Abnormal Presentation continued...
One option typically offered to women after 36 weeks is an "external
cephalic version," which involves manually rotating the baby in cog-like
fashion inside the uterus. These manipulations work about 50% to 60% of the
time. They're usually more successful on women who have given birth previously
because their uteruses stretch more easily.
"Versions" typically take place in the hospital, just in case an
emergency cesarean delivery becomes necessary. To make the procedure easier to
perform, safer for the baby and more tolerable for the mother-to-be, doctors
sometimes administer a uterine muscle relaxant, then use an ultrasound machine
and electronic fetal monitor as guides. The procedure typically doesn't involve
anesthesia, but sometimes an epidural can help with the version. Since not all
doctors have been trained to do versions, you may be referred to another
obstetrician in your area.
There is a very small risk that the maneuver could cause the baby's cord to
become entangled or the placenta to separate from the uterus. There's also a
chance that the baby might flip back into a breech position before delivery, so
some doctors induce labor immediately. The risk of reverting to breech is lower
closer to term, but the bigger the baby, the harder it is to turn.
The procedure can be uncomfortable, but avoids a cesarean section, which is
most likely if the baby can't be moved into the proper position.
Umbilical cord prolapse happens more often when a fetus is small, preterm,
in breech (frank, complete or incomplete/footling) presentation, or if its head
hasn't entered the mother's pelvis yet ("floating presenting part").
This prolapse can occur, too, if the amniotic sac breaks before the fetus has
moved into place in the pelvis.
Umbilical cord prolapse is an emergency. If you are not at the hospital when
it happens, call an ambulance to take you there. Until help arrives, get on
your hands and knees with your chest on the floor and your buttocks raised. In
this position, gravity will help keep the baby from pressing against the cord
and cutting off his or her blood and oxygen supply. Once you get to the
hospital, a cesarean delivery will probably be performed unless a vaginal birth
is already progressing naturally.
Umbilical Cord Compression
Umbilical cord compression can occur if the cord becomes wrapped around the
baby's neck or if it is positioned between the baby's head and the mother's
pelvic bone. You may be given oxygen to increase the amount available to your
baby. Your doctor may hurry along the delivery by using forceps or vacuum
assistance, or in some cases, delivering the baby by cesarean section.