Updated 14 April 2020 |
Published 20 March 2019
Fact Checked
Reviewed by Kate Shkodzik, MD, Obstetrician and gynecologist
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Babies often twist and turn throughout pregnancy, but most of them will move into the delivery position (head first) a few weeks before birth. When this doesn’t happen, the baby’s feet and/or butt are positioned in such a way that they get delivered first. This position is known as a breech presentation. Breech births are rare but occur in about 1 out of 25 full-term pregnancies.
Causes of breech presentation
What causes a breech presentation isn’t fully understood, but the American Pregnancy Association states that a breech birth has a tendency to occur more frequently in the following situations:
- if the pregnant woman has a history of several pregnancies
- if a woman is pregnant with multiples
- if a woman has a history of delivering prematurely
- if a woman has placenta previa
- if the uterus contains either too little or too much amniotic fluid
- if the woman’s uterus has an abnormal shape or other problems such as fibroids
Breech baby positions
A breech presentation happens when a baby doesn’t move into a delivery position before birth and instead stays in a bottom-down position. There are three types of breech baby positions: complete, footling, and frank breech.
Complete breech baby
In this breech presentation, the baby’s butt points down and their legs are folded at the knees, with the feet tucked in.
Frank breech baby
In frank breech presentation, the baby’s butt is aimed towards the birth canal, and their legs are straight up in front of their body, with their feet near the face or head.
Footling breech baby
In this breech presentation, one or both of the baby’s feet point down, so that they are the first part of the body to come out during delivery.
Turning a breech baby: is it possible?
If you have a breech presentation, you can try to turn the baby when you are between the 32nd and 37th weeks of your pregnancy. There are various methods to turn a baby, and the success rate of each method is different. You should discuss all the options with your obstetrician and follow their recommendations.
Medical techniques
External version (EV): This is a non-surgical method of turning a breech baby in the uterus. Most doctors suggest using this technique between the 36th and 38th weeks of pregnancy. During the procedure, your doctor will give you medicine to help your uterus relax. They may also use an ultrasound to locate the placenta, determine the baby’s position, and measure the quantity of amniotic fluid.
Your doctor will try to gently push your lower abdomen so that the position of your baby changes from breech to head down. Throughout this procedure, the doctor closely monitors your baby’s heartbeat. If any kind of problem occurs, they immediately stop the procedure. The success rate of EV is more than 50 percent. This procedure for turning a breech baby becomes more difficult as your due date approaches.
Chiropractic care: A technique developed by Larry Webster of the International Chiropractic Pediatric Association allows chiropractors to decrease stress on a pregnant woman’s pelvis, relaxing her uterus and the surrounding ligaments. Due to the relaxed state of the uterus, it becomes easier for the breech baby to turn naturally.
This technique of turning a breech baby is referred to as the Webster Breech Technique. According to a study published in the Journal of Manipulative and Physiological Therapeutics, the technique was found to have an 82 percent success rate. The study results further suggest that you should perform this technique during the eighth month (third trimester) of your pregnancy.
Natural techniques
The breech tilt: While lying on your back, use large, firm pillows to raise your hips about a foot off the floor. Do this three times every day for 10–15 minutes. You can do this technique when the baby is active and on an empty stomach. While doing this technique, concentrate on your baby, particularly in your abdominal area, and avoid tensing the body.
vagin*l breech delivery vs. cesarean breech birth
Most doctors don’t attempt a vagin*l breech delivery, but your doctor may attempt it in the following situations:
- Your baby is in frank breech position and is full term.
- Your doctor has been monitoring your baby’s heart rate, and they’re showing no signs of distress.
- The labor proceeds smoothly and steadily with your cervical opening widening with the descent of the baby.
- Your baby isn’t too big or your pelvis too narrow for your baby to pass safely through your birth canal.
- Anesthesia and the possibility for cesarean section are available on short notice.
Your doctor will probably not attempt a vagin*l breech delivery if:
- You have a footling breech baby.
- Your baby is smaller or larger than average.
- Your baby is lying in a certain position in the uterus; for instance, their neck is tilted back, making delivery difficult.
- You suffer from preeclampsia.
- You have placenta previa.
Complications and risks of a vagin*l breech delivery
During a breech birth, the baby’s head is the last part of the body to come out, which can make it harder for them to ease through your birth canal. In some cases, the doctor may use forceps to guide the baby’s head out.
Another thing that can happen during vagin*l breech delivery is cord prolapse when the umbilical cord gets squeezed while the baby is moving towards the opening of the uterus. This slows the supply of blood and oxygen to the baby. During vagin*l breech delivery, your doctor will monitor the baby’s heartbeat during the entire labor process. If your baby starts to show signs of distress, the doctor may consider a cesarean section (C-section).
When is a cesarean section done with a breech position?
Most doctors recommend a C-section for all babies with breech presentation, especially when they’re premature. This is because premature babies are smaller and more fragile. Their heads are also relatively larger than their bodies, so in breech position, they can’t stretch the cervical opening as much as a full-term baby can. This makes it even more difficult for the head to emerge.
Breech birth diagnostics
Your doctor will diagnose a breech presentation a few weeks before your due date by placing their hands on your lower abdomen and locating the baby’s head, butt, and back. If they feel that your baby may be lying in a breech presentation, they may use an ultrasound to confirm it.
Your doctor may also use special X-rays to determine the position of the baby and the size of your pelvis.
Breech birth happens when a baby doesn’t move into a head-first position before birth and instead stays in a bottom-down position. The cause of a breech presentation isn’t fully understood, but various situations make it more likely.
There are three types of breech baby positions, depending on the position of the baby in your uterus: complete, footling, and frank breech position. There are various methods for turning a breech baby, and you can try them between the 32nd and 37th weeks of pregnancy.
History of updates
Current version (14 April 2020)
Reviewed by Kate Shkodzik, MD, Obstetrician and gynecologist
Published (18 March 2019)
