Breech Position and Breech Birth

Topic Overview

What is breech position?

During most of pregnancy, there is enough room in the uterus for the baby (fetus) to change position. By 36 weeks of pregnancy, most babies turn into a head-down position. This is the normal and safest fetal position for birth.

But in about 4 out of 100 births, the baby doesn't naturally turn head-down. Instead, the baby is in a breech position.^{footnote 1} Babies in breech position usually must be delivered by C-section.

There are three main breech positions:

• Frank breech. The buttocks are in place to come out first during delivery. The legs are 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 knees are bent, and the feet are near the buttocks.
• Footling breech. One leg or both legs are stretched out below the buttocks. The leg or legs are in place to come out first during delivery.

What causes breech position?

Most of the time, there is no clear reason why the baby did not turn head-down.

In some cases, breech position may be linked to early labor, twins or more, problems with the uterus, or problems with the baby.^{footnote 2}

What are the signs that your baby is in breech position?

You probably won't be able to feel whether your baby is breech. But if you are 36 or more weeks pregnant and think you feel the baby's head pressing high up in your belly or you feel kicking in your lower belly, see your doctor for an exam.

How is a breech position diagnosed?

During a routine exam late in your pregnancy, your doctor will feel your upper and lower belly and may do a fetal ultrasound to find out if your baby is breech. Your doctor may also learn that your baby is breech when he or she checks your cervix.

How is breech position treated?

Sometimes a doctor can turn a baby from a breech position to a head-down position by using a procedure called an external cephalic version. (If you are using a midwife and your baby is in breech position, your midwife will refer you to a doctor for this procedure.) If the baby can be turned head-down before labor starts, you may be able to have a vaginal birth.

You also can ask your doctor if you can try certain positions at home that may help turn your baby. This is called postural management. There is no research to prove that this works, but it's not harmful. It may work for you.

It's normal to feel disappointed and worried about a breech pregnancy, especially if the doctor has tried to turn the baby without success. But most breech babies are healthy and don't have problems after birth. Talk to your doctor if you're concerned about your baby's health.

How is a breech baby delivered safely?

In most cases, a planned cesarean delivery (C-section) is safest for the baby. If your fetus is still in a breech position near your due date, your doctor will likely schedule a cesarean. If you are using a midwife, your midwife will refer you to a doctor for a scheduled C-section.

In rare cases, a cesarean breech birth may not be recommended or even possible. For instance, if a breech labor progresses too quickly, a vaginal birth may be the only option. During a twin birth in which the first twin is head-down and the second twin is breech, both babies may best be delivered vaginally.^{footnote 3}

No matter what position a baby is in, every labor and delivery is unique. 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 and your baby safe.