIE), which can cause seizures and cerebral palsy.
Prevalence and Risk Factors
Breech presentations occur in approximately 3-4% of full-term pregnancies. Several factors can increase the likelihood of a breech presentation, including:
- Multiple pregnancies (twins or triplets)
- Premature birth
- Abnormal uterine shape or fibroids
- Too much or too little amniotic fluid
- Placenta previa (when the placenta covers the cervix)
- Previous breech pregnancies
Risks of Breech Presentation
When a baby is in a breech position, there are several increased risks during delivery:
Umbilical Cord Prolapse
Umbilical cord prolapse is a serious complication that can occur during breech deliveries, especially in footling breech presentations. This happens when the umbilical cord slips through the cervix before the baby, becoming compressed between the baby and the birth canal. In cases of a nuchal cord, the cord is wrapped around the baby’s neck. Such compression can severely restrict blood flow and oxygen supply to the baby, potentially leading to rapid fetal distress or asphyxia. In cases of cord prolapse, immediate medical intervention, often in the form of an emergency cesarean section, is crucial to prevent severe complications or fetal death.
Head Entrapment
Head entrapment is a significant risk in breech deliveries, particularly in premature births where the baby’s head is relatively larger compared to the body. When the baby’s body has been delivered, but the head remains inside the birth canal, it can become trapped. This situation is extremely dangerous as it can lead to severe trauma to the baby’s head and neck, as well as asphyxia due to cord compression. The pressure on the baby’s head can also cause intracranial hemorrhage. In addition, attempts to position the baby can cause brain bleeds and hemorrhages, especially if the head gets caught in the birth canal. These traumatic injuries can cause HIE, cerebral palsy, seizures, and other birth injuries.
Sometimes forceps are used to help deliver the baby’s head. This is a risky delivery instrument that looks like a pair of salad tongs. If the forceps are not properly placed on the baby’s head, the head can be compressed, spinal cord injury can occur, and vessels in the brain can be torn, causing brain bleeds, hemorrhages, clots and strokes, all of which can cause cerebral palsy. Skilled obstetric maneuvers are required to safely deliver the head, and in some cases, an emergency C-section might be necessary.
Birth Trauma
Breech presentations increase the risk of various types of birth trauma. During a breech delivery, there’s a higher chance of injury to the baby’s hips, legs, arms, or shoulders as these parts emerge first and may be subject to more force or manipulation during the birthing process. Fractures, particularly to the clavicle or humerus, can occur. Soft tissue injuries are also more common in breech deliveries. In some cases, damage to the brachial plexus nerves can lead to conditions like Erb’s palsy. The risk of birth trauma is one of the main reasons why many healthcare providers recommend C-sections for breech presentations.
Oxygen Deprivation Leading to Birth Asphyxia
Perhaps the most serious risk associated with breech presentation is the increased likelihood of oxygen deprivation, potentially resulting in birth asphyxia. This can occur due to several factors inherent in breech deliveries. The compression of the umbilical cord, either due to prolapse or during the delivery of the head, can restrict oxygen supply.
Additionally, prolonged delivery, which is more common with breech presentations, can lead to fetal distress and reduced oxygenation. Birth asphyxia can have severe short-term and long-term consequences, including brain damage, cerebral palsy, developmental delays, or even fetal death. The risk of asphyxia is a primary reason why breech presentations require careful monitoring and often lead to the recommendation of a planned cesarean delivery.
Medical Management of Breech Presentations
Proper medical management of breech presentations is essential to minimize the risk of birth injuries, including birth asphyxia. Here are some standard approaches:
External Cephalic Version (ECV)
This procedure involves manually turning the baby to a head-down position from the outside of the mother’s abdomen. It’s typically attempted between 36 and 38 weeks of pregnancy. While ECV can be successful in many cases, it’s not always possible or recommended, especially if there are other complications present.
Planned Cesarean Section
For many breech pregnancies, especially in first-time mothers or when ECV is not successful or possible, a planned C-section is often recommended. This approach can significantly reduce the risks associated with vaginal breech deliveries.
Vaginal Breech Delivery
In some cases, particularly with experienced providers and under specific circumstances, a vaginal breech delivery may be attempted. However, this decision should be made carefully, considering factors such as the type of breech presentation, the size of the baby, the mother’s pelvis size, and the experience of the delivery team.
The Role of Medical Negligence in Birth Injuries
There are unfortunately instances where medical negligence can lead to preventable birth injuries. In the context of breech presentations and birth asphyxia, negligence might involve:
- Failure to diagnose: Not identifying a breech presentation through routine prenatal care and examinations.
- Inadequate monitoring: Failing to properly monitor the baby’s position and vital signs during pregnancy and labor.
- Delayed intervention: Not responding promptly to signs of fetal distress or other complications during labor and delivery.
- Improper technique: Using inappropriate methods or techniques during a breech delivery, potentially leading to birth trauma or asphyxia.
- Lack of informed consent: Not adequately informing parents about the risks associated with breech presentation and the available management options.
- Failure to perform timely C-section: Delaying a necessary cesarean section when vaginal delivery becomes too risky.
- Inadequate neonatal care: Not providing appropriate immediate care to a newborn showing signs of birth asphyxia.
When medical negligence occurs, the consequences can be devastating for families. It’s important to remember that while not all birth injuries are preventable, many can be avoided with proper care and adherence to medical standards.
Financial Considerations and Legal Options
The financial burden of caring for a child with a birth injury can be significant. In cases where medical negligence may have played a role, it’s important to understand your legal rights and options. A birth injury attorney can help you:
- Investigate the circumstances surrounding the birth injury
- Determine if medical negligence occurred
- Pursue compensation to help cover medical expenses, therapy costs, and long-term care needs
While no amount of compensation can undo the pain of a birth injury, it can provide the resources necessary to ensure your child receives the best possible care and support.
About ABC Law Centers: Birth Injury Lawyers
ABC Law Centers: Birth Injury Lawyers was established to focus exclusively on birth injury cases. A “birth injury” is any type of harm to a baby that occurs just before, during, or after birth. This includes issues such as oxygen deprivation, infection, and trauma. While some children with birth injuries make a complete recovery, others develop disabilities such as cerebral palsy, hypoxic-ischemic encephalopathy, seizure disorders such as epilepsy, and others.
It is considered medical malpractice if a birth injury or a related disability could have been prevented with proper care. Your child could have their lifelong treatment, care, and other crucial resources covered by a birth injury case settlement.
If you believe you may have a birth injury case for your child, please contact us today to learn more. We are happy to hear your story and answer your questions free of any obligation or charge, even if you decide not to pursue a legal case with us. If you do, you would pay nothing throughout the entire legal process unless we win.
