Breech describes the position of the baby just before or during delivery.
A few weeks before birth, most babies will reposition themselves so that their heads are pointed down towards the birth canal. This is the optimal position for birth. If this does not happen, the baby's buttocks or feet will be in place to be delivered first. This is called a breech presentation.
Breech positions occur in about 1 of 25 full-term births.
What are the different types of breech presentations?
- Frank breech: The fetus' buttocks are aimed toward the birth canal and the legs stick straight up in front of the body. The feet are near the head.
- Complete breech: The buttocks are down, with the legs folded at the knees and the feet near the buttocks.
- Footling breech: One or both of the fetus' feet are pointing down and will come out first.
What causes a breech presentation?
The causes of breech presentations are not fully known. However, a breech birth is more common :
- In women who have had multiple pregnancies
- In pregnancies of twins or triplets
- When there is history of premature delivery
- When the uterus has too much or too little amniotic fluid
- In an abnormal shaped uterus or a uterus with abnormal growths, such as fibroids.
- For women with placenta previa
How is a breech presentation diagnosed?
A few weeks prior to the due date, the health care provider may place his/her hands on the mother's lower abdomen to locate the baby's head, back, and buttocks. If they think the baby is in a breech position, an ultrasound may be used to confirm. Special x-rays can also determine the baby's position and measure the pelvis to determine if a vaginal delivery of a breech baby may be attempted.
Can a breech presentation mean something is wrong?
Most breech babies are born healthy. However, they do have a higher risk for certain problems than babies born head first. Birth defects are slightly more common in breech babies. A birth defect may be the reason they have not moved into the right position before birth.
Can a breech presentation be changed?
The best time to try to turn a breech baby is between 32-37 weeks of pregnancy. There are many different types of methods to use and all have different levels of success. Talk with your health care provider about which options they feel would be best for you to try.
Vaginal delivery vs. cesarean for breech birth?
Most health care providers do not believe a vaginal delivery is possible for a breech birth, although some will wait to make that decision until a woman is in labor. However, the following are often necessary in order for a vaginal birth to be attempted:
- 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; the cervix is widening and the baby is moving down
- 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 can be performed on short notice
What are the risks of a vaginal delivery for a baby that is breech?
In a breech birth, the baby's head is the last part to emerge, and it may be harder to ease it through the birth canal. Sometimes forceps are used to guide the baby's head out. Another potential problem is cord prolapse in which the umbilical cord can get squeezed as the baby moves toward the birth canal, slowing the baby's supply of oxygen and blood.
If a vaginal delivery is attempted, electronic fetal monitoring will be used to monitor the baby's heartbeat throughout labor. A cesarean delivery may be considered if there are any signs 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 that are in a breech position, especially those that are premature. Premature babies are small and fragile, and because the head is relatively larger, their bodies don't stretch the cervix as wide as full-term babies do during birth. This means that there may be less room for the head to emerge.