More recently, a special breech presentation of the child was not considered a serious pathology in obstetric practice. But today, the opinion of experts on this issue has changed. This is due to the likelihood of complications of labor and a fairly large percentage of congenital abnormalities in the development of the baby.

Definition and types

Corresponding to the norm, the longitudinal position of the fetus is diagnosed at the 25th week of pregnancy. When compared with the rest of the body, the baby's head at the time of birth has the largest diameter. Therefore, doctors associate the greatest difficulties with its passage during childbirth.

There are cases when the baby occupies not a vertical, but a transverse position in the mother's womb: his buttocks or legs are lowered down, which is most often diagnosed at the 26th week of pregnancy.

There are the following types of pelvic position of the baby:

1. The gluteal position is the most common type, in which the baby's buttocks are adjacent to the entrance, the legs are bent to the tummy, the baby's head and his arms are tightly pressed to the chest.
2. Mixed or heterogeneous position, a characteristic of such a presentation: the buttocks and feet of the baby are adjacent to the entrance.
3. Foot position - in which the feet of both legs or one leg are adjacent to the entrance.
4. Knee position - the child in the womb seems to be on his knees. This species is rarely seen in medical practice.

Throughout pregnancy, the baby constantly turns over and thereby changes its location. As a result, the vertical position of the fetus at week 20 may change, and at week 29 the doctor will find the pelvic position. Conversely, with a breech presentation of the fetus at week 20, it is difficult to make a final conclusion that this position will remain until the onset of the birth process.

Causes

Every woman in labor should know the dangers of breech presentation of the fetus. Indeed, in the very process of childbirth, sudden serious complications can occur that adversely affect the health of the baby and his mother. These include: suffocation of the baby, ruptures of the birth canal in the mother, spinal injury or intracranial injury in the infant. In order to avoid undesirable consequences, you should try to help the child with a breech presentation at the 35th week of pregnancy to change their position.

Causes of breech presentation of the fetus:

• decreased uterine tone;
• various anomalies of the female reproductive organs detected during diagnosis;
• over and under accumulation amniotic fluid;
• specific deviations in the development of the child;
• features of the placenta.

Most often, with a breech presentation of the fetus at 37 weeks of gestation, a cesarean section is indicated. But sometimes natural childbirth is possible, requiring the doctor's every minute control.

signs

The expectant mother does not feel the special unusual location of the baby in her womb. With a breech presentation of the fetus during pregnancy, a pregnant woman does not experience any pain or other discomfort. But this fact cannot mean that the problem does not exist at all.

Signs of breech presentation:

• At the 34th week of pregnancy, there is a more noticeable protrusion of the uterus above the pubis.
• With a breech presentation of the fetus at week 30, there is a more distinct listening to the baby's heartbeat at the site of the mother's navel, as well as a little to the left or right of it.
• With a breech presentation of the fetus at week 33, an unusual location of the child is felt when examining the vagina: his tailbone is felt with a diagnosed breech presentation, the heel tubercle and smaller fingers (not as long as on the handles) in the foot position.

Special gymnastics

In practice, if a breech presentation of the fetus is diagnosed at the 21st week of pregnancy, this position of the child will not necessarily remain until the very birth. For example, there may be a change in the position of the fetus at 34 weeks. breech presentation the fetus at 32 weeks can be changed by doing the necessary gymnastic elements.

Recommended gymnastics for breech presentation of the fetus includes the following actions:

1. The breech presentation of the fetus at 31 weeks can be changed if the pregnant woman makes 10 turns or rolls in a supine position from one side to the other. You need to perform the exercise three times a day.
2. At the 31st week of pregnancy, a woman is recommended to perform such a simple task: lying on her back, put a small pillow under her lower back. The back should be raised by about 20-30 cm. Remain in a given position from 3 to 12 minutes. Perform the exercise three times a day on an empty stomach.

A woman can start performing these exercises with a breech presentation of the fetus from 31–34 weeks after the permission of the attending physician. Possible contraindications may be scars on the uterus after undergoing surgical interventions, a special position of the placenta, toxicosis on later dates.

Other ways to change position

In addition to special gymnastics, the expectant mother can wear a bandage, which can also affect the change in the position of the baby in the womb. In addition, there is an opinion that with this pathology it is useful to sleep on the left side.

If the exercises do not bring a meaningful result and the longitudinal position of the fetus is not diagnosed, the attending physician may advise a specially designed procedure for external rotation of the baby. It can be carried out under ultrasound observation of the fetus at 36 weeks in a hospital setting. During the procedure, special substances are used that relax the uterine tone.

During its development, the baby, which is in the mother's tummy, rolls over several times. And after 22-23 weeks of pregnancy, the baby, as a rule, assumes a head-down position - and it is this arrangement of the fetus that is considered optimal for subsequent births. The head of the fetus is the largest part of its body in diameter, and therefore it is with its passage during delivery that the greatest difficulties are associated. After the baby's head passes through the birth canal, the rest of his body "by inertia" follows almost imperceptibly. If the baby is located vertically in the mother's tummy, that is, head down, in most cases this position does not bring any difficulties. But it also happens that the fetus occupies a transverse position in the womb: legs or buttocks down. In this case, we are talking about breech presentation during pregnancy, which is diagnosed, as a rule, by the 28th week during the next visit to the antenatal clinic. It should also be mentioned that the breech presentation detected at this time will not necessarily remain until the birth - the baby can change position up to 36 weeks. In addition, there are a number of measures that can help "turn" the fetus, thereby giving it a head position.

Causes of breech presentation of the fetus

Breech presentation of the fetus during pregnancy can be due to several factors. One of the main reasons doctors call a decrease in the tone and excitability of the uterus. Also, the causes of breech presentation are called, and abnormalities in the development of the uterus, placenta previa, some malformations of the fetus. Breech presentation can be breech, foot, mixed, knee - each of them is easily diagnosed by the doctor during a routine examination, after which ultrasound confirmation will be necessary. Breech presentation is considered not quite a normal position for both the baby and the mother - although it does not carry direct big threats.

Although natural childbirth with a breech presentation of the fetus is possible, caesarean section often becomes an indication for delivery. If the birth proceeds in a natural way, constant and enhanced monitoring by the doctor is necessary - childbirth from a breech presentation is much more often accompanied by complications.

Signs of breech presentation of the fetus

Physically, if there is a breech presentation of the fetus, the woman does not feel this pathology in any way. She is not disturbed by any pain symptoms or discomfort, which can clearly signal the "wrong" location of the baby in the uterus.

Breech presentation can only be determined through examinations. So, with breech presentation, experts note a higher standing of the uterine fundus above the pubis, which does not correspond to the gestational age. The fetal heartbeat is heard more clearly in the umbilical region or slightly above it on the right or left (depending on the position of the fetus).

Also, signs of breech presentation of the fetus reveal themselves during a vaginal examination. For example, with a breech presentation, a soft volumetric part, inguinal fold, coccyx and sacrum are probed. With adjacent breech and foot presentation, you can determine the baby's feet with a calcaneal tubercle and short fingers (other than fingers on the hands) located on the same line. To clarify the diagnosis, however, ultrasound will also be required.

Exercises for breech presentation of the fetus

You can “give” the baby a head position in the tummy with the help of special gymnastic exercises. You can use them starting from 32-34 weeks of pregnancy - after consultation with your doctor. Gymnastic exercises involve turning the future mother in a prone position from one side to the other: 3-4 times approximately every 7-10 minutes. This exercise is performed 2-3 times a day. You can also carry out an exercise that involves lifting the pelvis: lying on your back, you should put some kind of roller under the lower back (you can use ordinary pillows) so that the pelvis is 20-30 centimeters higher than the head. In this position, you need to stay from 5 to 15 minutes, but no more. The exercise is performed 2-3 times a day on an empty stomach. Contraindications for performing such gymnastics are scars on the uterus from any operations, late toxicosis. He offers his methods for breech presentation and alternative medicine, for example, acupuncture, homeopathy,.

If the above methods have not brought the desired results, the expectant mother may be offered an external rotation of the fetus. This procedure is carried out at about 34-37 weeks of pregnancy, always in a hospital with monitoring, ultrasound monitoring and using special preparations that relax the uterus. A successful external coup will make it possible later to carry out childbirth in a natural way, but since this procedure is rather difficult, and also has many contraindications (a scar on the uterus, obesity, the age of the primipara is more than 30 years old, preeclampsia,), it is not suitable for every pregnant woman and they produce it quite rare.

Childbirth with breech presentation of the fetus

If the breech presentation could not be eliminated by any of the methods, this should not become a reason for the disorder. In this case, the pregnant woman will be advised to go to the obstetric hospital earlier: here, after all the necessary examinations, the method of delivery will be chosen.

Without any serious contraindications, childbirth can proceed naturally - under the constant supervision of a doctor. If it is not possible, a caesarean section will be required. Indications for cesarean section with breech presentation are (more than 3.5 kilograms), the presence of a scar on the uterus, a narrow pelvis in a pregnant woman, placenta previa, presentation in a foot or mixed position.

Specially for- Tatyana Argamakova

Breech presentation is observed in 6% of pregnant women. At normal course pregnancy, the baby gets into the right place by 21 weeks of gestation. But due to the presence of a number of negative factors, it can remain unchanged until the 3rd trimester.

The abnormal position of the fetus is not dangerous until 22 weeks of gestation. During this period, it is likely that the child's place will turn over several more times in the womb, but if the pathology is observed in the later stages, it is dangerous for both the child and the mother.

What does breech presentation mean?

Breech presentation is the position of the embryo in the lower part of the uterus, near the fallopian tube. During gestation, the child should be head down, but in some situations it is able to change its position, and the buttocks or legs are below. This pathological condition is most often detected at 25 weeks of embryo development. With a breech presentation of a full-term fetus, the worst prognosis is the death or severe injury of the baby upon birth.

The incorrect position of the baby in the womb may be due to diseases of the uterus, a small amount of amniotic fluid, or a weak placenta. You can understand the development of pathology by the nature of the movement of the baby. Most often, such a deviation causes premature or with the help of caesarean section childbirth. The disease is treatable, which means that there is a chance to leave the baby safe and sound.

Possible causes of the problem

Why does such an anomaly occur?

Doctors identify the following reasons for the incorrect position of the baby:

1. Due to polyhydramnios, the mobility of the embryo increases, so there is a possibility that it may take an oblique position.
2. With polyhydramnios, the baby cannot fully move, and when changing positions, there is a low probability that he will again stand in the right place.
3. When a woman is carrying twins, there is less space in the womb. It becomes cramped for babies and one of them may look for a more comfortable position and therefore turns head up.
4. narrow pelvis expectant mother.
5. Abnormal position of the placenta (along the anterior wall).
6. Too much big size baby.
7. Myoma of the uterus.
8. Pathological condition of the ovaries.

If a woman does not have uterine diseases, the placenta is healthy and the embryo develops normally, then there is a chance to avoid polyhydramnios or oligohydramnios in the womb. A decrease in fluid is observed due to previous abortions, diseases of the genital organs, multiple fertilizations, and with problems that arose in a previous pregnancy. In addition, there is a special corrective gymnastics that can help the baby to stand in the correct position.

Diagnostic measures

Two types of diagnostics are used to detect pathology: external obstetrics and vaginal examination. During an external examination, the doctor determines the posture of the child, the soft and inactive part of the placenta by perturbations. In addition, this method reveals an increased standing of the uterine fundus, which may not correspond to the gestation trimester. The doctor determines the baby's mobility and listens to the heartbeat by listening to the baby in the navel area through a stethoscope.

Vaginal examination of the patient helps to identify the soft and voluminous part in the gluteal anomaly. In this way, it determines where the sacrum, coccyx and inguinal fold are located in the baby. If the girl has a mixed or foot presentation, then the doctor will detect the movement of the child's foot.

In addition, an ultrasound will help to make an accurate diagnosis of the incorrect position of the baby. It will show the location of the fetus and help determine the type of pathology. During the study period, the doctor also determines the position of the head, since if the presentation is incorrect, birth complications may occur (the cerebellum or cervical region may be damaged in an infant).

How is the pregnancy

Head and pelvic transverse presentation with a mild degree of development does not interfere with pregnancy, it proceeds normally without complications. The girl does not experience discomfort, pain or heaviness either at 10-19 weeks or at a later date. At 33 weeks, a woman is prescribed a special set of exercises that will help change the position of the fetus and facilitate childbirth.

The most commonly prescribed exercise is:

1. You need to take a lying position on the bed.
2. Turn alternately on the right and left side with an interval of 15 minutes.
3. Repeat the exercise 4-5 times in each direction.

Charging in a pathological condition is done 3-4 times a day. With the systematic exercise of the exercise, the fetus turns the head downward for 7-9 days, if there are no complications. The purpose of gymnastics is to increase the excitability of the walls of the uterus. Women are also advised to sleep on their side. If by the end of gestation no changes are visible, then the girl is hospitalized 1.5–2 weeks before the birth of the baby. This is a mandatory procedure for all pregnant women in whom ultrasound showed the disease. The pregnant woman is placed for preservation and in order to identify exactly how the baby will be born (naturally or by caesarean).

How is childbirth with breech presentation

How exactly the birth of the baby will take place is decided by the attending physician.

Whether a caesarean section will be scheduled depends on the following factors:

1. The age of the girl (after 35 years of age, natural childbirth can provoke a number of complications).
2. Pelvis size.
3. The course of pregnancy and its timing.
4. The body weight of the child and the fetus (if a girl, then most likely there will be a caesarean section, a boy will have a natural birth).
5. Vaginal diameter.

Most often, problems with childbirth occur due to the immaturity of the vagina, late withdrawal of water, vaginal pathologies, fibroids and difficult period gestation.

If the baby is born naturally, then before the contractions, pain medication is administered to the woman to relieve tension and minimize muscle spasms. It is administered when the cervix dilates 40–50 mm.

Due to the abnormal development of the disease during natural childbirth, the following complications may occur:

• late discharge of water;
• prolapse of the umbilical cord and particles of the placenta;
• development of uterine anomalies;
• childbirth is delayed;
• the appearance of acute hypoxia;
• premature detachment of the child's place from the walls of the uterus.

Such complications are dangerous for the fetus and mother, so childbirth takes place under the supervision of obstetricians. After the waters have broken, doctors examine the vagina to find out if the woman in labor can give birth to the child herself. If the loops fall out, then a caesarean section is performed.

Most often, childbirth with this diagnosis proceeds normally, but there is a high risk of complications and problems. Therefore, it is important for a girl in position to take preventive measures in order to facilitate childbirth.

Is it possible to eliminate the pathological position of the fetus

If the disease has developed in the early stages or is mild, there is a chance to eliminate the problem. Preventive gymnastics and drug treatment will come to the rescue.

The main measures that can eliminate the disease include:

1. In the second trimester of gestation, antispasmodic drugs are prescribed. They are taken at half the allowable dose 3-4 times a week.
2. The state of the muscles of the uterus is controlled. Anti-anxiety drugs may be prescribed.
3. Gymnastic exercises. A set of movements will help to change the incorrect placement of the embryo. All classes are held in a sitting or lying position for 15-20 minutes. They need to be done half an hour before meals. All actions are performed in compliance with the recommendations of the doctor.
4. Bandage. The belt will help support the stomach and relieve tension from the back, the muscles will be more relaxed, which will help the embryo to move more actively.
5. Sometimes an external transfer of the child to the head is used. But this method of treatment is quite dangerous, as it can harm the fetus and cause complications (hypoxia, injury to the baby, premature birth).

The real story in this video:

How doctors can help

When making a diagnosis of "oblique breech presentation", doctors can provide a woman with several types of assistance.

Correction of the pathological condition before the birth of the child

Identification of pathology is not always negative. There are times when there is a chance to correct the situation. If the disease was detected at 32–34 weeks of gestation, then doctors prescribe a special course of gymnastic exercises for the pregnant woman. Exercises can be performed at home, but during the period of therapy, you need to systematically visit a gynecologist to minimize the risks of developing the disease.

This treatment is contraindicated if a woman has:

• narrow pelvis;
• there is a risk of premature birth;
• had miscarriages or turnovers in a previous pregnancy;
• a lot / little amniotic fluid;
• diseases of the uterus;
• in the womb 2 or 3 fetuses;
• preeclampsia;
• diseases that prohibit exercise therapy.

Despite the fact that the method has many contraindications, it is very effective and early dates gestation helps the baby roll over. But in this case, self-treatment is impossible, it threatens to worsen the situation even more. All activities must be supervised by a specialist.

obstetric turn

If the deviation was detected at 6–7 months of pregnancy, then an obstetric turn can be made. The doctor performs certain mechanical manipulations that help the fetus turn head down. This operation may only be carried out by a qualified medical institution under the control of an ultrasound machine. It helps to control the condition of the child and track his coup.

Before doing the procedure, the girl must undergo certain training. You can not eat the night before the procedure, as it is only done on an empty stomach. In addition, it empties bladder, and drugs are injected intramuscularly to relax the muscles. This will reduce the risk of spasms and make the procedure less painful. obstetric turn allows only for certain types of disease and in the early stages of pregnancy. If the fetus does not fall into place by the end of pregnancy, then a caesarean section is prescribed.

Cesarean section with breech presentation of the fetus

A cesarean is done to safely remove the baby. It minimizes the risk of complications. Most often, it is done if the girl has a narrow pelvis, and the natural birth of a baby is dangerous for the life of two, or the biomechanism of childbirth is broken.

In addition, the location of the fetus plays an important role. If it is impossible to give birth on its own during its presentation, then a caesarean section is performed. The operation prevents possible problems and protects the uterus from damage. Reviews of doctors indicate that this is the safest option when staging with such an anomaly.

Conclusion

Breech presentation is observed due to many factors that can negatively affect the fetus and the expectant mother. In the early stages of development, the problem can be eliminated, pregnancy and childbirth will proceed normally.

But there are times when the pathological position of the fetus causes a number of complications and becomes a threat to the life of the mother and child. Therefore, when symptoms appear wrong location the baby should go to the hospital and undergo medical examination to prevent unwanted consequences.

Shortly before birth, the baby occupies a certain position in the uterus. In most cases, it is placed head down - towards the exit from the uterus, and turns back to the left. This is the correct, so-called head presentation, the most convenient for childbirth. This is how 90% of babies are born.

Varieties of breech presentations

However, today we will talk about those cases when the presenting part is the legs or buttocks. Frequency pelvic adhesions, according to various estimates, is in the range of 3-5% of the total number of newborns. In 67% of these pregnancies, the baby sits with his buttocks in the mother's pelvic ring, his legs are bent at the hip joints, and his knees are straightened. Less common is a mixed breech (20.0%) presentation, when the child enters the mother's pelvic ring not only with the buttocks, but also with the legs, more precisely, with the feet. Breech presentation includes complete foot presentation when the baby's legs are slightly extended at the hip and knee joints; and mixed foot presentation, when one leg is almost straight and the other is bent at the hip joint; and knee presentation, when the baby is presented with bent knees.

Factors affecting breech presentation

There are certain conditions due to which the baby takes the wrong position. There are the following factors:

• maternal (anomalies in the development of the uterus, limiting the mobility of the fetus and the possibility of turning the head down at the end of pregnancy; tumors of the uterus, a scar on the uterus, a narrow pelvis that prevent the head from being established at the entrance to the small pelvis; the uterus and fetus are not sufficiently fixed, which also leaves the baby with the opportunity to maneuver ; multiple pregnancies and, as a result, weakness of the abdominal muscles; previous births in the breech presentation);
• fetal (congenital anomalies fetal development; prematurity; neuromuscular and vestibular disorders of the fetus; multiple pregnancy, abnormal articulation of the fetus);
• placental (, a lot of and oligohydramnios, due to which the child moves freely, his head cannot be fixed in the mother's pelvic floor or, conversely, does not have the possibility of active movement, entanglement and shortness of the umbilical cord, which also limit mobility).

At the same time, the child, possessing the instinct of self-preservation, occupies the most convenient position for himself. Doctors do not disregard the hereditary factor: if a mother was born in a breech presentation, then there is a risk that her baby will take the same position.

Diagnosis of breech presentation

Breech presentation of the fetus is diagnosed primarily according to external obstetric and vaginal examination. At outdoor study the large one presenting to the entrance to the pelvis is determined, irregular shape, a softish consistency, an inactive part, while in the bottom of the uterus a large, round, hard, mobile, balloting part (fetal head) is determined. A higher standing of the uterine fundus above the pubis is characteristic, which does not correspond to the gestational age. The heartbeat is clearly heard at or above the navel. During vaginal examination with a purely breech presentation, a softish volumetric part is felt, on which the inguinal fold, sacrum and coccyx are determined. With a mixed breech and foot presentation, the feet of the fetus are determined.

Via ultrasound it is possible to determine not only the breech presentation itself, but also its appearance. The position of the fetal head and the degree of its extension are assessed. Excessive extension is fraught with serious complications in childbirth: trauma to the cervical spinal cord, cerebellum and other injuries.

coup attempt

Breech presentation, diagnosed before, should not be a cause for concern, enough dynamic observation. With tactics aimed at correcting the breech presentation on the head. There are conservative methods. For this purpose, it is appointed corrective gymnastics, the efficiency of which is 75-85%. However, it cannot be used for abnormalities in the development of the fetus, the threat of miscarriage, a scar on the uterus, infertility and miscarriage in history, preeclampsia, placenta previa, low or polyhydramnios, abnormalities in the development of the uterus, multiple pregnancy, narrow pelvis, severe extragenital diseases. In addition to gymnastics, unconventional methods: acupuncture/acupressure, aromatherapy, homeopathy, as well as the power of suggestion, light and sound effects on the fetus from the outside, swimming.

If breech presentation persists, external prophylactic prophylaxis can be performed at term. fetal head rotation proposed by B.L. Arkhangelsk, the efficiency of which ranges from 35 to 87%.

External prophylactic rotation should be performed by a highly qualified doctor in stationary conditions where, if necessary, a caesarean section can be performed and the necessary assistance to the newborn can be provided. After turning, it is necessary to consolidate the achieved result. For this, certain an exercise, which helps to fix the baby's head in the desired position. However, if the baby, despite all the efforts made, has not turned over, do not despair: even in this case, the possibility remains spontaneous childbirth.

Choice of method of delivery

A woman with a breech presentation of the fetus needs to go to the hospital for examination and the choice of rational tactics for the management of childbirth. Method of delivery is determined based on the number of births, the age of the mother, obstetric history, the readiness of the female body for childbirth, the size of the pelvis and other factors. Breech presentation of the fetus is not an absolute indication for caesarean section, however, in cases where it is combined with various complicating factors, the issue is decided in favor of operative delivery.

Indications for caesarean section in a planned manner with a full-term pregnancy, the age of the primiparous is more than 30 years; severe form of nephropathy; extragenital diseases requiring the exclusion of attempts; pronounced violation of fat metabolism; narrowing of the pelvis; estimated fetal weight over 3600 g in primiparous and over 4000 g in multiparous; fetal hypotrophy; signs of fetal hypoxia according to cardiotocography; violation of blood flow during doplerometry; ; extension of the head of the 3rd degree according to ultrasound; unpreparedness of the birth canal during gestation; overwearing; foot presentation of the fetus; breech presentation of the first fetus multiple pregnancy and other factors.

Childbirth is through natural birth canal with a good condition of the expectant mother and fetus, full-term pregnancy, normal pelvic size, average size of the fetus, with a bent or slightly unbent head, the presence of readiness of the birth canal, with a purely breech or mixed breech presentation.

It is best when breech presentation fetal labor has begun spontaneously. In the first stage of labor, a woman in labor must observe bed rest and lie on the side towards which the back of the fetus is facing in order to avoid complications (premature discharge of water, prolapse of the fetal leg or umbilical cord loops). Childbirth is under monitor control fetal heart rate and uterine contractions. In the second stage of labor, it turns out obstetric care in the form of a benefit, the purpose of which is to preserve the articulation of the fetus (the legs are extended along the body and pressed to the chest by the arms of the fetus). First, the child is born to the navel, then to the lower edge of the angle of the shoulder blades, then to the arms and shoulder girdle, and then to the head. When a child is born to the navel, his head presses the umbilical cord, and a lack of oxygen develops, therefore, no more than 5-10 minutes should pass until the child is born completely, otherwise the consequences of oxygen starvation will be very negative. Also produced perineal incision to speed up the birth of the head and make it less traumatic.

Childbirth at foot presentation through the natural birth canal are carried out only in multiparous with good labor activity, readiness of the birth canal, full-term pregnancy, medium size (weight up to 3500 g) and good condition of the fetus, a bent head, a woman's refusal of a caesarean section. At the same time, the obstetric benefit is as follows: the external genital organs are covered with a sterile napkin and the palm facing the vulva prevents the legs from falling out of the vagina prematurely. Leg hold contributes to the full disclosure of the uterine pharynx. The fetus during an attempt, as it were, squats down, and a mixed breech presentation is formed. Opposition to the born legs is exerted until the uterine os is fully opened. After that, the fetus is usually born without difficulty.

The condition of children born in a breech presentation through the natural birth canal requires special attention. Hypoxia experienced during childbirth can adversely affect nervous system child, such a pathology as a dislocation of the hip joint is possible. A neonatologist and resuscitator must be present at the birth. With these precautions, babies born this way do not differ in development from other babies.