A footling breech is a fetal position where one or both of a baby’s feet are positioned to enter the birth canal first. This differs from the typical head-down orientation expected for delivery. In this position, the baby’s feet are below the buttocks, making them the lowest part in the uterus.
Understanding Fetal Presentation
Fetal presentation refers to the part of the baby’s body closest to the birth canal. The most common and safest presentation is cephalic, where the baby is head-down, facing the birthing parent’s spine with the chin tucked to the chest. This head-first position allows the largest part of the baby to lead, effectively dilating the cervix.
Some babies adopt a breech presentation, where their buttocks or feet are positioned to deliver first. There are several types of breech. A frank breech occurs when the baby’s hips are flexed and legs extended straight up with feet near the head. In a complete breech, both hips and knees are flexed. A footling breech involves one or both feet extending downwards below the buttocks.
Specific Risks
The footling breech presentation carries distinct concerns. One risk is umbilical cord prolapse, where the cord slips out before the baby. This occurs more frequently because the smaller feet do not create a tight seal against the cervix, allowing space for the cord to descend when the amniotic sac ruptures. Cord prolapse is a medical emergency that can cut off the baby’s oxygen supply if compressed.
Another concern is head entrapment, which happens if the baby’s smaller body and feet pass through the cervix before it is fully dilated, causing the larger head to become stuck. This can lead to oxygen deprivation for the baby. The presenting foot might not provide adequate pressure for cervical dilation, unlike a head or buttocks, increasing this risk.
The footling position can increase the likelihood of premature rupture of membranes (PROM). The baby’s feet may not adequately seal the cervix, leading to the waters breaking earlier than expected. This can introduce risks such as infection or premature labor. There is also an increased potential for injury to the baby during a vaginal delivery compared to a head-first birth.
Management and Delivery
Medical professionals often identify a footling breech presentation through physical examination and confirm it with an ultrasound scan. The ultrasound provides clear visualization of the baby’s exact position, estimated size, and the placenta’s location. This diagnostic process helps determine the appropriate management strategy for delivery.
Given the heightened risks associated with footling breech, a Cesarean section (C-section) is frequently recommended as the safest delivery method. A C-section helps avoid potential complications like cord prolapse and head entrapment, which are more common with vaginal delivery in this presentation. While external cephalic version (ECV), a procedure to manually turn the baby from the outside, is sometimes attempted for other breech types, its success rate for footling breech is generally lower due to the baby’s position and the increased risk of complications during the procedure. Healthcare providers prioritize the safety of both the birthing parent and the baby when discussing delivery options.