American photographer Karyn loftesness This image has left us speechless. We see a woman giving birth to her breech baby.In the post accompanying this exceptional photograph, Karyn states that in the United States it is very rare for an obstetrics professional to assume responsibility for assisting a birth of this nature; although, as she herself points out, Fortunately, there are experienced doctors and midwives. who not only attend to these births, but also train other professionals to guide safe breech births.
Karyn, who has 4 children, declares herself passionate about birth photography, and is also hired to photograph pregnancies y BabiesThe image that went viral is from a job Loftesness will never forget: the birth of Silas, a baby who was in open buttocks position and whose birth was vaginal. The photographer recounts that the process was long and that they were about to call a doctor, but it wasn't necessary: Silas decided to be born just as his mother began to talk to him, showing how communication and maternal calmness They can be a great help during the birthing process.
What is a breech birth and how does it differ from a footling birth?
A "breech" presentation means that the pelvis of the fetus is in a longitudinal position is in contact with the superior strait of the maternal pelvisThat is, instead of presenting the head first (cephalic position), the baby positions itself with the buttocks or feet downBreech births, where the baby's head is not at the front but rather legs or buttocks are present, are rare: it is estimated that around one 3-4% of full-term pregnancies The babies remain in that position, and when this situation occurs many hospitals prefer to recommend the Caesarean section.
It is important to clarify that a A breech birth is not the same as a footling birthIn a breech birth, one or both of the baby's feet are the first to emerge. In the case of Silas's birth, documented by Karyn Loftesness, it was a breech birth, a position in which the baby has its buttocks down, legs bent and feet close to its head.
Despite their rarity, when these births are documented they can turn out deeply educationalThe photographic sequence of Silas's birth shows step by step how, without haste and with respectful assistance, The baby's buttocks appear first, usually stained with meconiumThen the genitals and umbilical cord are visible, later the legs appear (sometimes one before the other), the baby rotates to accommodate the shoulders, the arms appear, the torso and finally the head, all with a minimal intervention by the midwife, who waits for the body to do its job and only supports and guides the newborn when it is practically out.
How and when babies usually turn over: the spontaneous version
It is usual for the fetus to carry out by itself a cephalic version between weeks 28 and 32 spontaneouslyThis involves a change of position to a head-down position. Later, a version is also possible, especially in multiparous women (women who have already had children) or when there is polyhydramnios (excessive presence of amniotic fluid), which allows the baby more space to move.
However, there are babies who continue “head up” And they don't rotate, either because they are more comfortable that way, because there is too much or too little amniotic fluid, because of the shape of the uterus, the length of the umbilical cord, or because it is a multiple pregnancy in which one baby is head-down and another remains breech. In these cases, we speak of breech birth o breech presentation.
Babies are somewhat more likely to have a breech presentation if are born prematurely, if they are part of a multiple birth, if there is a abnormal level of amniotic fluid or if the mother has a uterus with a different shapeEven so, most fetuses turn on their own before week 36, so often the best initial approach is Observe and wait.
Classification of breech presentation
Without going into all the technical aspects of breech presentation past week 32, it is useful to know its basic classification because it guides medical decisions regarding the delivery method:
- Presentation of pure, simple or frank buttocksThe fetus has its lower limbs extended in ventral flexion, with its feet at shoulder level. This is the most common form and occurs around one 65-70% of casesIt is also the presentation that, in expert hands, is best associated with the possibility of a safe vaginal delivery.
- Presentation of full buttocksThe baby is in a "sitting" position, with knees and hip joints flexed, which increases the diameter of the presentationIts frequency is quite low, but it can raise more questions when planning the type of delivery.
- Presentation of incomplete buttocksOne or both feet or knees are in the vagina, and during childbirth this can occur prolapse of feet or kneesThis situation is associated with increased risk and usually indicates even closer monitoring, and even the recommendation of a cesarean section in many protocols.
From a medical point of view, There are clear criteria for attempting a vaginal delivery and also to recommend a cesarean section. Essentially, a breech vaginal delivery and a cephalic delivery are triggered in the same way: contractions begin, dilation progresses, and the expulsion phase occurs. The difference is that, in the case of a breech birth, The buttocks and legs will come out first. And lastly, the head. Theoretically, this position isn't the most favorable for birth, as it implies a certain increased risk to the babyFor example, because during childbirth the umbilical cord becomes trapped or because the head has more difficulty passing through the birth canal when the rest of the body has already emerged.
External cephalic version and other ways to help the baby turn
If the final stage of pregnancy is reached without the baby having turned head down, two main courses of action can be considered: help the baby turn over or accept the buttock presentation and decide the safest delivery route.
On the one hand, there is the external cephalic version (ECV)A cephalopelvic tilt, a medical procedure in which, through maneuvers on the mother's abdomen, an attempt is made to position the fetal head downwards. It is usually performed in the hospital's delivery room, with ultrasound and continuous monitoring, and has a approximate success rate of 60%The healthcare professional locates the baby's head using palpation and ultrasound and carefully attempts to turn it into the pelvis. The fetal heart rate is monitored before and after the procedure, and medication is often administered. medications to relax the uterusThis improves maternal comfort and increases the chances of success.
External cephalic version (ECV) is performed within a specific time frame, usually when the baby is old enough to no longer move easily but there is still a reasonable margin for maneuvering, and its objective is avoid non-cephalic presentationThis involves more risks whether the delivery is vaginal or a cesarean section is ultimately performed. Although complications are infrequent (onset of labor, rupture of membranes, minor bleeding, or, exceptionally, the need for an emergency cesarean section), each case is always assessed individually. The benefits outweigh the risks.
In addition to the external version, some women opt for exercises and supplementary resources that might encourage the baby to turn spontaneously: pelvic tilts, all-fours positions, gentle rocking on hands and knees, using gravity, stimulation with music or gentle changes in abdominal temperature, chiropractic techniques (such as the Webster method), acupuncture, certain yoga postures, or even swimming face down. None of these options guarantees the baby will turn, but in some cases they can be helpful and, above all, give the mother a feeling of active participation in the process, provided they are carried out with professional supervision when necessary. These options include the moxibustion, a common technique in support protocols.
When is a breech vaginal delivery possible and how to make it safer
From a clinical point of view, vaginal breech delivery can be a reasonable option when a series of conditions are met. It is usually considered a positive thing if it is a moderately sized babythat the mother has a adequate pelvis (sometimes already demonstrated in previous births), that the pregnancy has progressed normally and that the healthcare team has experience and specific protocol For this type of delivery, even taking all these factors into account, stricter criteria are applied than in a cephalic delivery, and it is assumed that circumstances may arise at any time during dilation or expulsion that warrant a cesarean section.
In an article of The Childbirth is Ours (EPEN)They quote Dr. Emilio Santos, who details several conditions for a breech birth to be as safe as possible: that the beginning of labor be spontaneous (not induced), that Hamilton's maneuver not be performed, that it give the mother enough time to dilate and that recommendations such as not inducing artificial rupture of membranes, restricting vaginal examinations, monitoring to rule out cord prolapse, and especially, be respected. allow the mother to choose the position in which she feels most comfortable.
On this last point, it is very illustrative to observe that in Karyn's image the mother is giving birth on all foursThis position promotes a more physiological position of the baby's back, makes better use of gravity, and helps labor progress. propulsion and not tractionThat is, the baby is born propelled by contractions and pushing, and not because the professional pulls on the baby's body. As EPEN explains, the philosophy is to support the pressure of the fundus of the uterus to avoid malpositions of the head and arms, reducing risks and respecting the physiology of birth as much as possible.
For the safety of the mother and baby, breech delivery of a single, full-term fetus is usually performed in operating roomwith essential staff who are prepared to act quickly if complications arise. Clinical decisions are individualized, combining scientific evidence with the pregnant woman's wishes, so that she can participate in an informed manner in the choice between an attempt at vaginal delivery or a Caesarean section.
Karyn Loftesness's photo sequence is not only moving; it also shows with enormous clarity how a breech birth, in a respectful environment, with trained professionals and a mother who is supported and listened to, can become a intense, powerful, and profoundly transformative experienceand helps to demystify a form of birth that, although infrequent, is part of the diversity of human births.
Cover Image - Property of Karyn loftesness, who has authorized its reproduction.
Picture - Pregmed
The article "Fascinating breech birth portrayed by Karyn Loftesness" was originally published in Mothers Today.
