bridge presentation in pregnancy

Breech Position: What It Means if Your Baby Is Breech

Medically reviewed for accuracy.

What does it mean if a baby is breech?

What are the different types of breech positions, what causes a baby to be breech, recommended reading, how can you tell if your baby is in a breech position, what does it mean to turn a breech baby, how can you turn a breech baby, how does labor usually start with a breech baby.

If your cervix dilates too slowly, if your baby doesn’t move down the birth canal steadily or if other problems arise, you’ll likely have a C-section. Talk your options over with your practitioner now to be prepared. Remember that though you may feel disappointed things didn’t turn out exactly as you envisioned, these feelings will melt away once your bundle of joy safely enters the world.

About What to Expect

Breech Births

In the last weeks of pregnancy, a baby usually moves so his or her head is positioned to come out of the vagina first during birth. This is called a vertex presentation. A breech presentation occurs when the baby’s buttocks, feet, or both are positioned to come out first during birth. This happens in 3–4% of full-term births.

What are the different types of breech birth presentations?

Complete breech: Here, the buttocks are pointing downward with the legs folded at the knees and feet near the buttocks.
Frank breech: In this position, the baby’s buttocks are aimed at the birth canal with its legs sticking straight up in front of his or her body and the feet near the head.
Footling breech: In this position, one or both of the baby’s feet point downward and will deliver before the rest of the body.

What causes a breech presentation?

The causes of breech presentations are not fully understood. However, the data show that breech birth is more common when:

You have been pregnant before
In pregnancies of multiples
When there is a history of premature delivery
When the uterus has too much or too little amniotic fluid
When there is an abnormally shaped uterus or a uterus with abnormal growths, such as fibroids
The placenta covers all or part of the opening of the uterus placenta previa

How is a breech presentation diagnosed?

A few weeks prior to the due date, the health care provider will place her hands on the mother’s lower abdomen to locate the baby’s head, back, and buttocks. If it appears that the baby might be in a breech position, they can use ultrasound or pelvic exam to confirm the position. Special x-rays can also be used to determine the baby’s position and the size of the pelvis to determine if a vaginal delivery of a breech baby can be safely attempted.

Can a breech presentation mean something is wrong?

Even though most breech babies are born healthy, there is a slightly elevated risk for certain problems. Birth defects are slightly more common in breech babies and the defect might be the reason that the baby failed to move into the right position prior to delivery.

Can a breech presentation be changed?

It is preferable to try to turn a breech baby between the 32nd and 37th weeks of pregnancy . The methods of turning a baby will vary and the success rate for each method can also vary. It is best to discuss the options with the health care provider to see which method she recommends.

Medical Techniques

External Cephalic Version (EVC) is a non-surgical technique to move the baby in the uterus. In this procedure, a medication is given to help relax the uterus. There might also be the use of an ultrasound to determine the position of the baby, the location of the placenta and the amount of amniotic fluid in the uterus.

Gentle pushing on the lower abdomen can turn the baby into the head-down position. Throughout the external version the baby’s heartbeat will be closely monitored so that if a problem develops, the health care provider will immediately stop the procedure. ECV usually is done near a delivery room so if a problem occurs, a cesarean delivery can be performed quickly. The external version has a high success rate and can be considered if you have had a previous cesarean delivery.

ECV will not be tried if:

You are carrying more than one fetus
There are concerns about the health of the fetus
You have certain abnormalities of the reproductive system
The placenta is in the wrong place
The placenta has come away from the wall of the uterus ( placental abruption )

Complications of EVC include:

Prelabor rupture of membranes
Changes in the fetus’s heart rate
Placental abruption
Preterm labor

Vaginal delivery versus cesarean for breech birth?

Most health care providers do not believe in attempting a vaginal delivery for a breech position. However, some will delay making a final decision until the woman is in labor. The following conditions are considered necessary in order to attempt a vaginal birth:

The baby is full-term and in the frank breech presentation
The baby does not show signs of distress while its heart rate is closely monitored.
The process of labor is smooth and steady with the cervix widening as the baby descends.
The health care provider estimates that the baby is not too big or the mother’s pelvis too narrow for the baby to pass safely through the birth canal.
Anesthesia is available and a cesarean delivery possible on short notice

What are the risks and complications of a vaginal delivery?

In a breech birth, the baby’s head is the last part of its body to emerge making it more difficult to ease it through the birth canal. Sometimes forceps are used to guide the baby’s head out of the birth canal. Another potential problem is cord prolapse . In this situation the umbilical cord is squeezed as the baby moves toward the birth canal, thus slowing the baby’s supply of oxygen and blood. In a vaginal breech delivery, electronic fetal monitoring will be used to monitor the baby’s heartbeat throughout the course of labor. Cesarean delivery may be an option if signs develop that the baby may be in distress.

When is a cesarean delivery used with a breech presentation?

Most health care providers recommend a cesarean delivery for all babies in a breech position, especially babies that are premature. Since premature babies are small and more fragile, and because the head of a premature baby is relatively larger in proportion to its body, the baby is unlikely to stretch the cervix as much as a full-term baby. This means that there might be less room for the head to emerge.

Want to Know More?

Creating Your Birth Plan
Labor & Birth Terms to Know
Cesarean Birth After Care

Compiled using information from the following sources:

ACOG: If Your Baby is Breech
William’s Obstetrics Twenty-Second Ed. Cunningham, F. Gary, et al, Ch. 24.
Danforth’s Obstetrics and Gynecology Ninth Ed. Scott, James R., et al, Ch. 21.

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If Your Baby Is Breech

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Frequently Asked Questions Expand All

In the last weeks of pregnancy, a fetus usually moves so his or her head is positioned to come out of the vagina first during birth. This is called a vertex presentation . A breech presentation occurs when the fetus’s buttocks, feet, or both are in place to come out first during birth. This happens in 3–4% of full-term births.

It is not always known why a fetus is breech. Some factors that may contribute to a fetus being in a breech presentation include the following:

You have been pregnant before.

There is more than one fetus in the uterus (twins or more).

There is too much or too little amniotic fluid .

The uterus is not normal in shape or has abnormal growths such as fibroids .

The placenta covers all or part of the opening of the uterus ( placenta previa )

The fetus is preterm .

Occasionally fetuses with certain birth defects will not turn into the head-down position before birth. However, most fetuses in a breech presentation are otherwise normal.

Your health care professional may be able to tell which way your fetus is facing by placing his or her hands at certain points on your abdomen. By feeling where the fetus's head, back, and buttocks are, it may be possible to find out what part of the fetus is presenting first. An ultrasound exam or pelvic exam may be used to confirm it.

External cephalic version (ECV) is an attempt to turn the fetus so that he or she is head down. ECV can improve your chance of having a vaginal birth. If the fetus is breech and your pregnancy is greater than 36 weeks your health care professional may suggest ECV.

ECV will not be tried if:

You are carrying more than one fetus

There are concerns about the health of the fetus

You have certain abnormalities of the reproductive system

The placenta is in the wrong place

The placenta has come away from the wall of the uterus ( placental abruption )

ECV can be considered if you have had a previous cesarean delivery .

The health care professional performs ECV by placing his or her hands on your abdomen. Firm pressure is applied to the abdomen so that the fetus rolls into a head-down position. Two people may be needed to perform ECV. Ultrasound also may be used to help guide the turning.

The fetus's heart rate is checked with fetal monitoring before and after ECV. If any problems arise with you or the fetus, ECV will be stopped right away. ECV usually is done near a delivery room. If a problem occurs, a cesarean delivery can be performed quickly, if necessary.

Complications may include the following:

Prelabor rupture of membranes

Changes in the fetus's heart rate

Placental abruption

Preterm labor

More than one half of attempts at ECV succeed. However, some fetuses who are successfully turned with ECV move back into a breech presentation. If this happens, ECV may be tried again. ECV tends to be harder to do as the time for birth gets closer. As the fetus grows bigger, there is less room for him or her to move.

Most fetuses that are breech are born by planned cesarean delivery. A planned vaginal birth of a single breech fetus may be considered in some situations. Both vaginal birth and cesarean birth carry certain risks when a fetus is breech. However, the risk of complications is higher with a planned vaginal delivery than with a planned cesarean delivery.

In a breech presentation, the body comes out first, leaving the baby’s head to be delivered last. The baby’s body may not stretch the cervix enough to allow room for the baby’s head to come out easily. There is a risk that the baby’s head or shoulders may become wedged against the bones of the mother’s pelvis. Another problem that can happen during a vaginal breech birth is a prolapsed umbilical cord . It can slip into the vagina before the baby is delivered. If there is pressure put on the cord or it becomes pinched, it can decrease the flow of blood and oxygen through the cord to the baby.

Although a planned cesarean birth is the most common way that breech fetuses are born, there may be reasons to try to avoid a cesarean birth.

A cesarean delivery is major surgery. Complications may include infection, bleeding, or injury to internal organs.

The type of anesthesia used sometimes causes problems.

Having a cesarean delivery also can lead to serious problems in future pregnancies, such as rupture of the uterus and complications with the placenta.

With each cesarean delivery, these risks increase.

If you are thinking about having a vaginal birth and your fetus is breech, your health care professional will review the risks and benefits of vaginal birth and cesarean birth in detail. You usually need to meet certain guidelines specific to your hospital. The experience of your health care professional in delivering breech babies vaginally also is an important factor.

Amniotic Fluid : Fluid in the sac that holds the fetus.

Anesthesia : Relief of pain by loss of sensation.

Breech Presentation : A position in which the feet or buttocks of the fetus would appear first during birth.

Cervix : The lower, narrow end of the uterus at the top of the vagina.

Cesarean Delivery : Delivery of a fetus from the uterus through an incision made in the woman’s abdomen.

External Cephalic Version (ECV) : A technique, performed late in pregnancy, in which the doctor attempts to manually move a breech baby into the head-down position.

Fetus : The stage of human development beyond 8 completed weeks after fertilization.

Fibroids : Growths that form in the muscle of the uterus. Fibroids usually are noncancerous.

Oxygen : An element that we breathe in to sustain life.

Pelvic Exam : A physical examination of a woman’s pelvic organs.

Placenta : Tissue that provides nourishment to and takes waste away from the fetus.

Placenta Previa : A condition in which the placenta covers the opening of the uterus.

Placental Abruption : A condition in which the placenta has begun to separate from the uterus before the fetus is born.

Prelabor Rupture of Membranes : Rupture of the amniotic membranes that happens before labor begins. Also called premature rupture of membranes (PROM).

Preterm : Less than 37 weeks of pregnancy.

Ultrasound Exam : A test in which sound waves are used to examine inner parts of the body. During pregnancy, ultrasound can be used to check the fetus.

Umbilical Cord : A cord-like structure containing blood vessels. It connects the fetus to the placenta.

Uterus : A muscular organ in the female pelvis. During pregnancy, this organ holds and nourishes the fetus.

Vagina : A tube-like structure surrounded by muscles. The vagina leads from the uterus to the outside of the body.

Vertex Presentation : A presentation of the fetus where the head is positioned down.

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Published: January 2019

Last reviewed: August 2022

Copyright 2024 by the American College of Obstetricians and Gynecologists. All rights reserved. Read copyright and permissions information . This information is designed as an educational aid for the public. It offers current information and opinions related to women's health. It is not intended as a statement of the standard of care. It does not explain all of the proper treatments or methods of care. It is not a substitute for the advice of a physician. Read ACOG’s complete disclaimer .

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What Does It Mean to Have a Frank Breech Baby?

Frank breech is the most common type of breech position. Learn what this position means for you and your baby.

Types of Breech Positions

How To Tell If Your Baby Is Breech

Causes of breech presentations, treatment for breech presentations, complications of a breech birth, what happens if my baby is breech.

If your baby is in a frank breech position, that means that their bottom is facing down towards the birth canal instead of their head. The part of the baby that is nearest to the cervix is called the presenting part. The presenting part, which is the part of the baby's body that is born first in a vaginal delivery , is usually the baby's head (known as vertex presentation).

In a small number of deliveries, however, a baby’s bottom or feet are in a position to be born first. This is called a breech presentation, and frank breech (bottom first, with feet up near the head) is the most common type.

Learn about the types of breech presentation including frank breech, what causes a baby to be breech, how it's treated, and what to expect with a breech delivery.

Jamie Grill / Getty Images

Frank Breech and Other Types of Breech Positions

Babies can be in all sorts of positions during pregnancy, but most babies eventually turn head down in late pregnancy. As pregnancy progresses, the more likely it is that the baby will turn and the head will be down near the cervix when it's time for delivery.

Breech Presentation Statistics

Before the 28th week of pregnancy, about 20% to 25% of babies are breech.
By the 34th week of pregnancy, most babies will turn and approximately 5% to 7% will be breech.
By full term, only 3% to 4% of babies (3 or 4 out of every 100 births) are breech.

Sometimes, however, babies are in a breech (bottom or leg down) position when labor begins. There are several types of breech positions.

Frank breech

A frank breech position is when the baby’s bottom is down, but their legs are straight up with their feet near their head. The presenting part is the buttocks.

A frank breech is the most common breech presentation, especially when a baby is born at full term. Of the 3% to 4% of term breech births, babies are in the frank breech position 50% to 70% of the time.

Complete breech

In this position, the bottom is down, but the baby's knees are also bent, so the feet are also down near the buttocks. The presenting part is not only the bottom but both feet as well. At delivery, about 10% of breech babies are in a complete breech position.

Incomplete (footling) breech

A footling breech position is when the baby’s legs are extended and facing straight down. Instead of the bottom, the presenting part is one foot (a single footling) or both feet (a double footling). Approximately 25% of breech deliveries are incomplete.

As your pregnancy progresses, your prenatal health care provider will examine you and keep track of your baby’s position . You might even be able to figure out how your baby is positioned on your own.

Here are some of the techniques you and your health care provider can use to tell which way your baby is facing.

Kicks : You can feel where your baby is kicking you and judge their general position. If you feel kicks in your lower pelvis, then the baby hasn’t turned head down yet. But if the kicks are up toward your ribs and the top of your uterus, then the baby’s head is most likely facing down.
Palpation : At your prenatal visits, your doctor or midwife will check your baby's position by palpating or feeling your belly to find the baby’s head, back, and bottom.
Heartbeat : Listening to the baby’s heartbeat is another way to tell where your baby is in the uterus. By finding the heartbeat's location, the doctor or midwife can get a better idea of the baby’s position.
Ultrasound : An ultrasound provides the best position information. It shows you and your health care team a picture of the baby and their exact position in your uterus. If your baby is breech, the ultrasound can determine the type of breech position your baby is in, such as frank breech or complete breech.
Pelvic exam : During labor, your health care provider can perform a pelvic examination . They will be able to feel whether the baby’s head or their bottom and feet are in the birth canal.

The size of the baby, amount of amniotic fluid , and amount of space inside the uterus are all factors that can contribute to a baby’s ability to move around.

The most common reason for a breech presentation is prematurity, but other factors could lead to a baby in a breech position:

Premature delivery : A premature baby is smaller and has more room inside the uterus to move around, which increases the chances that they will be in a breech presentation if you go into preterm labor .
Multiples : Twins or other multiples have less room in the uterus to move around and get into the head-down position for delivery.
Uterine issues : Fibroids or a heart-shaped uterus can get in the way of the baby’s ability to turn.
Shortened umbilical cord : If the umbilical cord is very short, the baby may not be able to move and turn.
Too much or too little amniotic fluid : Too much amniotic fluid gives the baby the ability to move around freely in the uterus. As they grow, they may still be able to flip and turn rather than turning head down and staying head down. Too little amniotic fluid , on the other hand, may prevent a baby from moving into the head-down position as they get closer to full-term.
Location of the placenta : When the placenta is low and covers all or part of the cervix, it’s called placenta previa . When the placenta is in this position, it takes up the room at the bottom of the uterus and can make it difficult for the baby to turn head down.
Congenital abnormalities in the baby : Some congenital abnormalities can affect the baby’s ability to move into the head-down position. These conditions are usually not a surprise at delivery since they are typically seen during prenatal ultrasound examinations .

If your baby is breech, you will face four possible outcomes to your pregnancy:

Your baby may turn on its own . Especially if it's early in your pregnancy, there is a chance your baby will turn from a breech position to a head-down position. Many prenatal health care providers will take a wait-and-see approach early on.
Your doctor may attempt to manually turn your baby . If there are no complications in your pregnancy and the baby has not yet turned on its own by the 36th or 37th week, your doctor may attempt to turn the baby using a manual procedure called external cephalic version (ECV). ECV works approximately 60% of the time.
Your doctor may schedule a C-section . For a baby that remains in a breech position in late pregnancy, most doctors will recommend a surgical birth via a C-section .
Your doctor may agree to help you attempt a vaginal delivery . The majority of pregnancy care providers will not deliver a breech baby vaginally, but a small percentage of doctors may be willing to work with you having a vaginal delivery with a breech baby.

You can also do some things to encourage your baby to turn head down , such as acupuncture and exercises like pelvic tilts and even walking.

Most babies who are born breech are healthy. But when a baby is frank breech or in any other breech position, there is a higher chance of a complicated labor and delivery. Here are some of the complications associated with breech birth.

Umbilical cord prolapse

During a vaginal breech delivery, there is a chance that the umbilical cord will come down through the cervix before the baby is born. As the baby comes through the birth canal, their body and head can press on the cord and cut off the supply of blood and oxygen that the cord is carrying.

This can affect the baby’s heart rate and the flow of oxygen and blood to the baby’s brain. The danger of a prolapsed cord is greater with a footling breech and a complete breech.

The risk of cord prolapse is less when the baby is in the frank breech position.

Head entrapment

The baby’s head can get stuck during the delivery if the baby’s body is born before the cervix fully dilates. This situation is dangerous since the head can press against the umbilical cord and cause asphyxia or a lack of oxygen.

Head entrapment is more common in premature deliveries because the baby’s head is typically bigger than their body.

Physical injuries to the baby

The risk of injury to the baby during delivery is higher when the baby is breech compared to when the baby is not breech. Preemies are more likely to injure their head and skull. Bruising, broken bones, and dislocated joints can also occur depending on the baby's position during birth.

Additionally, after a baby is born, breech newborns have a higher incidence of neonatal hip instability, also called developmental dysplasia of the hip (DDH). This complication occurs in between 12% to 24% of breech babies.

Physical injury to the gestational parent

The vaginal delivery of a breech baby can require an episiotomy and the use of forceps, which can cause injury to the birthing person's genital area.

Many babies will turn to the head-down position before labor begins. However, if your baby is still breech when labor begins, you and your doctor will have to decide between having a C-section or trying a vaginal birth.

Whenever possible, the standard choice is to deliver any breech baby who is premature or in distress via cesarean section. Since vaginal deliveries, even when all the above criteria are met, come with a higher risk of a difficult birth and birth injuries, most doctors prefer to deliver all breech presentations by C-section.

However, when there are no other complications, a baby in the frank breech position may be delivered vaginally if the doctor agrees to it and certain conditions are met:

Emergency resources are available
The baby is at least 36 weeks
The baby is not too big or too small
The baby’s head is in the right position (flexed)
The health care team has experience with breech deliveries
The size of your pelvis is large enough
There is continuous monitoring of the baby
You have delivered vaginally before

If any complications arise during the delivery, you may still need an emergency C-section .

If Your Baby Is Breech . American College of Obstetricians and Gynecologists . 2024.

A comparison of risk factors for breech presentation in preterm and term labor: A nationwide, population-based case-control study . Arch Gynecol Obstet . 2020.

Breech presentation: Vaginal versus cesarean delivery, which intervention leads to the best outcomes? . Acta Med Port. 2017.

Breech presentation . Medscape . 2022.

Breech presentation: CNGOF Guidelines for Clinical Practice - Information and management . Gynecol Obstet Fertil Senol. 2020.

Mode of Term Singleton Breech Delivery . American College of Obstetricians and Gynecologists . 2023.

Umbilical Cord Prolapse . StatPearls . 2023.

Incidence of acetabular dysplasia in breech infants following initially normal ultrasound: the effect of variable diagnostic criteria . J Child Orthop . 2017.

When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Breech presentation

Overview  
Theory  
Diagnosis  
Management  
Follow up  
Resources  

Breech presentation refers to the baby presenting for delivery with the buttocks or feet first rather than head.

Associated with increased morbidity and mortality for the mother in terms of emergency caesarean section and placenta praevia; and for the baby in terms of preterm birth, small fetal size, congenital anomalies, and perinatal mortality.

Incidence decreases as pregnancy progresses and by term occurs in 3% to 4% of singleton term pregnancies.

Treatment options include external cephalic version to increase the likelihood of vaginal birth or a planned caesarean section, the optimal gestation being 37 and 39 weeks, respectively.

Planned caesarean section is considered the safest form of delivery for infants with a persisting breech presentation at term.

Breech presentation in pregnancy occurs when a baby presents with the buttocks or feet rather than the head first (cephalic presentation) and is associated with increased morbidity and mortality for both the mother and the baby. [1] Cunningham F, Gant N, Leveno K, et al. Williams obstetrics. 21st ed. New York: McGraw-Hill; 1997. [2] Kish K, Collea JV. Malpresentation and cord prolapse. In: DeCherney AH, Nathan L, eds. Current obstetric and gynecologic diagnosis and treatment. New York: McGraw-Hill Professional; 2002. There is good current evidence regarding effective management of breech presentation in late pregnancy using external cephalic version and/or planned caesarean section.

History and exam

Key diagnostic factors.

presence of risk factors
buttocks or feet as the presenting part
fetal head under costal margin
fetal heartbeat above the maternal umbilicus

Other diagnostic factors

subcostal tenderness
pelvic or bladder pain

Risk factors

premature fetus
small for gestational age fetus
nulliparity
fetal congenital anomalies
previous breech delivery
uterine abnormalities
abnormal amniotic fluid volume
placental abnormalities
female fetus

Diagnostic investigations

1st investigations to order.

transabdominal/transvaginal ultrasound

Treatment algorithm

<37 weeks' gestation and in labour, ≥37 weeks' gestation not in labour, ≥37 weeks' gestation in labour: no imminent delivery, ≥37 weeks' gestation in labour: imminent delivery, contributors, natasha nassar, phd.

Associate Professor

Menzies Centre for Health Policy

Sydney School of Public Health

University of Sydney

Disclosures

NN has received salary support from Australian National Health and a Medical Research Council Career Development Fellowship; she is an author of a number of references cited in this topic.

Christine L. Roberts, MBBS, FAFPHM, DrPH

Research Director

Clinical and Population Health Division

Perinatal Medicine Group

Kolling Institute of Medical Research

CLR declares that she has no competing interests.

Jonathan Morris, MBChB, FRANZCOG, PhD

Professor of Obstetrics and Gynaecology and Head of Department

JM declares that he has no competing interests.

Peer reviewers

John w. bachman, md.

Consultant in Family Medicine

Department of Family Medicine

Mayo Clinic

JWB declares that he has no competing interests.

Rhona Hughes, MBChB

Lead Obstetrician

Lothian Simpson Centre for Reproductive Health

The Royal Infirmary

RH declares that she has no competing interests.

Brian Peat, MD

Director of Obstetrics

Women's and Children's Hospital

North Adelaide

South Australia

BP declares that he has no competing interests.

Lelia Duley, MBChB

Professor of Obstetric Epidemiology

University of Leeds

Bradford Institute of Health Research

Temple Bank House

Bradford Royal Infirmary

LD declares that she has no competing interests.

Justus Hofmeyr, MD

Head of the Department of Obstetrics and Gynaecology

East London Private Hospital

East London

South Africa

JH is an author of a number of references cited in this topic.

Differentials

Transverse lie
Caesarean birth
Mode of term singleton breech delivery

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Breech presentation.

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Continuing Education Activity

Breech presentation refers to the fetus in the longitudinal lie with the buttocks or lower extremity entering the pelvis first. The three types of breech presentation are frank, complete, and incomplete. In a frank breech, the fetus has flexion of both hips, and the legs are straight with the feet near the fetal face, in a pike position. This activity reviews the cause and pathophysiology of breech presentation and highlights the role of the interprofessional team in its management.

Determine the pathophysiology of breech presentation.
Apply the physical exam of a patient with a breech presentation.
Differentiate the treatment options for breech presentation.
Communicate the importance of improving care coordination among interprofessional team members to improve outcomes for patients affected by breech presentation.
Introduction

Breech presentation refers to the fetus in the longitudinal lie with the buttocks or lower extremity entering the pelvis first. The 3 types of breech presentation are frank, complete, and incomplete. In a frank breech, the fetus has flexion of both hips, and the legs are straight with the feet near the fetal face, in a pike position. The complete breech has the fetus sitting with flexion of both hips and both legs in a tuck position. Finally, the incomplete breech can have any combination of 1 or both hips extended, also known as footling (one leg extended) or double footling breech (both legs extended). [1] [2] [3]

Clinical conditions associated with breech presentation may increase or decrease fetal motility or affect the vertical polarity of the uterine cavity. Prematurity, multiple gestations, aneuploidies, congenital anomalies, Mullerian anomalies, uterine leiomyoma, and placental polarity as in placenta previa are most commonly associated with a breech presentation. Also, a previous history of breech presentation at term increases the risk of repeat breech presentation in subsequent pregnancies. [4] [5] These are discussed in more detail in the pathophysiology section.

Epidemiology

Breech presentation occurs in 3% to 4% of all term pregnancies. A higher percentage of breech presentations occurs with less advanced gestational age. At 32 weeks, 7% of fetuses are breech, and 25% are breech at 28 weeks or less.

Specifically, following 1 breech delivery, the recurrence rate for the second pregnancy was nearly 10%, and for a subsequent third pregnancy, it was 27%. Some have also described prior cesarean delivery as increasing the incidence of breech presentation twofold.

Pathophysiology

As mentioned previously, the most common clinical conditions or disease processes that result in breech presentation affect fetal motility or the vertical polarity of the uterine cavity. [6] [7] Conditions that change the vertical polarity or the uterine cavity or affect the ease or ability of the fetus to turn into the vertex presentation in the third trimester include:

Mullerian anomalies: Septate uterus, bicornuate uterus, and didelphys uterus
Placentation: Placenta previa as the placenta occupies the inferior portion of the uterine cavity. Therefore, the presenting part cannot engage
Uterine leiomyoma: Larger myomas are mainly located in the lower uterine segment, often intramural or submucosal, and prevent engagement of the presenting part.
Prematurity
Aneuploidies and fetal neuromuscular disorders commonly cause hypotonia of the fetus, inability to move effectively
Congenital anomalies: Fetal sacrococcygeal teratoma, fetal thyroid goiter
Polyhydramnios: The fetus is often in an unstable lie, unable to engage
Oligohydramnios: Fetus is unable to turn to the vertex due to lack of fluid
Laxity of the maternal abdominal wall: The Uterus falls forward, and the fetus cannot engage in the pelvis.

The risk of cord prolapse varies depending on the type of breech. Incomplete or footling breech carries the highest risk of cord prolapse at 15% to 18%, complete breech is lower at 4% to 6%, and frank breech is uncommon at 0.5%.

History and Physical

During the physical exam, using the Leopold maneuvers, palpation of a hard, round, mobile structure at the fundus and the inability to palpate a presenting part in the lower abdomen superior to the pubic bone or the engaged breech in the same area, should raise suspicion of a breech presentation.

During a cervical exam, findings may include the lack of a palpable presenting part, palpation of a lower extremity, usually a foot, or for the engaged breech, palpation of the soft tissue of the fetal buttocks may be noted. If the patient has been laboring, caution is warranted as the soft tissue of the fetal buttocks may be interpreted as caput of the fetal vertex. Any of these findings should raise suspicion, and an ultrasound should be performed.

An abdominal exam using the Leopold maneuvers in combination with the cervical exam can diagnose a breech presentation. Ultrasound should confirm the diagnosis. The fetal lie and presenting part should be visualized and documented on ultrasound. If a breech presentation is diagnosed, specific information, including the specific type of breech, the degree of flexion of the fetal head, estimated fetal weight, amniotic fluid volume, placental location, and fetal anatomy review (if not already done previously), should be documented.

Treatment / Management

Expertise in the delivery of the vaginal breech baby is becoming less common due to fewer vaginal breech deliveries being offered throughout the United States and in most industrialized countries. The Term Breech Trial (TBT), a well-designed, multicenter, international, randomized controlled trial published in 2000, compared planned vaginal delivery to planned cesarean delivery for the term breech infant. The investigators reported that delivery by planned cesarean resulted in significantly lower perinatal mortality, neonatal mortality, and serious neonatal morbidity. Also, the 2 groups had no significant difference in maternal morbidity or mortality. Since that time, the rate of term breech infants delivered by planned cesarean has increased dramatically. Follow-up studies to the TBT have been published looking at maternal morbidity and outcomes of the children at 2 years. Although these reports did not show any significant difference in the risk of death and neurodevelopmental, these studies were felt to be underpowered. [8] [9] [10] [11]

Since the TBT, many authors have argued that there are still some specific situations in that vaginal breech delivery is a potential, safe alternative to a planned cesarean. Many smaller retrospective studies have reported no difference in neonatal morbidity or mortality using these criteria.

The initial criteria used in these reports were similar: gestational age greater than 37 weeks, frank or complete breech presentation, no fetal anomalies on ultrasound examination, adequate maternal pelvis, and estimated fetal weight between 2500 g and 4000 g. In addition, the protocol presented by 1 report required documentation of fetal head flexion and adequate amniotic fluid volume, defined as a 3-cm vertical pocket. Oxytocin induction or augmentation was not offered, and strict criteria were established for normal labor progress. CT pelvimetry did determine an adequate maternal pelvis.

Despite debate on both sides, the current recommendation for the breech presentation at term includes offering an external cephalic version (ECV) to those patients who meet the criteria, and for those who are not candidates or decline external cephalic version, a planned cesarean section for delivery sometime after 39 weeks.

Regarding the premature breech, gestational age determines the mode of delivery. Before 26 weeks, there is a lack of quality clinical evidence to guide the mode of delivery. One large retrospective cohort study recently concluded that from 28 to 31 6/7 weeks, there is a significant decrease in perinatal morbidity and mortality in a planned cesarean delivery versus intended vaginal delivery, while there is no difference in perinatal morbidity and mortality in gestational age 32 to 36 weeks. Of note is that no prospective clinical trials examine this issue due to a lack of recruitment.

Differential Diagnosis

The differential diagnoses for the breech presentation include the following:

Face and brow presentation
Fetal anomalies
Fetal death
Grand multiparity
Multiple pregnancies
Oligohydramnios
Pelvis Anatomy
Preterm labor
Primigravida
Uterine anomalies
Pearls and Other Issues

In light of the decrease in planned vaginal breech deliveries, thus the decrease in expertise in managing this clinical scenario, it is prudent that policies requiring simulation and instruction in the delivery technique for vaginal breech birth are established to care for the emergency breech vaginal delivery.

Enhancing Healthcare Team Outcomes

A breech delivery is usually managed by an obstetrician, labor, delivery nurse, anesthesiologist, and neonatologist. The ultimate decision rests on the obstetrician. To prevent complications, today, cesarean sections are performed, and experience with vaginal deliveries of breech presentation is limited. For healthcare workers including the midwife who has no experience with a breech delivery, it is vital to communicate with an obstetrician, otherwise one risks litigation if complications arise during delivery. [12] [13] [14]

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Disclosure: Caron Gray declares no relevant financial relationships with ineligible companies.

Disclosure: Meaghan Shanahan declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

Cite this Page Gray CJ, Shanahan MM. Breech Presentation. [Updated 2022 Nov 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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Breech presentation: what it is and how it can affect your baby's delivery.

As you get close to your due date, your baby might sense she’s approaching her grand entrance and move into a head-down position in your uterus, ready to be born. However, in some cases, she might choose another position instead, such as bottom or feet down. When this happens, it’s called a breech presentation. Read on to learn how your healthcare provider checks the position of your baby, what delivery options you may have if your baby is breech, and what can cause a breech presentation.

What Is Breech?

During your pregnancy, your baby has likely taken every opportunity to let you know she means business by kicking up a storm and doing countless somersaults. It's natural for your baby to move and shift positions within the uterus. Then, usually between 32 and 36 weeks of pregnancy, your baby will likely get into a head-down position in preparation for being born.

There is a small chance — just 3 to 4 percent — that your baby may not move into this head-down position by the time your pregnancy is full term. This is called a breech presentation. The chance of a breech presentation is higher if your pregnancy is not yet full term or if you go into preterm labor .

Types of Birth Positions

There are many different types of positions, including a number of breech presentations, that your baby may take on before birth:

Frank breech presentation. Your baby's bottom is positioned downward. This is the most common type of breech presentation.

Complete breech presentation. Your baby's feet are positioned downward with her hips and knees flexed, almost cross-legged.

Incomplete breech presentation. Your baby's feet are positioned downward with only one hip or one knee flexed.

Shoulder presentation or transverse lie. This is a form of breech in which your baby is positioned horizontally in the uterus. Few babies remain this way at the time of delivery.

Footling breech. One or both of your baby's feet are pointed downward.

Cephalic or vertex presentation (occiput). Your baby is in the normal position for delivery. Her head is down and she’s facing toward your back.

Cephalic or vertex presentation (occiput posterior). In some cases, your baby may be in a downward position but with her face toward your front. If this happens in early labor, your baby may naturally turn to face your back on her own, or, later in labor, your provider may decide to manually assist the baby in getting into this position. If this doesn't work, your baby can still be delivered vaginally, but delivery may be prolonged and more painful.

The causes of your baby being in breech position aren't always clear, but it can be more common if any of the following apply to you:

You've been pregnant before

You are pregnant with twins (read on to learn more about twin breech)

The uterus has more or less amniotic fluid than usual

The uterus has an abnormal shape or has abnormal growths, such as fibroids.

You have a condition called placenta previa , which is when the placenta covers the cervix.

Your healthcare provider likely already knows whether any of these factors affect your situation, but you might want to mention it just to be sure.

Diagnosis of a Breech Presentation

At one of your prenatal visits in the lead up to your due date, your provider will check that everything is progressing as planned , and will examine your abdomen to try to find out whether your baby is in the correct head-down position. If your provider thinks there may be a breech presentation, she or he may recommend an ultrasound exam to confirm it.

Can a Breech Baby Be Turned?

If your baby is breech, your provider may consider turning your baby so that a vaginal delivery can proceed, if that’s in the cards for you anyway. Alternatively, your provider may recommend that a cesarean delivery is the safer option.

Keep in mind, your baby's position might change at some point before delivery day, so your provider may recommend waiting and seeing.

If you are 37 weeks pregnant or more, your provider may recommend turning your baby through a process called external cephalic version or ECV.

ECV involves your provider placing hands on your abdomen and applying firm pressure in order to turn the baby. This procedure will most likely be done near a delivery room. Your provider may offer an epidural block to help with any pain this procedure causes.

An ECV is about 50 percent effective and there is a small risk of complications. You and your baby will be monitored closely before, during, and after the procedure to ensure that both of you are doing well.

If the ECV procedure is successful, your baby can be delivered vaginally , if there’s no other impediment.

Delivery Options for a Breech Baby

If your baby is in a breech position, the risks associated with a vaginal delivery are much higher than with a cesarean section. Risks include the umbilical cord cutting off his blood supply or his head or shoulders becoming stuck. That’s why, in some cases, your provider may recommend a cesarean delivery .

It could be that your provider’s level of experience in delivering breech babies might also inform the discussion you have with your provider about what’s right for your situation. Ultimately, your provider will recommend the best course of action for you and your baby based on your personal situation.

Twins and Breech Presentation

It's possible for twins to be delivered vaginally if the first baby — the lower-positioned twin — is correctly positioned with the head facing down. Of course, that's if the twin pregnancy is otherwise progressing well and there are no complications. If the second twin is in a breech position, the provider may do an ECV procedure to get this baby in the correct head-down position for a vaginal delivery, too.

If the first twin baby (the one lower down) is in a breech position, the provider may recommend a cesarean section. Triplets or more will most likely require a cesarean section.

Although you might feel like the added stress of a breech baby is the last thing you need as you approach your due date, remember that your healthcare provider has seen this situation before and will know what to do to ensure your baby is delivered safely. Next thing you know, you'll be bringing your brand-new baby home , stocking up on diapers, waking up for late-night feedings, and reveling in your baby's growth .

See all sources

Cleveland clinic: Cesarean Birth (C-Section)
Cleveland Clinic: Fetal Positions for Birth
Mayo Clinic: Fetal presentation before birth
Mayo Clinic: Prenatal care: 3rd trimester visits
Mayo Clinic: Third Trimester
Book: Your Pregnancy and Childbirth: Month to Month, Sixth Edition Paperback – January 1, 2016 by American College of Obstetricians and Gynecologists (Author)

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Breech Baby: What Causes it and What to Expect

A mother holds her newborn infants hand after breech delivery.

Are you wondering what it means to have a breech baby and what it means for your delivery?

From very early in the pregnancy, your tiny acrobat is twisting, turning, kicking, and tumbling about, suspended in the amniotic fluid in your uterus. As they grow, it gets harder to turn around—you’ll feel lots of somersaults and karate kicks!

By the time you’re at week 36, the position your baby is in begins to matter for delivery. Most babies will have turned so their heads are down toward the birth canal, but some have not—they are in the breech position. A breech baby presents with their buttocks and/or feet first instead of their head, which is a higher risk position for vaginal birth.

But just because your baby is in a breech position doesn’t mean they will stay that way. The closer the baby gets to full term, however, the harder it is to turn around on their own.

The Importance of Fetal Position Before Delivery

The position of the baby’s head matters for delivery. During birth, the baby’s head pushes through the vaginal canal, widening it and making it possible for the rest of the body to follow more easily. If the baby’s buttocks or feet lead the way, labor can become more difficult and dangerous.

Dangers of a vaginal breech birth include cord prolapse (a rare emergency when the umbilical cord exits the cervical opening first), traumatic injury such as a dislocated shoulder, or reduced oxygen if the head cannot pass through the canal after the rest of the body quickly enough. To avoid these risks, your OBGYN may recommend turning the baby to the head down position with an external, manual manipulation called external cephalic version (ECV). If that doesn’t work or your baby remains in the breech position at week 39 gestation, your OBGYN will recommend a C-section as the safest birth option.

Breech Positions

Your baby’s position will be assessed at your 36 week visit with a small ultrasound. By this time, most babies will be positioned with their head down toward the birth canal. However, about 3-4% of them will not.

There are three types of breech baby positions:

Frank Breech Position

The baby is in a pike position, with both feet up near the baby’s head.

Incomplete Breech Position

One leg is up by the baby’s head.

Complete Breech Position

Both knees are bent and the baby’s feet and bottom are closest to the birth canal.

Causes of Breech Baby

Most of the time, the position of the baby is a chance occurrence with no clear cause. In about 15% of breech cases, a uterine abnormality is the cause. Other reported risk factors include:

A previous sibling or either parent who was in breech presentation
Uterine abnormality (bicornuate or septate uterus, fibroid)
Placental location (placenta previa, cornual placenta)
Extremes of amniotic fluid volume (polyhydramnios, oligohydramnios)
Fetal anomaly (anencephaly, hydrocephaly, sacrococcygeal teratoma, neck mass)
Crowding from multiple gestation
Fetal neurologic impairment
Maternal hypothyroidism
Older maternal age

How to Fix Breech Position Naturally

In many situations, babies move out of the breech position on their own.

Some natural solutions women use to encourage a breech baby to turn over before the 39th week include:

Moxibustion
Acupuncture
Chiropractic care

While these methods do not have sufficient evidence to prove they are effective, they are not harmful if performed by a licensed professional.

Yoga and swimming are other activities that could encourage the baby to turn around by creating a sense of more space as your posture changes.

OBGYNs can perform an external cephalic version (ECV) if a baby has not shifted positions after 37 weeks gestation. To perform this procedure, the OBGYN will place their hands on the mother’s stomach and apply pressure to physically turn the baby. This can be painful and does carry some risk, which is why it is performed in the hospital. In many circumstances, a spinal anesthetic (epidural) can be offered.

Chances of C-Section with Breech Baby

If a baby is still presenting as breech by week 39 and interventions have not encouraged the baby to turn around, a C-Section will be recommended nearly 100% of the time.

In the case of twins , if the first baby is born head first and the second is in breech position, the second baby can be born breech with a vaginal delivery under certain circumstances.

Breech Births and Birth Defects

In most cases, babies who are born breech do not experience lasting harm. The most common problem associated with breech babies is hip dysplasia due to their reduced movement and position in the uterus.

All the reasons babies can end up topsy-turvy by the final weeks of pregnancy aren’t fully understood. But with regular check-ins, you and your OBGYN can be prepared for a safer, smoother delivery.

Dr. Sarah Yanke, M.D. of Madison Women's Health

Woman smiling after getting an epidural during labor

5801 Research Park Blvd, Suite 400, Madison WI 53719

608-729-6300

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Breech, posterior, transverse lie: What position is my baby in?

Fetal presentation, or how your baby is situated in your womb at birth, is determined by the body part that's positioned to come out first, and it can affect the way you deliver. At the time of delivery, 97 percent of babies are head-down (cephalic presentation). But there are several other possibilities, including feet or bottom first (breech) as well as sideways (transverse lie) and diagonal (oblique lie).

Fetal presentation and position

During the last trimester of your pregnancy, your provider will check your baby's presentation by feeling your belly to locate the head, bottom, and back. If it's unclear, your provider may do an ultrasound or an internal exam to feel what part of the baby is in your pelvis.

Fetal position refers to whether the baby is facing your spine (anterior position) or facing your belly (posterior position). Fetal position can change often: Your baby may be face up at the beginning of labor and face down at delivery.

Here are the many possibilities for fetal presentation and position in the womb.

Medical illustrations by Jonathan Dimes

Head down, facing down (anterior position)

A baby who is head down and facing your spine is in the anterior position. This is the most common fetal presentation and the easiest position for a vaginal delivery.

This position is also known as "occiput anterior" because the back of your baby's skull (occipital bone) is in the front (anterior) of your pelvis.

Head down, facing up (posterior position)

In the posterior position , your baby is head down and facing your belly. You may also hear it called "sunny-side up" because babies who stay in this position are born facing up. But many babies who are facing up during labor rotate to the easier face down (anterior) position before birth.

Posterior position is formally known as "occiput posterior" because the back of your baby's skull (occipital bone) is in the back (posterior) of your pelvis.

Frank breech

In the frank breech presentation, both the baby's legs are extended so that the feet are up near the face. This is the most common type of breech presentation. Breech babies are difficult to deliver vaginally, so most arrive by c-section .

Some providers will attempt to turn your baby manually to the head down position by applying pressure to your belly. This is called an external cephalic version , and it has a 58 percent success rate for turning breech babies. For more information, see our article on breech birth .

Complete breech

A complete breech is when your baby is bottom down with hips and knees bent in a tuck or cross-legged position. If your baby is in a complete breech, you may feel kicking in your lower abdomen.

Incomplete breech

In an incomplete breech, one of the baby's knees is bent so that the foot is tucked next to the bottom with the other leg extended, positioning that foot closer to the face.

Single footling breech

In the single footling breech presentation, one of the baby's feet is pointed toward your cervix.

Double footling breech

In the double footling breech presentation, both of the baby's feet are pointed toward your cervix.

Transverse lie

In a transverse lie, the baby is lying horizontally in your uterus and may be facing up toward your head or down toward your feet. Babies settle this way less than 1 percent of the time, but it happens more commonly if you're carrying multiples or deliver before your due date.

If your baby stays in a transverse lie until the end of your pregnancy, it can be dangerous for delivery. Your provider will likely schedule a c-section or attempt an external cephalic version , which is highly successful for turning babies in this position.

Oblique lie

In rare cases, your baby may lie diagonally in your uterus, with his rump facing the side of your body at an angle.

Like the transverse lie, this position is more common earlier in pregnancy, and it's likely your provider will intervene if your baby is still in the oblique lie at the end of your third trimester.

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What to know if your baby is breech

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Cord prolapse during pregnancy

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BabyCenter's editorial team is committed to providing the most helpful and trustworthy pregnancy and parenting information in the world. When creating and updating content, we rely on credible sources: respected health organizations, professional groups of doctors and other experts, and published studies in peer-reviewed journals. We believe you should always know the source of the information you're seeing. Learn more about our editorial and medical review policies .

Ahmad A et al. 2014. Association of fetal position at onset of labor and mode of delivery: A prospective cohort study. Ultrasound in obstetrics & gynecology 43(2):176-182. https://www.ncbi.nlm.nih.gov/pubmed/23929533 Opens a new window [Accessed September 2021]

Gray CJ and Shanahan MM. 2019. Breech presentation. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK448063/ Opens a new window [Accessed September 2021]

Hankins GD. 1990. Transverse lie. American Journal of Perinatology 7(1):66-70. https://www.ncbi.nlm.nih.gov/pubmed/2131781 Opens a new window [Accessed September 2021]

Medline Plus. 2020. Your baby in the birth canal. U.S. National Library of Medicine. https://medlineplus.gov/ency/article/002060.htm Opens a new window [Accessed September 2021]

Where to go next

First, recognize breech presentation when the buttocks appear in the birth canal before the head does. Experienced providers can deliver some babies in frank or complete breech presentations. Have a cloth or surgical towel available as well as other instruments used for routine deliveries and prepare for what to do if vaginal delivery is unsuccessful.

This position is a frank breech.

This position is a complete breech.

And this position is an incomplete complete breech.

Allow delivery to the level of the umbilicus with maternal effort. If possible, do this without touching the infant. Anticipate umbilical cord compression and possibly fetal decelerations.

To deliver a leg, splint the medial thigh parallel to the femur and sweep the thigh laterally. Repeat this procedure to deliver the other leg.

Wrap a towel around the infant, putting your fingers on the anterior superior iliac spines and your thumbs on the sacrum.

Assist the mother’s efforts during contractions by applying gentle traction to help deliver the body to the level of the scapulas.

Rotate the body in either direction to make one shoulder anterior. Deliver the anterior arm by sweeping it across the chest. Rotate the infant 180 degrees in either direction. Deliver the arm that is now anterior the same way the other arm was delivered. Move the towel up to cover the arms and rotate the body to make the back anterior.

To deliver the head, place your index and middle fingers of one hand over the fetal maxilla to flex the head, while the body rests on your palm and forearm, as shown here. With your other hand, hook 2 fingers over the neck, grasp the shoulder, and apply gentle downward traction. Have an assistant apply suprapubic pressure to help maintain head flexion and deliver the head.

Procedure by Will Stone, MD, and Kate Leonard, MD, Walter Reed National Military Medical Center Residency in Obstetrics and Gynecology; and Shad Deering, COL, MD, Chair, Department of Obstetrics and Gynecology, Uniformed Services University. Assisted by Elizabeth N. Weissbrod, MA, CMI, Eric Wilson, 2LT, and Jamie Bradshaw at the Val G. Hemming Simulation Center at the Uniformed Services University.

Fetal Presentation, Position, and Lie (Including Breech Presentation)

6.1 Breech presentation

Presentation of the feet or buttocks of the foetus.

6.1.1 The different breech presentations

In a complete breech presentation, the legs are tucked, and the foetus is in a crouching position (Figure 6.1a).
In a frank breech presentation, the legs are extended, raised in front of the torso, with the feet near the head (Figure 6.1b).
In a footling breech presentation (rare), one or both feet present first, with the buttocks higher up and the lower limbs extended or half-bent (Figure 6.1c).

6.1.2 Diagnosis

The cephalic pole is palpable in the uterine fundus; round, hard, and mobile; the indentation of the neck can be felt.
The inferior pole is voluminous, irregular, less hard, and less mobile than the head.
During labour, vaginal examination reveals a “soft mass” divided by the cleft between the buttocks, with a hard projection at end of the cleft (the coccyx and sacrum).
After rupture of the membranes: the anus can be felt in the middle of the cleft; a foot may also be felt.
The clinical diagnosis may be difficult: a hand may be mistaken for a foot, a face for a breech.

6.1.3 Management

Route of delivery.

Before labour, external version (Chapter 7, Section 7.7 ) may be attempted to avoid breech delivery.

If external version is contra-indicated or unsuccessful, the breech position alone – in the absence of any other anomaly – is not, strictly speaking, a dystocic presentation, and does not automatically require a caesarean section. Deliver vaginally, if possible – even if the woman is primiparous.

Breech deliveries must be done in a CEmONC facility, especially for primiparous women.

Favourable factors for vaginal delivery are:

Frank breech presentation;
A history of vaginal delivery (whatever the presentation);
Normally progressing dilation during labour.

The footling breech presentation is a very unfavourable position for vaginal delivery (risk of foot or cord prolapse). In this situation, the route of delivery depends on the number of previous births, the state of the membranes and how far advanced the labour is.

During labour

Monitor dilation every 2 to 4 hours.
If contractions are of good quality, dilation is progressing, and the foetal heart rate is regular, an expectant approach is best. Do not rupture the membranes unless dilation stops.
If the uterine contractions are inadequate, labour can be actively managed with oxytocin.

Note : if the dilation stales, transfer the mother to a CEmONC facility unless already done, to ensure access to surgical facility for potential caesarean section.

At delivery

Insert an IV line before expulsion starts.
Consider episiotomy at expulsion. Episiotomy is performed when the perineum is sufficiently distended by the foetus's buttocks.
Presence of meconium or meconium-stained amniotic fluid is common during breech delivery and is not necessarily a sign of foetal distress.
The infant delivers unaided , as a result of the mother's pushing, simply supported by the birth attendant who gently holds the infant by the bony parts (hips and sacrum), with no traction. Do not pull on the legs.

Once the umbilicus is out, the rest of the delivery must be completed within 3 minutes, otherwise compression of the cord will deprive the infant of oxygen. Do not touch the infant until the shoulder blades appear to avoid triggering the respiratory reflex before the head is delivered.

Monitor the position of the infant's back; impede rotation into posterior position.

Figures 6.2 - Breech delivery

6.1.4 Breech delivery problems

Posterior orientation.

If the infant’s back is posterior during expulsion, take hold of the hips and turn into an anterior position (this is a rare occurrence).

Obstructed shoulders

The shoulders can become stuck and hold back the infant's upper chest and head. This can occur when the arms are raised as the shoulders pass through the mother's pelvis. There are 2 methods for lowering the arms so that the shoulders can descend:

1 - Lovset's manoeuvre

With thumbs on the infant's sacrum, take hold of the hips and pelvis with the other fingers.
Turn the infant 90° (back to the left or to the right), to bring the anterior shoulder underneath the symphysis and engage the arm. Deliver the anterior arm.
Then do a 180° counter-rotation (back to the right or to the left); this engages the posterior arm, which is then delivered.

Figures 6.3 - Lovset's manoeuvre

6.3c - Delivering the anterior arm and shoulder

2 - Suzor’s manoeuvre

In case the previous method fails:

Turn the infant 90° (its back to the right or to the left).
Pull the infant downward: insert one hand along the back to look for the anterior arm. With the operator thumb in the infant armpit and middle finger along the arm, bring down the arm (Figure 6.4a).
Lift infant upward by the feet in order to deliver the posterior shoulder (Figure 6.4b).

Figures 6.4 - Suzor's manoeuvre

6.4b - Delivering the posterior shoulder

Head entrapment

The infant's head is bulkier than the body, and can get trapped in the mother's pelvis or soft tissue.

There are various manoeuvres for delivering the head by flexing it, so that it descends properly, and then pivoting it up and around the mother's symphysis. These manoeuvres must be done without delay, since the infant must be allowed to breathe as soon as possible. All these manoeuvres must be performed smoothly, without traction on the infant.

1 - Bracht's manoeuvre

After the arms are delivered, the infant is grasped by the hips and lifted with two hands toward the mother's stomach, without any traction, the neck pivoting around the symphysis.
Having an assistant apply suprapubic pressure facilitates delivery of the aftercoming head.

2 - Modified Mauriceau manoeuvre

Infant's head occiput anterior.
Kneel to get a good traction angle: 45° downward.
Support the infant on the hand and forearm, then insert the index and middle fingers, placing them on the infant’s maxilla. Placing the index and middle fingers into the infant’s mouth is not recommended, as this can fracture the mandible.
Place the index and middle fingers of the other hand on either side of the infant's neck and lower the infant's head to bring the sub-occiput under the symphysis (Figure 6.6a).
Tip the infant’s head and with a sweeping motion bring the back up toward the mother's abdomen, pivoting the occiput around her symphysis pubis (Figure 6.6b).
Suprapubic pressure on the infant's head along the pelvic axis helps delivery of the head.
As a last resort, symphysiotomy (Chapter 5, Section 5.7 ) can be combined with this manoeuvre.

Figures 6.6 - Modified Mauriceau manoeuvre

6.6a - Step 1 Infant straddles the birth attendant's forearm; the head, occiput anterior, is lowered to bring the occiput in contact with the symphysis.

6.6b - Step 2 The infant's back is tipped up toward the mother's abdomen.

3 - Forceps on aftercoming head

This procedure can only be performed by an operator experienced in using forceps.

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Breech Presentation - An Overview

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What Is A Breech Presentation?

Normally, the head of the baby will move closer to the birth canal a few weeks before birth. A breech presentation occurs when the fetus is lying longitudinally, and its buttocks or feet will be positioned to be delivered first. It happens in approximately 1 out of 25 full-term births. The probability of breech presentation decreases with the increase in gestational age (a measure of the age of a pregnancy taken from the beginning of a woman's last menstrual period to the date).

Why Does Breech Presentation Happen?

It happens due to the following reasons-

In multiple pregnancies.

When there is a history of prematurity.

When there is too much or too little amniotic fluid in the uterus.

When the shape of the uterus is abnormal due to any growths like fibroids, etc. Generally, the shape of the uterus is like an upside-down pear. If the shape is different, the space for the fully grown baby may be less to move into the position.

With women having placenta previa where the placenta covers all or part of the cervix.

Fetal abnormalities.

The previous history of breech presentation at term increases the risk of the same in subsequent pregnancies.

What Are the Types of Breech Presentation?

Approximately 20 % of babies are at a breech position at 28 weeks of gestational age. This spontaneously changes to a cephalic presentation in most babies where the head is positioned down to enter the vagina first. Only 3 % are breech at term. There are three main types of breech presentation depending upon the position of the legs.

It includes-

Complete breach (flexed)- (5 % to 10 %) both the legs are bent at the hips and knees.

Frank (extended) breech- (50 % to 70 %) both the legs of the babyface straight up and their feet near their head while the buttocks are aimed at the birth canal.

Footling breech- (10 % to 30 %)- one or both the feet are pointing downwards and will deliver before the rest of the body.

What Are the Clinical Features of Breech Presentation?

The diagnosis of breech presentation is not significant until 32 weeks to 35 weeks, as the fetus is likely to revert to a cephalic presentation before delivery. In 20 % of cases, breech presentation is not diagnosed until labor. This presentation is usually identified on clinical examination and cervical examination. On palpation of the mother's abdomen, the round fetal head can be felt in the upper part of the uterus, and irregular mass, which usually represents the fetal buttocks and legs, is felt in the pelvis. It can also be suspected if the fetal heartbeat is auscultated higher on the maternal abdomen. Signs of fetal distress, such as meconium-stained liquor, can also be there. On vaginal examination, the foot can be felt through the cervical opening.

What Are the Investigations Used?

If a breech presentation is suspected, it should be confirmed by an ultrasound scan. This can identify the type of breach and reveal any fetal or uterine abnormalities that may risk breech presentation during delivery. On ultrasound, the fetal lying position, the degree of flexion of the fetal head, estimated fetal weight, amniotic fluid volume , placental location, and fetal anatomy review should also be documented.

What Are the Risks and Complications Involved in Breech Presentation?

The importance of breech position is only during delivery. The complications of delivering a baby at breech position vaginally include-

Injuring the baby's legs or arms, such as dislocated or broken bones.

Umbilical cord problems- the umbilical cord can be flattened or twisted during delivery, and it can cause nerve or brain damage due to lack of oxygen.

The baby's head may get entrapped.

There can be premature rupture of membranes.

Birth asphyxia - a condition where the baby does not receive enough oxygen before, during, or directly after birth. In severe cases, this can be life-threatening.

Intracranial bleeding due to rapid compression of the head during delivery.

How to Manage Breech Presentation?

The breech position can be managed at term by,

The External Cephalic Version (ECV) - It is manipulating a fetus to a cephalic presentation through the maternal abdomen. It is performed in the hospital and involves placing hands on the abdomen and applying firm pressure to turn your baby's head down. This technique has a 50 % success rate, but only 10 % of breech presentations spontaneously reverts to normal positions. If this is successful, vaginal delivery can be attempted. The complications of using this technique are:

Transient fetal heart abnormalities revert to normal. In some cases, this condition can be persistent.

The placenta may separate from the inner wall of the uterus before birth. This is called placental abruption and results in premature labor.

The baby might turn back to breech position .

It is contraindicated in individuals with a recent history of bleeding during pregnancy , ruptured membranes, uterine abnormalities, or previous cesarean section .

Cesarean Section - If ECV is unsuccessful, a cesarean section is advised. The risk of morbidity and mortality immediately at birth is high in planned vaginal breech birth cases compared to cesarean in term babies.

Vaginal Breech Birth - Women in advanced labor who have breech presentation may still opt for vaginal delivery. There are three types of vaginal delivery. It includes-

Spontaneous Breech Delivery - No traction or manipulation of the baby is used in this technique. It happens in very preterm babies.

Assisted Breech Delivery - This is a prevalent type of vaginal breech delivery. The fetus is allowed to deliver up to the umbilicus spontaneously, and then certain maneuvers are initiated to deliver the remaining part of the body.

Total Extraction Delivery - The fetal feet are grasped, and the entire fetus is extracted. It should only be used for a noncephalic second twin as the cervix may not be adequately dilated to allow the passage of the head in single pregnancies.

But vaginal breech delivery is contraindicated in the footling breech as the feet and legs can slip through a non-fully dilated cervix, and the shoulders or head can become trapped.

Vaginal breech delivery requires an experienced obstetrician and careful counseling of the patients. The external cephalic version is a safe alternative to vaginal breech delivery or cesarean delivery, reducing the C-section delivery rate. Parents must be educated about the potential risks and benefits to the mother and neonate for vaginal breech delivery and cesarean delivery. They must also be informed about the risk of Cesarean in subsequent pregnancies and their complications.

Breech - series—Types of breech presentation

https://medlineplus.gov/ency/presentations/100193_3.htm

Breech Presentation

https://www.ncbi.nlm.nih.gov/books/NBK448063/

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What can i do if my baby is breech.

Last Updated June 2023 | This article was created by familydoctor.org editorial staff and reviewed by Deepak S. Patel, MD, FAAFP, FACSM

Right before birth, most babies are in a headfirst position in the mother’s uterus. Sometimes, the baby is in a bottom-first (or feet-first) position. This is called a breech birth or breech baby. Babies can be breech early in pregnancy. Most of them turn on their own to be headfirst by the time of delivery. As you get closer to your due date, your doctor will be able to tell if your baby is breech. They can check by a physical exam, ultrasound, or both.

Breech babies are more likely in these cases:

Early, or premature births
Multiple births (two or more babies)
An abnormal level of amniotic fluid
An abnormal shaped uterus

Path to improved health

It’s important to see your doctor regularly throughout your pregnancy. Your doctor can tell if your baby is breech and help plan what to do. There are several ways to try and turn your baby. Your doctor may suggest methods to help turn the baby naturally. These could be the first attempt if it is still early and there are no health problems or concerns. Another option is to do a procedure called external cephalic version (ECV). Or your doctor may want to schedule a cesarean delivery (C-section).

External cephalic version

ECV is one way to turn a baby from breech position to head down position while it’s still in the uterus. The doctor will apply pressure to your stomach to turn the baby from the outside. Sometimes, they use ultrasound as well.

Many women who have normal pregnancies can have ECV. You should not have ECV if you have:

Vaginal bleeding
A placenta that is near or covering the opening of the uterus
A low level of fluid in the sac that surrounds and protects the baby
An abnormal fetal heart
Premature rupture of the membranes
Twins or other multiples pregnancy

ECV usually is done in a hospital toward the end of pregnancy, around 37 weeks. Before the procedure, the doctor will do an ultrasound to confirm that your baby is breech. They also will monitor your baby’s heart rate to make sure it is normal. The doctor may give you medicine to relax the muscles in your uterus. This can help decrease discomfort and increase the success of turning your baby. The medicine may be given as a shot or through a vein (IV). It is very safe, with no risk to your baby.

During the ECV, you will lie down and the doctor will place their hands on your stomach. After locating the baby’s head, the doctor will gently try to turn the baby to the headfirst position.

After the procedure, your doctor will monitor your baby’s heart rate again. If the procedure is successful, you shouldn’t have to stay in the hospital. Your chance of having a normal vaginal delivery is high. However, there is a chance that the baby can turn back around to the breech position. The success rate of ECV depends on several factors:

How close you are to your due date
The amount of fluid around your baby
How many pregnancies you have had
The weight of your baby
How the placenta is positioned
The position of your baby

If the procedure is not successful, your doctor will talk to you about delivery. They will discuss the pros and cons of having a vaginal delivery or a C- section. The doctor may suggest repeating the ECV.

The risks of ECV are small, but include:

Early onset labor
Minor blood loss for either the baby or the mother
Fetal distress leading to an emergency C-section

Natural methods

Some people look to natural ways to try and turn their baby. These methods include exercise positions, certain stimulants, and alternative medicine. They may help but there is no scientific evidence that they work.

Breech tilt, or pelvic tilt : Lie on the floor with your legs bent and your feet flat on the ground. Raise your hips and pelvis into a bridge position. Stay in the tilt for about 10 to 20 minutes. You can do this exercise three times a day. It may help to do it at a time when your baby is actively moving in your uterus.
Inversion : There are a few moves you can do that use gravity to try and turn the baby. They help relax your pelvic muscles and uterus. One option is to rest in the child’s pose for 10 to 15 minutes. A second option is to gently rock back and forth on your hands and knees. You also can make circles with your pelvis to promote activity.
Music: Certain sounds may appeal to your baby. Place headphones or a speaker at the bottom of your uterus to encourage them to turn.
Temperature : Like music, your baby may respond to temperature. Try placing something cold at the top of your stomach where your baby’s head is. Then, place something warm (not hot) at the bottom of your stomach.
Webster technique : This is a chiropractic approach. It is meant to align your pelvis and hips and relax your uterus. The goal is to encourage your baby to turn.
Acupuncture : This is a form of Chinese medicine. It involves placing needles at pressure points to balance your body’s energy. It may help relax your uterus and stimulate your baby’s movement.

Things to consider

It is not always possible to turn your baby from being breech. Some breech babies can be safely delivered through the vagina, but usually doctors deliver them by C-section. Risks involved with a C-section include bleeding and infection. There also can be a longer hospital stay for both the mother and her baby.

Other risks can occur for breech babies who are born vaginally. These include:

Injuries during or after delivery
Separation of the baby’s hip socket and thigh bone
Problems with the umbilical cord. For example, the umbilical cord can be flattened during delivery. This can cause nerve and brain damage due to a lack of oxygen.

Questions to ask your doctor

How can I tell if my baby is breech?
If my baby is breech, does it mean there is something wrong with them?
What are the benefits and risks of ECV?
What are my options for delivery if my baby remains in the breech position?
What are the health risks to my baby and me if they are born breech?

Medline Plus: Breech Birth

Last Updated: March 10, 2023

This article was contributed by familydoctor.org editorial staff.

This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.

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COMMENTS

Breech Position: What It Means if Your Baby Is Breech
WhatToExpect.com, Pelvic Tilt Exercises During Pregnancy, May 2021. National Center for Biotechnology Information, External Cephalic Version, July 2020. National Center for Biotechnology Information, National Library of Medicine, A population-based case-control study of risk factors for breech presentation, January 1996.
Breech Baby: Causes, Complications, and Turning
Overview. About 3-4 percent of all pregnancies will result in the baby being breech. A breech pregnancy occurs when the baby (or babies!) is positioned head-up in the woman's uterus, so the feet ...
Breech Presentation: Types, Causes, Risks
Learn more about the types, causes, and risks of breech presentation, along with how breech babies are typically delivered. ... American Pregnancy Association. Breech Presentation. Gray CJ ...
Breech Presentation
Breech Births. In the last weeks of pregnancy, a baby usually moves so his or her head is positioned to come out of the vagina first during birth. This is called a vertex presentation. A breech presentation occurs when the baby's buttocks, feet, or both are positioned to come out first during birth. This happens in 3-4% of full-term births.
Fetal Presentation, Position, and Lie (Including Breech Presentation
Toward the end of pregnancy, the fetus moves into position for delivery. Normally, the presentation is vertex (head first), and the position is occiput anterior (facing toward the pregnant person's spine) and with the face and body angled to one side and the neck flexed. Variations in fetal presentations include face, brow, breech, and shoulder.
Overview of breech presentation
The main types of breech presentation are: Frank breech - Both hips are flexed and both knees are extended so that the feet are adjacent to the head ( figure 1 ); accounts for 50 to 70 percent of breech fetuses at term. Complete breech - Both hips and both knees are flexed ( figure 2 ); accounts for 5 to 10 percent of breech fetuses at term.
If Your Baby Is Breech
In the last weeks of pregnancy, a fetus usually moves so his or her head is positioned to come out of the vagina first during birth. This is called a vertex presentation.A breech presentation occurs when the fetus's buttocks, feet, or both are in place to come out first during birth. This happens in 3-4% of full-term births.
Frank Breech Position: What Does It Mean?
Frank breech. A frank breech position is when the baby's bottom is down, but their legs are straight up with their feet near their head. The presenting part is the buttocks. A frank breech is ...
Breech presentation
Breech presentation in pregnancy occurs when a baby presents with the buttocks or feet rather than the head first (cephalic presentation) and is associated with increased morbidity and mortality for both the mother and the baby. Cunningham F, Gant N, Leveno K, et al. Williams obstetrics. 21st ed. New York: McGraw-Hill; 1997. Kish K, Collea JV.
Breech Presentation
Breech presentation refers to the fetus in the longitudinal lie with the buttocks or lower extremity entering the pelvis first. The 3 types of breech presentation are frank, complete, and incomplete. In a frank breech, the fetus has flexion of both hips, and the legs are straight with the feet near the fetal face, in a pike position. The complete breech has the fetus sitting with flexion of ...
Breech position baby: How to turn a breech baby
Garcia MM et al. 2019 Effectiveness and safety of acupuncture and moxibustion in pregnant women with noncephalic presentation: An overview of systematic reviews. Evidence Based Complementary Alternative Medicine 7036914. https://pubmed.ncbi.nlm.nih.gov/31885661/ Opens a new window [Accessed November 2021] Gray C. 2021. Breech presentation ...
Breech Baby
Then, usually between 32 and 36 weeks of pregnancy, your baby will likely get into a head-down position in preparation for being born. There is a small chance — just 3 to 4 percent — that your baby may not move into this head-down position by the time your pregnancy is full term. This is called a breech presentation.
PDF Patient advice sheet Breech presentation (Turning my baby and options
rst in the womb (uterus) instead of in th. usual headfirst (cephalic) position. In early pregnancy breech is very common. As. pregnancy continues, a baby usually turns by itself into the headfirst position. B. ies are lying headfirst, ready to be born.A breech baby at the en. Three in every 100 (3%) babies are breech at the end of pregnancy.
Breech Baby: What Causes it and What to Expect
Most of the time, the position of the baby is a chance occurrence with no clear cause. In about 15% of breech cases, a uterine abnormality is the cause. Other reported risk factors include: A previous sibling or either parent who was in breech presentation. Uterine abnormality (bicornuate or septate uterus, fibroid)
What Is a Breech Birth? Types, Causes, and Giving Birth
Types, Causes, and Giving Birth. A breech birth is rare, occurring in about 1 out of 25 full-term pregnancies. It happens when a baby does not move into a delivery position before birth and stays in a bottom-down position instead. We'll tell you everything you need to know about breech presentation at the Flo website.
Fetal presentation: Breech, posterior, transverse lie, and more
Fetal presentation, or how your baby is situated in your womb at birth, is determined by the body part that's positioned to come out first, and it can affect the way you deliver. At the time of delivery, 97 percent of babies are head-down (cephalic presentation). But there are several other possibilities, including feet or bottom first (breech ...
How to Deliver a Baby in Breech Presentation
Deliver the anterior arm by sweeping it across the chest. Rotate the infant 180 degrees in either direction. Deliver the arm that is now anterior the same way the other arm was delivered. Move the towel up to cover the arms and rotate the body to make the back anterior. To deliver the head, place your index and middle fingers of one hand over ...
Breech birth
A breech birth is when a baby is born bottom first instead of head first, as is normal. [1] Around 3-5% of pregnant women at term (37-40 weeks pregnant) have a breech baby. [2] Due to their higher than average rate of possible complications for the baby, breech births are generally considered higher risk. [3] Breech births also occur in many other mammals such as dogs and horses, see ...
6.1 Breech presentation
Presentation of the feet or buttocks of the foetus. 6.1.1 The different breech presentations. In a complete breech presentation, the legs are tucked, and the foetus is in a crouching position (Figure 6.1a).; In a frank breech presentation, the legs are extended, raised in front of the torso, with the feet near the head (Figure 6.1b).; In a footling breech presentation (rare), one or both feet ...
What Is Breech Presentation?
A breech presentation occurs when the fetus is lying longitudinally, and its buttocks or feet will be positioned to be delivered first. It happens in approximately 1 out of 25 full-term births. The probability of breech presentation decreases with the increase in gestational age (a measure of the age of a pregnancy taken from the beginning of a ...
What Can I Do if My Baby is Breech?
Breech tilt, or pelvic tilt: Lie on the floor with your legs bent and your feet flat on the ground. Raise your hips and pelvis into a bridge position. Stay in the tilt for about 10 to 20 minutes. You can do this exercise three times a day. It may help to do it at a time when your baby is actively moving in your uterus.

Breech Position: What It Means if Your Baby Is Breech

What does it mean if a baby is breech?

About What to Expect

Breech Births

What are the different types of breech birth presentations?

What causes a breech presentation?

How is a breech presentation diagnosed?

Can a breech presentation mean something is wrong?

Can a breech presentation be changed?

Medical Techniques

ECV will not be tried if:

Complications of EVC include:

Vaginal delivery versus cesarean for breech birth?

What are the risks and complications of a vaginal delivery?

When is a cesarean delivery used with a breech presentation?

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Disclosures

Christine L. Roberts, MBBS, FAFPHM, DrPH

Jonathan Morris, MBChB, FRANZCOG, PhD

Peer reviewers

Rhona Hughes, MBChB

Brian Peat, MD

Lelia Duley, MBChB

Justus Hofmeyr, MD

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