From the moment of conception to the very birth, the expectant mother is constantly in fear for her little miracle, which has been in her womb for all these 9 months. After all, the baby will have to go a huge difficult path from a tiny cell to a little man, and on it he faces many problems.
If the pregnancy is proceeding well, the fetus is developing correctly and no problems have been identified, then a woman may well give birth without any extraneous manipulations. But not everything goes as we would like. One of the frequent pathologies that are a direct indication for cesarean section is the incorrect location of the fetus before childbirth.
Little information for future parents
From the very first weeks of its attachment to the uterus, the little baby begins to actively move and even push off from the walls, since it is still too small and there is plenty of space in the uterus. But this freedom lasts only until the middle of the second trimester. Further, it becomes more difficult for the child to change the pose. He is forced to accept the most convenient position for him and for future births, and in such a state to wait for the birth.
That is why obstetricians from the antenatal clinic, starting from 30 to 34 weeks, carefully monitor the location of the fetus in the womb and try to choose the best option for delivery. And yet you should not panic ahead of time: there are cases when a child at the very last moment somehow takes the right position and was born naturally healthy.
What are the types of pathologies?
Usually, an experienced obstetrician-gynecologist can determine the position of the fetus by palpating the pregnant woman’s stomach, but still the final verdict will be delivered after an ultrasound examination, and only then will the doctors decide how to take birth. Of course, you should not be very upset, but every expectant mother is simply obliged to know what pathologies can be and what to expect in a particular case.
So, the fetus can be in the pelvic or cerebral presentation, which, in turn, have separate varieties. We will talk about them below. At the next admission to the LCD, the future mother can hear, in addition to the location of the fetus, about the so-called position. This term is used in medicine to refer to the back of a child and the uterine wall. The baby can be positioned longitudinally, that is, head down or up, or across, respectively, with the head to the right or left.
With a longitudinal arrangement, natural childbirth without complications is possible if the child’s head is below, that is, closer to the birth canal. True, even in this case there are small nuances, but in general a woman in labor is quite capable of giving birth herself.
In cases where the fetus is transverse, natural delivery is completely excluded. In this case, there is only one way - cesarean section.
Pelvic presentation
This is the case when a child literally "sits" at the exit. In this case, the pelvic presentation can, in turn, be of several types:
gluteal (baby's head on top, buttocks on the bottom, legs raised closer to the face);
foot (the child, as it were, stands on his feet or, possibly, only on one leg);
mixed (the baby with this presentation can "sit" on the buttocks, bending the legs at the knees).
Childbirth with pelvic presentation is, in principle, possible, but very risky. During labor, both the mother and the baby can be seriously injured. Therefore, it is recommended to listen to doctors and agree to a cesarean section.
Fetal presentation
This is the most correct and safe position in which injuries for the baby and the woman in labor are minimized. With head presentation, the baby's head is located at the most birth canal and appears first during childbirth.
Head presentation can also be divided into several types:
The occipital is the most ideal and natural position of the child, in which the baby will move the back of the head forward along the birth canal.
Forehead.
Frontal - according to doctors, the most dangerous head presentation. In this case, the only way out is a cesarean section.
Facial presentation of the fetus is almost as dangerous as the frontal presentation. When advancing through the birth canal, there is a risk of spinal injury. It is on this type of pathology that we will dwell in more detail below.
What does facial presentation of the fetus mean and how is it dangerous?
This is an extreme degree of extension of the baby's head. And initially, when lowering, a frontal presentation is observed, and only then does it turn into a facial presentation. Usually, such a presentation occurs immediately at the time of delivery, but there are cases when such a condition occurs long before the onset of labor and is diagnosed using ultrasound examination.
According to some clinical data, such a presentation is observed in approximately 0.30% of all pregnant women. At the same time, multiparous women are subject to such pathologies more often than primiparous.
How is abnormal presentation of the fetus diagnosed?
With facial presentation, the baby's head strongly leans back and is pressed against the back, while the chest of the baby is adjacent to the walls of the uterus. All these conditions together create a number of characteristic features by which an experienced obstetrician can easily determine the presence of facial presentation of the fetus.
In the correct diagnosis, a vaginal examination will also be useful , which must be done very carefully so as not to harm the baby. The doctor can easily feel the chin on one side, and the nose and eyebrows on the other. In this case, the presence of facial presentation is not in doubt.
Why is this happening?
Such abnormal presentation of the fetus in the uterus is extremely rare, approximately 1 in 400 births. More often susceptible to such a pathology are multiparous women. The causes of facial presentation of the fetus can be different: a narrow pelvis of the woman in labor, too low tonus of the uterus, uneven contraction of its sides.
The facial presentation of the fetus (child) can be either primary or secondary. The first option is observed extremely rarely, and is noted long before the onset of labor. The reasons may be different, for example, when a thyroid tumor is observed in a child. Secondary previa is observed more often. It is formed from the so-called frontal. Basically, this happens with a narrow pelvis in a woman in labor.
The mechanism of childbirth with facial presentation of the fetus
At the very beginning of labor activity with facial presentation, the child’s head, instead of bending over, extends posteriorly. Next is the internal rotation of the head, this occurs during the transition from the wide part of the small pelvis to the narrow. Then there is an extension of the chin anteriorly, while the head is located in the pelvic floor. And finally, the teething of the face of the baby occurs. Ultimately, there is a rotation of the shoulders and head exactly as it does with occipital presentation.
The consequences of natural childbirth with facial presentation for a child and mother
The consequences of facial presentation of the fetus (child) as a whole depend on the course of labor and the professionalism of doctors. It should be understood that such a pathology cannot but affect the condition of the baby. Immediately after birth, severe swelling and hemorrhages on the eyelids, lips of the newborn are observed. The tongue and the bottom of the oral cavity are extremely swollen, which leads to problems with feeding in the first days of the baby's life.
The prognosis and consequences of facial presentation of the fetus are relatively favorable. As a rule, 93% of women in labor do not need surgery and only 20% had a perineal rupture.
Unfortunately, despite the positive prognosis for facial presentation of the fetus, the consequences for the child are not always favorable. Under such circumstances, the number of stillbirths increases sharply. The main problem in this case is the entanglement of the umbilical cord, which is observed much more often than with occipital presentation.
Reviews of experienced mothers
If you go through the numerous women's forums on the Internet, we can conclude that the consequences of facial presentation of the fetus, as well as reviews, may differ depending on the specific situation. Often women note that primary presentation is not a sentence, and everything can change, that is, the baby can still turn as it should, at the most unpredictable moment. Many mothers are advised to perform a series of exercises to adjust the position of the fetus in the uterus, but before listening to their advice, it would be useful to consult a doctor professionally about this.
But still it’s worth being realistic and not waiting for a miracle to the last. If your gynecologist says that a facial presentation of the fetus is observed, the consequences and reasons of which force you to resort to cesarean section, then you should not risk your health and the baby, but completely rely on the many years of experience of the doctor.
How are births conducted with a similar pathology
If facial presentation is established and there is no labor activity yet, expectant tactics are used. In other words, doctors are likely to put the expectant mother in the maternity hospital in advance, but will not do anything. In most cases, everything is decided by nature itself and childbirth takes place without any serious consequences for the mother and baby. In the case of facial presentation, natural delivery, although complicated, is still possible. With frontal presentation, especially in combination with the normal size of the pelvis and full-term pregnancy, natural childbirth is impossible. They will occur if the frontal presentation passes into the facial or anterior head, with a small fetus and a spacious pelvis.
If the opening of the cervix begins, it is necessary to put the woman in labor on her back and try not to damage the fetal bladder. In the presence of a large fetus or narrow pelvis of the woman in childbirth and facial presentation of the fetus, the recommendations of doctors always converge in immediate surgical intervention. Otherwise, there is a risk of missing the most favorable time and causing serious harm to both the mother and the child.
Why can a fetus even take the wrong pose?
As we wrote above, it is inherent in nature that before childbirth the child takes the most favorable position for himself and his mother, that is, longitudinally, with an occipital presentation. But, alas, there are cases when something goes wrong and the baby is not located as it should. There may be several reasons:
After repeated curettage, abortion, multiple births, and even cesarean section surgery, hypertonicity of the lower parts of the uterus can be observed, while in the upper sections there will be a significant decrease in tone. Due to this condition, the fetus may push off from entering the pelvis and assume an unnatural position for it.
An important role is played by the characteristics of the child himself, for example, a large or too active fetus, prematurity.
Marked abnormalities of the uterus (bicorn, saddle uterus, fibroids), narrow pelvis.
The entanglement of the umbilical cord, resulting in severely limited fetal mobility.
Methods for correcting misrepresentation
There is a set of exercises with which you can adjust the location of the fetus before the birth. The complex will be recommended by the attending physician. In addition to gymnastics, methods such as diving into the pool, acupuncture, homeopathy, psychological suggestion, aromatherapy and even music therapy can be used. You can try everything that your heart desires, only with the condition: to be extremely careful and not shy about any questions (even the most insignificant) to your gynecologist.
The effectiveness of such exercises, according to some reports, can reach 80%. But it is worth remembering that in no case should you do this without prior consultation with a leading doctor. After all, the situation in each case is individual and there may be serious contraindications. So, to direct contraindications to such gymnastics include scars and tumors on the uterus, placenta previa, gestosis, severe inflammatory diseases. In this way, you can do significant harm instead of good.
And remember: in any case, the final verdict must be made by the doctor and he knows best how serious everything is. And if a decision is made to have a cesarean section, there is nothing wrong with that. The main thing is that a healthy baby is born, and everything is in order with mom.