Breech Position And Breech Birth

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Topic Overview

What is breech position?

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

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

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

See an illustration of breech positions .

What causes breech position during pregnancy?

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

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

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

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

How is a breech position diagnosed?

Your health professional can feel your upper and lower abdomen and may examine your cervix for signs that your fetus is breech. For a definitive diagnosis, a fetal ultrasound provides a picture of how your fetus is positioned.

How is a breech baby delivered safely?

The American College of Obstetricians and Gynecologists (ACOG) now recommends a planned cesarean delivery at term if a breech fetus cannot be turned to the head-down position using external cephalic version before labor begins.⁴ This is because about 5 of every 100 breech infants delivered vaginally suffer serious complications, some causing disability. (This means that 95 of every 100 newborns have no serious problems from vaginal breech birth.) To compare, cesarean delivery causes serious problems in less than 1 of every 100 breech infants.⁵

Vaginal breech birth risks (for the infant) are lowest when a mother has had two or more vaginal births before. But even in this case, a cesarean delivery would be even lower-risk.⁶

Sometimes, a vaginal breech birth does happen, such as when labor happens quickly. Talk to your doctor ahead of time about this possibility. Some doctors have little experience doing this kind of delivery, which is more risky for the newborn.⁷

Frequently Asked Questions

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Last updated:	May 05, 2006
Author:	Kathe Gallagher, MSW
Reviewed By:	Joy Melnikow, MD, MPH - Family Medicine, William Gilbert, MD - Perinatology
Editors:	Kathleen M. Ariss, MS, Pat Truman