In normal pregnancies, the baby's head is positioned near the mother's cervix, and it comes out first during delivery. This is called vertex presentation and applies to approximately 96 percent of full-term pregnancies. The remaining 4 percent of babies are in the breech presentation, which means that the buttocks and/or feet are closest to the cervix. Learn more about the breech definition, causes, and how to deliver a breech baby.
What is a Breech Baby?
During your pregnancy, your baby constantly moves around the uterus. Indeed, most babies do somersaults up until the 36th week of pregnancy, when they pick their final position in the womb, says Laura Riley, M.D, an OB-GYN in New York City. A small percentage end up “upside-down” in breech presentation, with their feet or buttocks near the cervix.
How do you diagnosis breech presentation? Your midwife or doctor can feel the position of your baby's head through your abdominal wall—or they can conduct a vaginal exam if your cervix is open. Suspected breech presentation should be confirmed through ultrasound, then you’ll have a full discussion about delivery options, potential issues, and risks.
Types of Breech Presentation
There are three types of breech babies: frank, footling, and complete. Learn about the differences here.
Frank Breech: The baby’s bottom faces the cervix and his legs are straight up. This is the most common type of breech presentation.
Footling Breech: One or both of the baby's feet are in the birth canal, where they’re positioned to be delivered first.
Complete Breech: The baby’s bottom faces the cervix. His legs are bent at the knees, and his feet are near his bottom. The least common type of breech presentation.
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The baby can also be in transverse breech position, meaning that he’s sideways in the uterus. Oblique breech means he’s pointing toward one of the mother’s hips.
Breech Baby Causes
The baby and the shape of your uterus determine presentation. You can’t control either of these factors, so breech presentation usually isn’t preventable. And while the cause often isn't known, there are certain risk factors that may increase your risk of a breech baby:
- You’re pregnant with multiples
- This isn’t your first pregnancy
- You’ve had a previous breech baby
- You have placenta previa (the placenta partially or fully covers the cervix)
- You have a history of premature delivery
- The uterus has abnormal growths or fibroids
- There’s insufficient amounts of amniotic fluid in the uterus (too much or too little)
- The fetus has abnormalities involving the muscular or central nervous system
The Dangers of Breech Presentation
Your baby's presentation is extremely important during labor. It's both difficult and risky to deliver a breech baby vaginally. That’s because the baby's feet and umbilical cord can get tangled. Also, in rare occasions, the smaller parts (legs, body, arms) may slide out before the cervix is fully dilated, but the larger head may get stuck. During a difficult, stressful delivery, your baby could be damaged or even die.
Breech Birth: How Can I Deliver an Upside-Down Baby?
A baby can be breech off and on throughout pregnancy without causing concern. But around 36 or 37 weeks, your doctor may recommend a version (also called an external cephalic version), which is the manual turning of the baby into the head-down position, says Dr. Riley. Using ultrasound, your doctor will place her hands on your abdomen and apply pressure, pushing the baby's bottom up and guiding the head to encourage a somersault. “She is literally trying to turn the baby upside down,” says Dr. Riley.
Risks of a version include premature rupture of the membranes, placental abruption, tangling of the cord, or starting labor. The procedure works about half the time; the success rate is higher if a woman has had a baby before. Some babies will move back into the breech position even after the version, and if this is the case, you’ll need a cesarean delivery.
The majority of breech babies are born through C-section. These are usually scheduled between 38 and 39 weeks, before labor can begin naturally.