Breech birth is a condition where a baby is positioned to be delivered buttocks or feet first instead of the normal head-first (cephalic) presentation. This occurs in about 3–4% of full-term deliveries and is influenced by factors such as fetal movement ability and uterine space constraints[1]. The relationship between breech birth and cerebral palsy (CP), a group of permanent movement disorders caused by brain damage, is complex and involves multiple medical considerations.
Cerebral palsy primarily results from brain injury or abnormal brain development occurring before, during, or shortly after birth. The most common types of brain damage linked to CP include hypoxic-ischemic encephalopathy (HIE), periventricular leukomalacia (PVL), intracranial hemorrhage, and cerebral dysgenesis[2]. These conditions often stem from reduced oxygen or blood flow to the brain, trauma, or developmental abnormalities.
**Is Breech Birth Directly Tied to Cerebral Palsy?**
Breech presentation itself is not a direct cause of cerebral palsy, but it can be associated with increased risks that may contribute to brain injury leading to CP. The key medical concern with breech births is the potential for complications during delivery that can cause oxygen deprivation (hypoxia) or trauma to the baby’s brain. For example, prolonged oxygen deprivation during a difficult breech delivery can cause permanent neurological damage, including cerebral palsy[1][2].
The risk factors linking breech birth to CP include:
– **Oxygen deprivation during delivery:** Breech births can be more complicated and prolonged, increasing the chance of hypoxic events. Hypoxic-ischemic encephalopathy (HIE), caused by reduced oxygen and blood flow, is a leading cause of CP[2].
– **Trauma during delivery:** Breech presentation may increase the risk of physical trauma to the baby’s head or body during birth, potentially causing brain injury. For instance, nerve palsies and hip subluxation have been reported in newborns with breech history, indicating mechanical stress[3].
– **Underlying fetal conditions:** Some fetuses in breech position may have reduced ability to move or neurological impairments that both cause the breech presentation and increase CP risk. This means the breech position might be a marker rather than a cause of brain injury[1].
– **Prematurity and low birth weight:** Breech presentation is more common in preterm births, which themselves carry a higher risk of brain injury and CP[1][2].
**Medical Management and Prevention**
Modern obstetric care aims to reduce the risks associated with breech births through careful monitoring and delivery planning. Cesarean section is often recommended for breech presentations at term to minimize trauma and oxygen deprivation risks. When vaginal breech delivery is attempted, it requires skilled clinicians and strict protocols to avoid complications[1].
Preventive measures during pregnancy and delivery include:
– Monitoring fetal position and attempting to turn breech babies before labor (external cephalic version).
– Close surveillance for signs of fetal distress during labor.
– Prompt intervention if delivery is not progressing or if oxygen deprivation is suspected.
– Use of emergency protocols and medications as needed to manage complications[5].
**Research and Evidence**
While breech birth is associated with increased risks, the direct causal link to cerebral palsy is not definitively established. The literature indicates that cerebral palsy is mor
