A breech presentation describes a baby positioned bottom-down or feet-first in the womb, rather than the typical head-down position. Discovering that a baby is in a breech position at 24 weeks of pregnancy can naturally lead to questions for expectant parents.
Understanding Breech Presentation
There are several ways a baby can present in a breech position. A frank breech is when the baby’s bottom is positioned to exit first, with the hips flexed and the legs extended straight up towards the head. In a complete breech, the baby’s bottom is also positioned first, but both hips and knees are flexed, with the feet tucked near the bottom. An incomplete or footling breech occurs when one or both of the baby’s feet are positioned to deliver first, with the legs extended below the bottom.
24 Weeks: A Snapshot in Time
Finding a baby in a breech position at 24 weeks of gestation is a frequent occurrence and generally not an immediate concern. At 28 weeks or less, approximately 25% of babies are in a breech position. The uterus still contains ample space and amniotic fluid at this stage, allowing the baby ample room to move and change positions frequently. Many babies will naturally turn head-down as they grow and the pregnancy progresses. Around 3 to 4 percent of babies remain in a breech position by the end of pregnancy at term, as most move into the head-down position around 32 to 38 weeks.
Factors Influencing Breech Position
Several factors can influence why a baby might be in a breech position, though often no specific reason is identified. Abnormalities in amniotic fluid (too much or too little) or structural variations of the uterus (such as fibroids or a bicornuate uterus) can affect the baby’s ability to turn or limit its space for movement. A low-lying placenta, known as placenta previa, may also contribute to a breech presentation. Additionally, carrying multiple babies can reduce the available space for each fetus to orient head-down. Babies born prematurely also have a higher chance of being in a breech position.
Monitoring and Management
When a breech presentation is identified at 24 weeks, healthcare providers typically adopt a “wait and see” approach. This involves continued monitoring of the baby’s position during routine prenatal appointments. Follow-up ultrasounds are often scheduled between 32 and 36 weeks of gestation to confirm the baby’s orientation and observe if it spontaneously turns head-down. Non-invasive methods, such as feeling the abdomen, are also used to assess the baby’s position.
Approaches if Breech Persists
If the baby remains in a breech position closer to term, healthcare providers may discuss various approaches. One option is an external cephalic version (ECV), a procedure where a healthcare provider attempts to manually turn the baby to a head-down position by applying pressure to the abdomen. ECV has a success rate averaging 50% to 58%. If an ECV is not successful or is not an option, a planned Cesarean section (C-section) is often recommended as the safest delivery method for a persistent breech presentation. While less common, a vaginal breech birth may be considered in very specific circumstances, depending on factors like the type of breech, the baby’s size, and the healthcare provider’s expertise.