Breech Position and Breech Birth

Topic Overview

What is breech position?

Throughout most of pregnancy, the uterus is roomy enough to allow a fetus to change position. By 36 weeks of pregnancy, most fetuses turn into a head-down, or vertex, position. This is the normal and safest fetal position for birth.

In 4% of births, the fetus does not naturally turn late in the pregnancy. Instead, the fetus assumes a breech presentation.¹ There are three main breech positions:

• Frank breech. The buttocks are in place to come out first during delivery. The legs extend straight up in front of the body, with the feet near the head. This is the most common type of breech position.
• Complete breech. The buttocks are down near the birth canal. The legs are folded at the knees, and the feet are near the buttocks.
• Footling breech. One leg (single footling) or both legs (double footling) are stretched out below the buttocks. The leg(s) are in place to come out first during delivery.

See a picture of breech positions .

What causes breech position during pregnancy?

In more than half of breech births, there is no obvious problem or known cause for the fetus's failure to turn head-down.² In other cases, breech position might be linked to:³

• Labor that begins before the 37th week of pregnancy (preterm labor), before a fetus is likely to turn head-down on its own.
• Multiple pregnancy. Limited space for two or more fetuses can prevent them from moving into the head-down position before delivery.
• Fetal abnormalities, including heart, digestive tract, and brain problems, such as Down syndrome, anencephaly, or hydrocephalus.
• Too much amniotic fluid in the uterus (polyhydramnios) or too little amniotic fluid (oligohydramnios).
• Uterine problems, such as an unusually shaped uterus or uterine fibroids, which are noncancerous growths in the uterine wall.
• Relaxed uterine muscle due to past pregnancies.

What are possible signs that my fetus is in breech position?

It is unlikely that you will be able to tell whether your fetus is breech based on symptoms. But if you are 36 or more weeks pregnant and think you feel your fetus's head pressing up and/or you feel kicking in your lower pelvis, see your doctor for an examination.

How is a breech position diagnosed?

Your doctor can feel your upper and lower abdomen and may examine your cervix for signs that your fetus is breech. And a fetal ultrasound can provide a picture of how your fetus is positioned.

How is a breech baby delivered safely?

Sometimes it is possible for a doctor to turn a baby from a breech position to a head-down position by using a procedure called an external cephalic version. The American College of Obstetricians and Gynecologists (ACOG) recommends that doctors offer and perform this procedure whenever possible.⁴

No matter what position a baby is in, every labor and delivery is unique. Talk to your doctor about how to have the safest delivery for your breech baby.

Sometimes it is possible to have a planned vaginal delivery with a breech birth, but most of the time a planned cesarean delivery is recommended as safer for the baby. This recommendation is based on a large study comparing cesarean and vaginal breech deliveries. Many doctors have very little experience with vaginal breech deliveries.⁴

And even though you and your doctor have a birth plan for labor and delivery, plans can change. If something unexpected happens, your doctor may need to make some quick decisions to keep you or your baby safe.

Frequently Asked Questions

Symptoms

Breech presentation does not necessarily feel unusual to the mother. You are most likely to learn of a breech fetus during a routine prenatal visit or during labor and delivery.

Before 36 weeks of pregnancy, you are unlikely to notice your fetus moving freely between head-down and head-up positions. Even after 36 weeks, you may not know if your fetus is breech unless you feel:

• Your fetus's relatively hard head high up in your abdomen.
• More movement low in the abdomen.

Exams and Tests

You are most likely to discover that your fetus is in the breech position during a routine prenatal exam late in your pregnancy. Your doctor:

• Will gently press on various areas of your abdomen. Often a fetus's position can be determined by noticing that the head (which is relatively hard) is above the buttocks (which are relatively soft), or that the heart is higher up than normal.
• May examine your cervix. This is done by placing gloved fingers into the vagina and feeling the cervix. During this exam, the round, smooth feel of the fetal head pressing on the cervix can often be distinguished from the soft, irregular feel of a breech presentation.

See pictures of different breech positions .

If the exam suggests that your fetus is in the breech position, a fetal ultrasound test will be done to confirm the diagnosis.

If your doctor attempts to move the fetus into a head-down position (external cephalic version):

• Fetal ultrasound will be used before, after, and possibly during the procedure to evaluate the fetus's position and heart rate.
• Electronic fetal heart monitoring will be used before and after the procedure. An active fetus whose heart rate increases normally with movement is usually considered to be healthy. If the fetus's heart rate becomes abnormal, the version procedure may be stopped.

Treatment Overview

By the 36th week of most pregnancies, the fetus naturally turns head-down (vertex). In this position, the fetus is ready for a head-first delivery through the birth canal. If your fetus is bottom-down (breech position) as your due date approaches, your doctor will most likely recommend a scheduled cesarean delivery (C-section). But if your fetus can be turned before labor starts, you can try for a vaginal labor and delivery.

See pictures of different breech positions .

Turning a breech fetus

Trying a version procedure to turn your fetus increases your chances of being able to deliver vaginally.^{5, 1} You may also try at-home postural management. Even though it is not a well-studied or proven method, it is considered safe and has the potential to be effective.⁶

• External cephalic version (or version) is done in a medical setting with constant fetal heart rate monitoring. You will have an ultrasound before and after the version attempt. Your doctor may first give you a medicine to relax your uterine muscles. To turn the fetus, your doctor will press on specific areas of your abdomen. Version can be repeated several times if the first attempts to turn the fetus are unsuccessful.
• Postural management is something you do at home. You carefully position yourself with your hips raised above your head several times a day for several weeks.

If a version is successful, your fetus's position will be checked regularly until labor begins. If your fetus stays head-down, a planned cesarean is not needed, and you can expect to go through labor. You may deliver vaginally or by cesarean, depending on how the birthing process goes. In one study, women who had given birth before had a lower cesarean rate after a successful version procedure compared to women delivering for the first time.²

Delivering a breech infant

Most breech infants are delivered by planned cesarean section (C-section) to prevent harm to the infant. If your fetus remains in or returns to breech position near your due date, your doctor will likely schedule a cesarean. For more information, see the topic Cesarean Section.

Sometimes a cesarean breech birth is neither possible nor recommended. When a breech labor progresses too quickly, a vaginal birth may be the only delivery option. During a twin birth, a second twin who is breech may best be delivered vaginally.⁴ Risks are lowest for the newborn when a doctor has a lot of experience doing this kind of delivery.⁷

A fetus in a breech position can be delivered by:

• A perinatologist.
• A family medicine doctor with training in cesarean deliveries.
• An obstetrician.

If you have a certified nurse-midwife or certified professional midwife for obstetric care, she will refer you to a doctor for a cesarean or a vaginal breech delivery.

Your pediatrician or family medicine doctor may be present during the delivery in case your newborn needs care after birth.

Home Treatment

Healthy pregnancy choices

Whether or not your fetus is known to be in breech position, you can help with delivering a healthy baby.

• Have regular prenatal checkups throughout your pregnancy. Knowing your fetus's position before you go into labor will help prevent breech birth complications.
• Eat a balanced diet.
• Avoid substances that are dangerous to your fetus, such as tobacco, alcohol, and illegal drugs.

For more information about staying healthy during pregnancy, see the topic Pregnancy.

Managing your breech pregnancy

If your fetus is in a breech position, ask your doctor if you can try postural management, using certain positions that use gravity to turn your fetus. Although this method has not been proved to turn the fetus into a head-down position, it isn't known to be harmful and may work for you.

It is normal to feel disappointed and worried when learning about a breech pregnancy, especially when attempts to turn the fetus are not successful. If you have concerns about your fetus's health, talk to your doctor. Most breech babies are healthy and do not have problems after birth.

After delivery by cesarean section, you will need extra help with basic household and infant care tasks for a few weeks. Although you will be able to get up and walk around within a few days, you will not be able to do any heavy lifting. For more information, see the topic Cesarean Section.

Other Places To Get Help

Organization

Related Information

• Cesarean Section
• Multiple Pregnancy: Twins or More
• Pregnancy
• Rh Sensitization During Pregnancy
• Vaginal Birth After Cesarean (VBAC)

References

Citations

1. American College of Obstetricians and Gynecologists (2000, reaffirmed 2005). External cephalic version. ACOG Practice Bulletin No. 13. Washington, DC: American College of Obstetricians and Gynecologists.

2. Cruikshank DP (2003). Breech, other malpresentations, and umbilical cord complications. In JR Scott et al., eds., Danforth's Obstetrics and Gynecology, 9th ed., pp. 381-395. Philadelphia: Lippincott Williams and Wilkins.

3. Cunningham FG, et al. (2005). Breech presentation and delivery. In Williams Obstetrics, 22nd ed., pp. 565-586. New York: McGraw-Hill.

4. American College of Obstetricians and Gynecologists (2006). Mode of term singleton breech delivery. ACOG Committee Opinion No. 340. Washington, DC: American College of Obstetricians and Gynecologists.

5. Hofmeyr GJ, Kulier R (1996). External cephalic version for breech presentation at term. Cochrane Database of Systematic Reviews (1). Oxford: Update Software.

6. Hofmeyr GJ, Kulier R (2000). Cephalic version by postural management for breech presentation. Cochrane Database of Systematic Reviews (3). Oxford: Update Software.

7. Su M, et al. (2003). Factors associated with adverse perinatal outcome in the Term Breech Trial. American Journal of Obstetrics and Gynecology, 189: 740-745.

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