Breech birth
Written by Dr. Ariane Zaique-Thouveny, gynaecologist-obstetrician at Polyclinique Majorelle (Nancy, France)
Breech presentation at term occurs in around 4 to 5% of pregnancies and requires specific care. If your obstetrician discovers your baby is breech at term, they’ll offer you several options.
Types of breech position
There are two types of breech position:
- A “complete” breech where the foetus appears to be sitting cross-legged
- An “incomplete” breech where the foetus has one or more legs up.
Usually detected in the eighth month during a physical examination, breech presentation is confirmed by ultrasound most of the time.
What can I do if my baby is breech?
If your baby is breech, your obstetrician will discuss the various possibilities with you.
You could try External Cephalic Version (ECV), for example, where your doctor or midwife will attempt to rotate your baby into a head-down position by applying gentle pressure to your abdomen. Generally offered from week 36, ECV has a success rate of about 50 to 60%. ECV is painless for both the mother and child and is carried out in the maternity ward over a period of a few hours. Your baby’s position is then checked by ultrasound and its heartbeat recorded. You may also be given medication to relax the uterus.
Afterwards, your baby’s heart rate will be monitored and a blood test taken. If you’re rhesus negative, you’ll be given an intravenous injection of anti-D immunoglobulin to avoid blood incompatibility. Your baby’s heartbeat will be checked again the following day.
Complications are rare but can include uterine contractions, labour, blood loss or amniotic fluid loss, and exceptional abnormalities in foetal heartbeat making an emergency caesarean section (C-section) necessary. Acupuncture or moxibustion can also be of great help.
Yoga positions such as the bridge pose could also help your baby turn around. Every morning and evening, lie on your back for around 20 minutes, with your bottom up in the air (about 30 cm from the ground).
Can I have a vaginal birth or will I need a C-section?
If your baby’s still breech, your doctor will straight away evaluate the chances of a successful vaginal birth or the need for a C-section by performing a pelvic X-ray. The purpose of this X-ray is to determine the diameter of your pelvis and to assess foetopelvic disproportion, in other words, to compare the baby’s measurements to those of your pelvis.
A baby showing signs of growth restriction (growth retardation) or excess growth (foetal macrosomia), as well as gestational diabetes, placenta praevia, a previous C-section, whether the baby is your first child, etc. are all factors that could constitute a medical contraindication. Your doctor will take all these into account before agreeing if you should attempt a vaginal delivery or not. How you want to give birth is at the heart of your decision, but you must follow your obstetrician’s advice. They’ll have previously discussed the various options available to you, and the benefits and risks inherent to each.
If you’re considering a planned C-section, remember that this is a major operation, most of the time performed under local or regional analgesia (epidural or spinal anaesthesia). Your obstetrician will make a horizontal cut usually at the edge of your pubic hair and open up your womb to extract your baby. They’ll then stitch up the walls of your womb and abdomen. Aftercare and hospitalisation are longer than for vaginal delivery, although a C-section can significantly reduce (but not completely eliminate) the risks of trauma that can occur during vaginal delivery (infection, haemorrhage, phlebitis, etc.). If you fall pregnant again, the scar on your womb could expose you to the risk of uterine rupture or placental abnormalities, although this is rare.
If, and with your doctor’s agreement, you still want to give birth vaginally, be aware that as for any delivery, a C-section is possible at any time. When you arrive in the delivery room, you’ll be given an ultrasound to confirm your baby’s position and assess its head measurements and flexion. You’ll be encouraged to have an epidural. You should be dilating and progressing “brilliantly”, regularly and smoothly, i.e. labour must be progressing as it should. When your baby appears, it’s quite impressive – bottom first, then the feet, then the rest of the body and finally the head. Your obstetrician may use special manoeuvres to deliver your baby to prevent any potential complications. A gynaecologist, midwife, child care professional, anaesthetist and paediatrician will all be present.
The most important thing is communication with your obstetrician, who, like you, wants labour to happen under the best possible conditions, so that both you and your baby stay healthy.
Tokophobia: when you’re terrified of childbirth
Written by Sandra Jacquemont, Head of Maternity-Neonatology, Clinique Kennedy (Nîmes).
From the Greek tokos, meaning childbirth, and phobos, meaning fear, tokophobia is the morbid fear of pregnancy and childbirth. Over and above a woman’s rational fear of these events, tokophobia is an extreme, irrational and persistent terror that leads to avoidance behaviours towards motherhood, often manifesting itself in panic attacks, insomnia and nightmares.
Tokophobia was first medically described in the 18th century, when cases of suicide were reported due to extreme fear. These observations can also be found during the 19th century, when maternal and infant mortality rates were high, and the fear of pregnancy and childbirth thus understandable. Nowadays, with medical progress and a significantly decreasing mortality rates, the fear of pregnancy and childbirth is considered irrational. Paradoxically, today’s “medicalisation” of childbirth can cause other fears such as the fear of hospitals, doctors, medical instruments and, unchanged for centuries, the fear of pain and death in childbirth.
The different types of tokophobia
Psychiatrists have identified three types of tokophobia:
- Primary tokophobia that affects nulliparous women (those who have never given birth). This often dates back to childhood or adolescence following a bad experience (sexual abuse, negative family experience of childbirth, etc.). Such women have normal sexual relations, but contraception is excessive and scrupulous, with several methods used simultaneously. When the desire to have a child overcomes the fear, these women will often insist on a planned C-section.
- Secondary tokophobia that affects multiparous women (those who have given birth more than once). This can occur after a difficult childbirth, and can be physical (instrumental extraction, painful episiotomy, etc.) or psychological (disabled child, stillbirth, etc.).
- Tokophobia that is one of the symptoms of prenatal depression, where awareness of pregnancy and its implications lead to a depressive syndrome.
What causes tokophobia?
Certain personality traits such as suffering from general anxiety and depression can predispose women to develop tokophobia which in turn can increase the risk of suicide. Tokophobia may also be experienced by women with obsessive-compulsive disorder (being obsessed with cleanliness and contamination) who are striving to reach an “ideal” in pregnancy and childbirth.
Tokophobia can also have physical causes such as sexual abuse, a traumatic childbirth experience or where simply touching the vagina causes flashbacks.
Social or cultural explanations can also be observed, where common myths about pregnancy (“your body will change horribly”), labour (“it went on for two days”) and childbirth (“I was in so much pain I thought I was going to die”) can be real sources of fear for women. The stories heard, the poor quality of information on the internet and reality TV shows can undermine confidence in a woman’s ability to give birth, and exert a negative influence.
Consequences of tokophobia
Tokophobia can have a number of consequences:
Risks for the mother:
- Insomnia/lack of sleep
- Prenatal depression
- Severe vomiting during pregnancy
- Requesting an abortion
- Requesting a C-section
- Long labour with increased use of epidural analgesia
- Increased risk of assisted childbirth
- Increased risk of postpartum depression
- Weak bond with the infant
- No further pregnancies or long delay between pregnancies
- Subsequent sterilisation.
Risks for the baby:
- Weak bond with the mother
- Increase in admissions to the Neonatal Intensive Care Unit (+8%)
- Lower birth weight infant
- Long-term emotional effects on the infant.
How can I cope?
If you suffer from tokophobia, it’s vital that you’re taken in hand by a team of health professionals. It’s important to express your fears and anxieties and to involve the father of your future child. Speak to a midwife to learn how to relax, and take antenatal classes. Talk to your gynaecologist who can refer you to a psychologist, recommend relaxation methods (sophrology, hypnosis) and discuss the best birth plan for you.
Don’t let this phobia spoil the wonderful adventure that is motherhood!
Cutting the umbilical cord
Cutting the umbilical cord is often highly symbolic, and if present, the father or birth partner can perform the gesture if desired. Cutting the cord physically and symbolically separates the baby from its mother, after nine months of being bonded. But in practice, when and how should the umbilical cord be cut?
The function of the umbilical cord
The umbilical cord forms between the fourth and eighth week of pregnancy. During pregnancy, the cord allows for the vital transfers between the placenta and the blood of the foetus. The baby receives oxygen and the nutrients necessary for its proper development through the cord. The cord has no use after childbirth since the baby can now breathe on its own and adapt to its new environment. This is why it has to be cut.
When should the cord be cut?
All health professionals agree that the umbilical cord should be cut during the first minutes of the baby’s life. It used to be customary to cut it within seconds of the baby’s birth, although today the World Health Organization recommends waiting a few minutes longer to limit any risk of anaemia (lack of red globules) and improve oxygenation.
How does the procedure take place?
Just after the birth, the midwife will clamp the umbilical cord, by placing two clamps a few centimetres apart to interrupt the blood flow in the cord. They will then cut the cord between these two clamps or ask the father or birth partner to do so if they wish and if there’s no medical contraindication.
It’s important to specify that the umbilical cord has no nerve – neither the baby nor the mother will feel any pain.
Cord aftercare
During the days following the birth, and when you go home, cord aftercare is going to be very important. It’s crucial to avoid all potential risk of infection, especially any related to the proximity of stools and urine. This is why when you’re in hospital you’ll be taught proper aftercare hygiene measures. Don’t hesitate to ask a health professional, more than once if necessary, to show you the right gestures so you can go home without having to worry.
The stump that’s attached to your baby will fall off naturally between five and 20 days after birth, leaving a scar, more commonly known as a bellybutton! Once the stump has fallen off, you should continue the care for a few more days to ensure that the scaring is as neat as possible.
Donating cord blood
Most of the time, the umbilical cord is discarded just after birth. However, donating cord blood can help save lives, since the cord’s blood cells can be used to treat certain blood diseases such as leukaemia. To find out more, see “Donating cord blood” in this advice sheet, or ask the French blood association (Etablissement français du sang) for more information.
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