Breech Position in Pregnancy: Types, Causes, Risks and Treatment Options

Breech Baby Position: Causes, Signs & Delivery Options

A breech baby is positioned differently from a baby who is head down. The exact position of the baby's legs and feet determines the type of breech presentation.

The position can change several times during pregnancy. This is especially common in the first couple of months, when the baby has plenty of space to move. The baby usually moves into position for birth as the uterus becomes more crowded.

What Is a Breech Position in Pregnancy?

A breech position in pregnancy occurs when the baby's bottom or feet are positioned towards the cervix and birth canal. When the baby's head is down, it is in the cephalic position.

Breech position is common earlier in pregnancy. The majority of babies will turn their heads without the help of treatment. When the baby is still breech in the last few weeks of pregnancy, additional evaluation becomes important as there are some risks associated with breech birth that may not exist with head-first birth.

What Are the Three Types of Breech?

There are several types of breech presentation, primarily based on the baby's leg and foot position.

Frank Breech

Frank breech means the baby sits with her butt pointing downward and both legs pointing upward in front of her. The knees stay straight, and the feet are near the baby's head. Frank breech is one of the more common types of breech presentation at or near term. 

Complete Breech

If the baby is in complete breech, the baby's butt is down, and the hips and knees are bent. The baby seems to be sitting cross-legged within the womb. The baby can move the legs and feet, but the bottom is the closest part to the birth canal.

Footling Breech

When one or both feet face down towards the birth canal, it is called footling breech. The feet are positioned below the baby's bottom.

This position requires special attention when planning birth. Because of increased difficulty in delivery, a footling presentation may not be a good indication for a vaginal breech birth.

What Causes a Breech Baby?

There is not always a clear explanation for why a baby remains breech. In many cases, there is no clear reason why a baby remains in the breech position. But some factors can make it more difficult for the baby to turn.

Uterine or Placental Factors

The size or shape of the uterus, as well as the placenta's position, may restrict the baby's movement.  

Multiple Pregnancy

Multiple pregnancies, such as twins, may raise the risk for an unusual baby position. As pregnancy progresses, babies have less freedom of movement.

Amniotic Fluid Levels

Excessive or insufficient amniotic fluid may affect your baby's movement. This can make it harder for the baby to get into the head-down position.

Premature Pregnancy

Breech presentation is more common in premature births because there may not have been enough time for the baby to turn into a head-down position. 

When No Specific Cause Is Identified

In many pregnancies, there is no specific cause. A breech position doesn't always mean there is a problem with the baby. It might just be a form of the baby's position at that point of gestation.

Signs and Symptoms of a Breech Baby

A breech position typically doesn't produce any symptoms. Some pregnant women may notice changes in where they feel foetal movements, but these patterns cannot reliably determine the baby's position. A healthcare professional can determine the baby's position during routine antenatal (pre-birth) checks.  If there is uncertainty, an ultrasound can provide a clearer assessment.

How Is Breech Position Diagnosed?

Abdominal Examination

In the abdominal assessment, the health care provider touches various parts of the abdomen. This helps locate the position of the baby's head, spine, and buttocks.

The abdominal assessment can lead to a diagnosis of a breech presentation, especially in the late stages of pregnancy. But it is not always conclusive. 

Ultrasound Assessment

An ultrasound can confirm the baby's presentation. It can also assess fetal growth, amniotic fluid volume, and placental position. Ultrasound is especially helpful in managing pregnancy towards the end.

Is Breech Baby Position High Risk?

Not all breech babies are necessarily high-risk pregnancies. Many babies are breech earlier in pregnancy and later turn head down naturally.

The main concern is when the baby is still breech late in pregnancy. Because the head is the largest part of the baby's body, there is a risk that it may become difficult to deliver after the body has passed through the birth canal. 

Individual risk depends on factors such as the type of breech, the baby's size, fetal position, gestational age, and maternal health. Also take into account the experience of the maternity team when it comes to vaginal breech birth.

What Are the Treatment Options for Breech Birth?

The right approach depends on the pregnancy and how the baby is lying. External cephalic version, planned cesarean section and, in selected cases, planned vaginal breech delivery - These are the main options for managing breech presentation near delivery.

External Cephalic Version

External cephalic version (ECV) is a procedure used to turn a breech baby into a head-down position. A trained health care professional gently presses against the abdomen to encourage the baby to turn.

ECV is generally performed around 36 weeks, if appropriate, and is effective in about 50% of cases. During the procedure, the baby's heart rate is checked, and the procedure should be carried out where emergency caesarean birth is available if required. ECV can be uncomfortable or painful. The risk of serious complications is minimal, although risks are discussed beforehand.

Planned Caesarean Birth

A planned cesarean section may be suggested if the baby remains in a breech position near delivery and vaginal breech birth is not considered suitable.

A cesarean birth may be planned to minimise some risks to the baby from a vaginal breech birth. This is a major surgery, though, and there are risks to the mother from infection, bleeding and future problems with pregnancy. The decision should be made individually and discussed with the obstetric team.

Vaginal Breech Birth in Selected Cases

Vaginal breech birth may be considered in carefully selected pregnancies. The decision depends on the type of breech presentation, baby's estimated size and position, maternal health status and the availability of an experienced team.

Footling breech presentation is generally not considered suitable for planned vaginal breech birth. In cases where vaginal breech delivery is deemed suitable, the process should be performed at a hospital where there is an experienced maternity team, together with immediate access to caesarean breech delivery.

Can a Breech Baby Turn Naturally?

Yes. A breech baby may turn on its own, especially early on in pregnancy. Most babies move into a head-down position by around 36 to 37 weeks. 

That's why a breech position often doesn't need treatment if it happens early in pregnancy. The situation is reassessed as pregnancy progresses.

Sleeping Positions to Turn a Breech Baby

Many people discuss specific sleep/sitting positions to encourage a breech baby to turn. But at present there is no good scientific data to support that lying or sitting in a specific position always turns a breech baby.

This is particularly relevant when it comes to naturally turning a breech baby. Discuss all exercise, posture, and complementary practices with a health care professional before using them during pregnancy. Some evidence suggests moxibustion may affect the likelihood of the baby turning, but the evidence is limited. Use it only if a competent healthcare provider approves it.

How to Avoid Breech Position in Pregnancy

There is no reliable way to prevent breech presentation. In most cases, there is no known cause.

Regular antenatal checks are necessary. They enable health workers to monitor the foetus's growth and development, the position of the placenta, amniotic fluid, and the foetus's presentation during pregnancy. If a breech position is detected, the emphasis should be on accurate assessment rather than attempting to prevent breech presentation with unproven techniques.

What Happens If the Baby Remains Breech Near Delivery?

The healthcare professional will typically discuss the options if the baby is still breech at 36 weeks. These can be ECV, planned Caesarean birth or planned vaginal breech birth (planned VBBS) in appropriate cases.

The final plan depends on the individual pregnancy. A baby may also turn after a discussion about delivery options, although spontaneous turning becomes less likely later in pregnancy. In the case of a planned caesarean birth, if labour starts before the time, the health care team will determine the safest mode of delivery at that time.

Breech Position and Pregnancy Monitoring

Careful monitoring is required as a breech presentation approaches term. An abdominal exam and ultrasound may confirm the baby's position and evaluate other factors that could affect delivery.

Don't overlook the emotions associated with breech presentation. Pregnancy is an experience where both physical and emotional aspects play a major role, and having a breech baby will add another level of uncertainty, especially when the mode of delivery is altered.

With clear communication, expecting parents can better understand why a certain option has been recommended. It is not just about moving the baby's position. It is about choosing a method that supports the health and well-being of both the baby and the mother.

Conclusion

A breech presentation is more common during the early months of pregnancy; however, most babies tend to turn around to have their head facing downwards. If the baby does not move from its current position near the end of pregnancy, it is not necessarily an abnormality.

ECV, planned caesarean birth or, in selected cases, vaginal breech birth may be considered depending on the individual pregnancy. With appropriate monitoring and guidance from the healthcare team, expecting parents can make informed decisions about delivery.