The position of a fetus inside the uterus is a primary consideration in planning for birth, especially as a pregnancy nears its end. In the third trimester, most babies naturally move into a head-down position, known as a cephalic presentation. When a small percentage of fetuses remain oriented with their bottom or feet positioned to descend first, this alternative positioning is known as a breech presentation, requiring careful planning for delivery.
What is a Breech Presentation?
A breech presentation is defined by the fetus being in a longitudinal lie with the buttocks or lower extremities situated closest to the birth canal. While many babies are breech earlier in pregnancy, only about 3% to 4% of fetuses remain in this position at full term, considered 37 weeks of gestation or later. The specific way a baby is folded dictates the type of breech presentation.
The Frank Breech is the most common type, occurring when the baby’s hips are flexed, but the legs are extended straight up toward the head. In a Complete Breech, both the baby’s hips and knees are flexed, giving the appearance of sitting cross-legged. The third category, often called an Incomplete or Footling Breech, occurs when one or both of the baby’s feet are positioned to enter the birth canal first.
Signs You Might Notice
While only medical professionals can confirm a fetal position, a pregnant person may notice subjective signs suggesting a breech presentation. The most common indication is the sensation of the baby’s hardest part, the head, pressing high up under the rib cage or near the top of the uterus. The head is typically felt as a hard, round, and firm mass that moves independently of the trunk.
A breech position also changes where fetal movement is felt most intensely, often resulting in kicks felt low in the abdomen, around the bladder or pelvis. This high positioning of the baby’s bulk can cause discomfort, breathlessness, or a feeling of fullness after eating small amounts, as pressure is placed on the stomach and lungs. These signs are not definitive, but they should prompt a discussion with a healthcare provider.
How Healthcare Providers Determine Position
Healthcare providers use a combination of physical examination and imaging to accurately determine fetal position. The initial assessment often involves Leopold’s maneuvers, which are four specific steps of palpation performed externally on the pregnant abdomen. In a breech presentation, the provider will feel the hard, round head at the top, or fundus, of the uterus, and the softer buttocks in the lower abdomen.
The primary method for confirming a suspected breech presentation is an ultrasound scan. Ultrasound provides a visual confirmation of the fetal lie and presentation. It is also used to precisely identify the specific type of breech, such as Frank or Footling, which is necessary for delivery planning.
Options for Managing a Breech Baby
If a baby remains in a breech position at or near term, the first option offered is often an External Cephalic Version (ECV). This procedure involves a healthcare provider attempting to manually turn the baby from the outside of the abdomen. ECV is typically performed around 37 weeks of gestation near an operating room in case complications arise.
The overall success rate for an ECV is approximately 58%, though it is often higher for those who have previously given birth. If the ECV is unsuccessful or unsafe, delivery planning focuses on the safest mode of birth. The most common route for a term breech baby is a planned Cesarean section, though a planned vaginal breech delivery is an option in select cases depending on factors like the type of breech and provider skill.