Breech Position and Breech Birth

Topic Overview

What is breech position?

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

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

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

See a picture of breech positions.

What causes breech position during pregnancy?

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

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

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

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

How is a breech position diagnosed?

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

How is a breech baby delivered safely?

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

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

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

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

Frequently Asked Questions

Learning about breech position and breech birth:	What is breech position? What causes breech position near the end of pregnancy? What types of fetal problems are linked to breech position? What symptoms are related to breech position?
Being diagnosed:	How is a breech pregnancy diagnosed?
Getting treatment:	How is a breech pregnancy treated before birth? How is a breech baby delivered? What can I do at home for a breech pregnancy?

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Author:	Bets Davis, MFA	Last Updated: April 28, 2008
Medical Review:	Joy Melnikow, MD, MPH - Family Medicine William Gilbert, MD - Perinatology
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