Breech presentation occurs when a baby is positioned feet or bottom first in the uterus, rather than the typical head-down orientation. This natural variation in fetal positioning happens in a small percentage of pregnancies and does not reflect anything the expectant parent did or did not do. While most babies shift to a head-down position before birth, some remain breech.
Understanding Breech Presentation
Breech presentation describes when the baby’s lower body is positioned to exit the birth canal first. There are three primary types of breech positions. Frank breech is the most common, where the baby’s hips are flexed with legs extended straight up, bringing their feet close to their head. Complete breech occurs when the baby’s hips and knees are both flexed, resembling a cross-legged or sitting position. Footling breech involves one or both of the baby’s feet positioned to deliver first, with the legs extended below the buttocks.
Most babies naturally move into a head-down position by the third trimester, around 36 weeks of pregnancy. A breech presentation is usually identified during routine prenatal care, often through a physical examination of the abdomen. If a breech position is suspected, an ultrasound scan is used to confirm the baby’s exact orientation and rule out other factors.
Factors Influencing Fetal Position
Several factors can influence why a baby might remain in a breech position. The shape and condition of the uterus can play a role. Conditions such as a bicornuate uterus, which has an abnormal shape, or the presence of fibroids, benign growths in the uterus, can restrict the space available for the baby to turn. Placenta previa, where the placenta covers part or all of the cervix, can also obstruct the baby’s ability to move into a head-down position.
The volume of amniotic fluid surrounding the baby can also affect fetal positioning. Polyhydramnios, excessive amniotic fluid, can provide the baby with too much room, allowing for constant movement without settling into a head-down position. Conversely, oligohydramnios, too little amniotic fluid, can restrict the baby’s movement, making it difficult for them to turn. Both extremes can lead to a breech presentation.
Fetal factors also contribute to breech presentations. Prematurity is a common reason, as babies born before full term have less time to naturally turn head-down. Multiple gestations, such as twins or triplets, limit the available space in the uterus, making it more challenging for all babies to assume a head-down position. Certain fetal anomalies can affect the baby’s ability to move or position itself correctly. A history of a previous breech birth can also increase the likelihood of another breech presentation in subsequent pregnancies.
Managing a Breech Pregnancy
Once a breech presentation is confirmed, around 36 to 37 weeks of pregnancy, healthcare providers discuss management options. A common consideration for breech babies is a planned Cesarean section (C-section) due to risks associated with vaginal breech birth. These risks include umbilical cord prolapse, where the cord exits before the baby, potentially cutting off oxygen, or the baby’s head becoming trapped during delivery.
One intervention is an External Cephalic Version (ECV). This procedure involves a healthcare provider manually attempting to turn the baby from the outside of the abdomen into a head-down position. ECV is performed after 36 weeks of pregnancy and has a success rate of around 40-50%. While considered safe, ECV carries minor risks such as premature rupture of membranes, placental abruption, or temporary changes in the baby’s heart rate. It is not suitable for all pregnancies, especially if there are multiple babies or issues like placenta previa.
If ECV is unsuccessful or not an option, a planned C-section is recommended as the safest delivery method for the baby. While vaginal breech birth is possible in specific circumstances, it is less common and usually reserved for situations with experienced providers and strict criteria. Expectant parents are encouraged to have discussions with their healthcare team to understand available options and make an informed decision regarding the delivery plan.