Having gone through a seemingly normal pregnancy without any major complications, 30-year-old Mary Njambi was looking forward to a successful natural delivery.
But that was not to be. She went through a long and painful labour, which eventually led to her undergoing a caesarean section (C-section) as her baby’s position during delivery was ‘incorrect’.
“His feet were coming out first instead of the head. And the doctors said this was risky for my health. So I was advised to have surgery, which I was not expecting. But I had no choice.”
Eventually, Mary delivered the baby but she had to be admitted for about two weeks for observation since she had bled a lot during surgery and could have easily lost her life.
A new study published in this month’s Plos Medicine Journal shows that subjecting expectant women to ultrasound scans at 36 weeks of pregnancy can help address such challenges.
These pregnancy ultrasounds would enable health workers to identify babies lying in abnormal positions early enough hence averting delivery complications or emergency C-sections that can adversely affect the health of mothers and babies.
Naturally, as the pregnancy duration comes to an end, the unborn child usually positions itself in an angle that is ideal for delivery.
Babies usually do this by moving their head closer to the birth canal. This ensures that during delivery, it is the head that comes out first before the rest of the body.
But this alignment process may fail to happen correctly such as in Mary’s case. As a result, the baby ends up lying in a position that will make the buttocks or feet come out first during delivery. This is referred to as the breech position.
Failure to diagnose this anomaly early enough can lead to babies getting stuck in the birth canal or having their oxygen supply from the umbilical cord cut off during delivery.
This increases stillbirth risks and likelihood of the baby dying shortly after birth.
For mothers, having babies in the breech position enhances their chances of getting infections, having a raptured uterus or going through post-partum bleeding that is life- threatening.
It can also lead to other long-term effects such as obstetrical fistula, caused by a hole developing between the vagina and rectum or bladder due to a difficult delivery. The condition results in incontinence of urine or faeces.
In most cases, health workers usually seek to determine the position of the unborn child before delivery by palpation of the pregnant woman’s abdomen.
This method is highly subjective and can fail to identify babies lying in abnormal positions as its success rate usually is tied to the health worker performing the palpitations.
Those with experienced hands can easily detect breech positions while the relatively new ones may miss out some cases, falsely assuming that the baby is in the right position.
By routinely using ultrasounds, the researchers note that undiagnosed breech position in labour could be avoided, lowering the risk of complications for both the mother and baby.
In the new study, researchers performed screening ultrasounds at 36 weeks of pregnancy in 3,879 women having first pregnancies in England.
A total of 179 women were found to have babies in breech positions by the scans.
However, in over half of these cases (55 percent), there was no prior suspicion that the baby was presenting in the breech position.
Making the diagnosis at 36 weeks allowed women to opt for an attempt at turning the baby, called external cephalic version.
Doctors do this by pressing their hands on the outside of the mother’s belly to try to turn the foetus. The goal is to get the baby to turn in the womb and assume a head-down position.
If this conversion is successful, it will allow the mother to deliver naturally (vaginal birth) and avoid caesarean delivery.
For the women who declined this procedure during the study, or where it was unsuccessful, a planned C-section was arranged.
None of the women with babies in breech position opted to attempt a vaginal birth, which is associated with an increased risk of complications, particularly in first pregnancies.
Across the UK, an analysis based on the study findings estimated that routine scanning could prevent about 15,000 undiagnosed breech position presentations, more than 4,000 emergency C-sections and 7 to 8 baby deaths per year.
Common causes of breech positions include pregnancies of multiples (more than one child), history of premature delivery, too much or too little amniotic fluid in the uterus, abnormal shaped uterus, uterus with growths (like fibroids) or a placenta that lies low in the uterus.