What is the main concern with a breech presentation at delivery?

A breech presentation refers to a situation during labor where the baby is positioned such that the buttocks or feet are positioned to be delivered first instead of the head. This positioning raises significant concerns primarily due to the increased risk of complications and injuries during the birthing process.

In a breech delivery, the body of the baby can get stuck after the buttocks or feet have been born, which can lead to issues such as asphyxia due to the umbilical cord being compressed. There is also a higher risk of birth trauma, which can include injury to the fetus’s spine and head. In addition, there's potential for entrapment of the baby's arms or normal anatomical structures being disrupted during a breech delivery. These complications often necessitate the use of cesarean delivery, particularly for any breech presentation that is not in a favorable position for vaginal delivery.

This primary concern about the increased risk of complications during a breech delivery is essential for the healthcare provider to consider for the safety of both the baby and the mother. The other factors listed, such as difficulty obtaining a fetal heart rate, higher likelihood of maternal infections, or longer recovery time, while notable in certain contexts, are not the most pressing issues directly associated with