Breech Position and Breech Birth

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Breech Position and Breech Birth

Topic Overview

What is breech position?

During most of pregnancy, there is enough room in the uterus for the baby (fetus) to change position. By 36 weeks of pregnancy, most babies turn into a head-down position. This is the normal and safest fetal position for birth.

But in about 4 out of 100 births, the baby does not naturally turn head-down late in the pregnancy. Instead, the baby is in a breech position.1 Babies in breech position usually must be delivered by C-section.

There are three main breech positions:

  • Frank breech. The buttocks are in place to come out first during delivery. The legs are straight up in front of the body, with the feet near the head. This is the most common type of breech position.
  • Complete breech. The buttocks are down near the birth canal. The knees are bent, and the feet are near the buttocks.
  • Footling breech. One leg or both legs are stretched out below the buttocks. The leg or legs are in place to come out first during delivery.

See a picture of breech positions.

What causes breech position during pregnancy?

There is often no clear reason why the baby did not turn head-down. In other cases, breech position might be linked to:2

  • Labour that begins before the 37th week of pregnancy, before the baby is likely to turn head-down on its own.
  • Twins or more. Limited space for two or more babies can prevent them from moving into the head-down position before delivery.
  • Too much or too little amniotic fluid in the uterus.
  • Problems with the uterus, such as an oddly shaped uterus or uterine fibroids, which are non-cancerous growths in the uterine wall.
  • Stretched and weakened uterine muscle from past pregnancies.
  • Problems with the baby, including heart, digestive tract, and brain problems, such as Down syndrome, anencephaly, or hydrocephalus.

What are the signs that your baby is in breech position?

You probably will not be able to feel whether your baby is breech. But if you are 36 or more weeks pregnant and think you feel the baby’s head pressing high up in your belly and/or you feel kicking in your lower belly, see your doctor for an examination.

How is a breech position diagnosed?

During a routine examination late in your pregnancy, your doctor will feel your upper and lower belly and may do a fetal ultrasound to find out if your baby is breech. Your doctor may also learn that your baby is breech when he or she checks your cervix.

How is breech position treated?

Sometimes it is possible for a doctor to turn a baby from a breech position to a head-down position by using a procedure called an external cephalic version. If the baby can be turned head-down before labour starts, you may be able to have a vaginal birth.

You also can ask your doctor if you can try certain positions at home that may help turn your baby. There is no research to prove that this works, but it’s not harmful. It may work for you.

It’s normal to feel disappointed and worried about a breech pregnancy, especially if the doctor has tried to turn the baby without success. But most breech babies are healthy and do not have problems after birth. Talk to your doctor if you're concerned about your baby’s health.

How is a breech baby delivered safely?

Most of the time a planned caesarean delivery (C-section) is safest for the baby. But sometimes it is possible to have a planned vaginal delivery with a breech birth. Talk to your doctor about how to have the safest delivery for your breech baby.

If you are using a midwife and your baby is in breech position, your midwife will refer you to a doctor for an external cephalic version or a scheduled C-section.

No matter what position a baby is in, every labour and delivery is unique. Even though you and your doctor have a birth plan for labour and delivery, plans can change. If something unexpected happens, your doctor may need to make some quick decisions to keep you and your baby safe.

Frequently Asked Questions

Learning about breech position and breech birth:

Being diagnosed:

Getting treatment:

Symptoms

Breech presentation does not necessarily feel unusual to the mother. You are most likely to learn of a breech fetus during a routine prenatal visit or during labour and delivery.

Before 36 weeks of pregnancy, you are unlikely to notice your fetus moving freely between head-down and head-up positions. Even after 36 weeks, you may not know if your fetus is breech unless you feel:

  • Your fetus's relatively hard head high up in your abdomen.
  • More movement low in the abdomen.

Examinations and Tests

You are most likely to discover that your fetus is in the breech position during a routine prenatal examination late in your pregnancy.

  • Your doctor will gently press on various areas of your abdomen. Often a fetus's position can be determined by noticing that the head (which is relatively hard) is above the buttocks (which are relatively soft), or that the heart is higher up than normal.
  • Also, when your doctor checks your cervix, he or she may learn that your baby is breech. This is done by placing gloved fingers into the vagina and feeling the cervix. During this examination, the round, smooth feel of the fetal head pressing on the cervix can often be distinguished from the soft, irregular feel of a breech presentation.

See pictures of different breech positions.

If the examination suggests that your fetus is in the breech position, a fetal ultrasound test will be done to confirm the diagnosis.

If your doctor tries to move the fetus into a head-down position (external cephalic version):

  • Fetal ultrasound will be used before, after, and possibly during the procedure to evaluate the fetus's position and heart rate.
  • Electronic fetal heart monitoring will be used before and after the procedure. An active fetus whose heart rate increases normally with movement is usually considered to be healthy. If the fetus's heart rate becomes abnormal, the version procedure may be stopped.

Treatment Overview

By the 36th week of most pregnancies, the fetus naturally turns head-down (vertex). In this position, the fetus is ready for a head-first delivery through the birth canal. If your fetus is bottom-down (breech position) as your due date approaches, your doctor will most likely recommend a scheduled caesarean delivery (C-section). But if your fetus can be turned before labour starts, you can try for a vaginal labour and delivery.

See pictures of different breech positions.

Turning a breech fetus

A version procedure can turn a baby from a breech position to a head-down position. Also, you can ask your doctor if you can try certain positions at home that may help turn your baby. There is no research to prove that this works, but it’s not harmful. It may work for you.

  • External cephalic version (or version) is done in a medical setting with constant fetal heart rate monitoring. You will have an ultrasound before and after the version attempt. Your doctor may first give you a medicine to relax your uterine muscles. To turn the fetus, your doctor will press on specific areas of your abdomen. Version can be repeated several times if the first attempts to turn the fetus are not successful.
  • Postural management is something you do at home. You carefully position yourself with your hips raised above your head several times a day for several weeks.

If a version is successful, your fetus's position will be checked regularly until labour begins. If your fetus stays head-down, a planned caesarean is not needed, and you can expect to go through labour. You may deliver vaginally or by caesarean, depending on how the birthing process goes.

Delivering a breech infant

Most breech infants are delivered by planned caesarean section (C-section) to prevent harm to the infant. If your fetus stays in or returns to breech position near your due date, your doctor will likely schedule a caesarean. For more information, see the topic Caesarean Section.

Sometimes a caesarean breech birth is neither possible nor recommended. When a breech labour progresses too quickly, a vaginal birth may be the only delivery option. During a twin birth, a second twin who is breech may best be delivered vaginally.3 Risks are lowest for the newborn when a doctor has a lot of experience doing this kind of delivery.4

A fetus in a breech position can be delivered by:

If you have a registered midwife for obstetric care, and your baby is breech, your midwife will refer you to a doctor for an external cephalic version or a scheduled C-section.

Your family doctor, general practitioner, or pediatrician may be present during the delivery in case your newborn needs care after birth.

Home Treatment

Healthy pregnancy choices

Whether or not your fetus is known to be in breech position, you can help with delivering a healthy baby.

  • Have regular prenatal checkups throughout your pregnancy. Knowing your fetus's position before you go into labour will help prevent breech birth complications.
  • Eat a balanced diet.
  • Avoid substances that are dangerous to your fetus, such as tobacco, alcohol, and illegal drugs.

For more information about staying healthy during pregnancy, see the topic Pregnancy.

Managing your breech pregnancy

If your fetus is in a breech position, ask your doctor if you can try postural management, using certain positions that use gravity to turn your fetus. Although this method has not been proved to turn the fetus into a head-down position, it isn't known to be harmful and may work for you.

It is normal to feel disappointed and worried when learning about a breech pregnancy, especially when attempts to turn the fetus are not successful. If you have concerns about your fetus's health, talk to your doctor. Most breech babies are healthy and do not have problems after birth.

After delivery by caesarean section, you will need extra help with basic household and infant care tasks for a few weeks. Although you will be able to get up and walk around within a few days, you will not be able to do any heavy lifting. For more information, see the topic Caesarean Section.

Other Places To Get Help

Organization

Society of Obstetricians and Gynaecologists of Canada (SOGC)
780 Echo Drive
Ottawa, ON  K1S 5R7
Phone: 1-800-561-2416
(613) 730-4192
Fax: (613) 730-4314
Email: helpdesk@sogc.com
Web Address: www.sogc.org
 

The mission of SOGC is to promote optimal women's health through leadership, collaboration, education, research, and advocacy in the practice of obstetrics and gynaecology.


References

Citations

  1. American College of Obstetricians and Gynecologists (2000, reaffirmed 2009). External cephalic version. ACOG Practice Bulletin No. 13. Obstetrics and Gynecology, 95(2): 1–7.
  2. Cunningham FG, et al. (2010). Breech presentation and delivery. In Williams Obstetrics, 23rd ed., pp. 527–543. New York: McGraw-Hill.
  3. American College of Obstetricians and Gynecologists (2006, reaffirmed 2008). Mode of term singleton breech delivery. ACOG Committee Opinion No. 340. Obstetrics and Gynecology, 108: 235–237.
  4. Su M, et al. (2003). Factors associated with adverse perinatal outcome in the Term Breech Trial. American Journal of Obstetrics and Gynecology, 189: 740–745.

Credits

By Healthwise Staff
Primary Medical Reviewer Sarah Marshall, MD - Family Medicine
Primary Medical Reviewer Brian D. O'Brien, MD - Internal Medicine
Specialist Medical Reviewer William Gilbert, MD - Maternal and Fetal Medicine
Last Revised June 22, 2010

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information.