A breech presentation occurs when a baby is positioned inside the uterus with their feet or buttocks oriented toward the birth canal, rather than the head. This orientation is common in early pregnancy. It becomes a clinical concern in the late third trimester, typically if the baby remains breech after the 36th or 37th week. The fetus has grown significantly, reducing the space available for a spontaneous turn into the head-down position.
The Physical Sensations of a Breech Baby
The subjective feeling of carrying a breech baby differs noticeably from the typical head-down position. Individuals often report feeling a hard, round mass located high up in the abdomen, usually under the ribs or sternum. This sensation is the baby’s skull, the densest part of the fetal body. The head in this high location can cause physical discomfort, making it difficult to take deep breaths or sit comfortably.
This positioning can lead to increased pressure on the upper digestive organs, contributing to a feeling of fullness after eating small amounts of food. In contrast, the baby’s softer bottom and limbs are felt lower in the pelvis near the pubic bone. This lower sensation is often described as a softer, less irregular bump that is not as distinct or solid as the head.
The location of fetal movement, particularly strong kicks, is a distinguishing sign. When the baby is breech, the feet are positioned low. The most vigorous movements may be felt in the lower abdomen, sometimes directed toward the bladder or cervix, resulting in sharp, sudden sensations. Conversely, the lighter, swiping movements of the hands and arms are often felt higher up near the ribs.
How Healthcare Providers Confirm Breech Position
While the mother’s sensations can raise suspicion, healthcare providers use objective methods to confirm a breech presentation. Initial confirmation involves a hands-on abdominal examination known as Leopold’s Maneuvers. The provider systematically palpates the uterus to identify the fetal poles—the head and the buttocks—at the top and bottom of the abdomen.
The provider attempts to distinguish the hard, round, and mobile head, which in a breech presentation is typically felt at the top of the uterus near the ribs. The presenting part (buttocks or feet) is felt lower near the pelvis and is identified as a softer, less defined, and less mobile mass.
Once the clinical examination suggests a breech position, an ultrasound provides definitive visual confirmation. The ultrasound confirms the orientation and determines the specific type of breech presentation. The three main types are frank breech, complete breech, and footling breech. Imaging also provides information about amniotic fluid volume and the placenta’s location, which factor into management decisions.
Options for Managing a Breech Pregnancy
Once a breech position is confirmed in the final weeks of pregnancy, options for encouraging the baby to turn or planning delivery are discussed. Some individuals explore non-medical techniques, such as postural exercises designed to utilize gravity. However, these methods have limited scientific evidence for turning a baby that is already at term.
The primary medical intervention is the External Cephalic Version (ECV), an attempt by a provider to manually turn the baby from the outside. This procedure is typically attempted around 37 weeks of gestation in a hospital setting with emergency support available. The provider applies firm, steady pressure to the abdomen to guide the baby into a head-down position.
The success rate for an ECV is approximately 50 to 58%. Medication may be given to relax the uterine muscles, increasing the chances of a successful turn. The procedure carries a low risk of complications, such as a temporary change in the baby’s heart rate, and is offered to avoid a cesarean section. If successful, the individual can plan for a conventional vaginal birth.
If the ECV is unsuccessful or the baby remains breech, the delivery plan focuses on the safest way to give birth. The most common plan in industrialized nations is a planned cesarean section, which avoids the risks associated with a vaginal breech delivery. In select cases, involving a frank or complete breech and an experienced medical team, a planned vaginal breech birth may still be considered after reviewing the risks and benefits.