A breech baby is a term used to describe a baby who is positioned in the uterus with their buttocks or feet facing the birth canal, rather than the head. A breech presentation occurs in approximately 3-4% of full-term pregnancies and can increase the risk of certain complications during labor and delivery. This article will review the existing evidence on breech presentation and its management. It discusses the various factors that may increase the likelihood of a breech presentation, including advanced maternal age, multiple pregnancies, and fetal anomalies. The articles also explore the different methods used to diagnose breech presentation, such as physical examination and ultrasound imaging.

 

What is a Breech Baby?

A breech baby is a term used to describe a baby who is positioned in the uterus with their buttocks or feet facing the birth canal instead of the head. Typically, during the third trimester of pregnancy, babies start to move into a head-down position, which is ideal for a vaginal delivery. However, in some cases, a baby may remain in a breech position, which can complicate the delivery process. There are several types of breech presentation, including complete breech (where the baby's buttocks are closest to the birth canal and the legs are bent at the hips and knees), frank breech (where the baby's buttocks are closest to the birth canal and the legs are straight up in front of their body), and footling breech (where one or both of the baby's feet are closest to the birth canal).

 

How Common is a Breech Baby?

Breech presentation, where the baby is positioned in the uterus with their buttocks or feet facing the birth canal instead of the head, occurs in approximately 3-4% of full-term pregnancies. This means that the vast majority of babies will turn to a head-down position before delivery, which is the optimal position for a vaginal birth.

Breech presentation is more common earlier in pregnancy and becomes less likely as the baby grows and there is less space to move around in the uterus. Factors that may increase the likelihood of a breech presentation include premature birth, multiple pregnancies, a uterine abnormality, and fetal anomalies. Maternal age, parity (number of pregnancies), and the use of certain medications or substances during pregnancy may also play a role.

While breech presentation does increase the risk of certain complications during labor and delivery, many breech babies are born healthy and without any major issues. The management of breech presentation largely depends on the gestational age of the fetus and the clinical situation and may involve vaginal delivery, external cephalic version (ECV), or cesarean section.

 

What are the Types of Breech Baby?

There are three main types of breech presentation, depending on the position of the baby in the uterus:

• Frank breech. This is the most common type of breech presentation, accounting for about 65-70% of cases. In this position, the baby's buttocks are closest to the birth canal, and its legs are extended straight up in front of its body, with its feet near the head. This position can make it difficult for the baby to descend through the birth canal, as their head is the largest part of the body and typically needs to be the first to pass through. However, in some cases, the baby's buttocks may help to dilate the cervix and make it easier for the head to pass through during delivery. In certain circumstances, healthcare providers may attempt a vaginal delivery of a frank breech baby, especially if the baby is at term, of normal size, and in a good position.
• Complete breech. In a complete breech presentation, the baby's buttocks are closest to the birth canal, and their legs are bent at the hips and knees, with their feet near their bottom. This position can also make it difficult for the baby to descend through the birth canal, but in some cases, the flexed position of the baby's legs may help to make them more compact and easier to deliver. Similar to a frank breech baby, in certain circumstances, a complete breech baby may be delivered vaginally, but it will depend on several factors such as the size of the baby and the position of the baby in the uterus.
• Footling breech. In this position, one or both of the baby's feet are closest to the birth canal, with their legs extended upwards. This position is the most challenging for vaginal delivery, as the feet or legs can present first, which can cause the baby's head to become trapped behind the pelvis. Footling breech presentation carries the highest risk of complications, and cesarean delivery is usually the preferred method of delivery for these cases.

There are also less common types of breech presentation, such as oblique breech, transverse breech, or kneeling breech. The type of breech presentation can impact the management options available to healthcare providers and the safety of vaginal delivery, so it is important for healthcare providers to carefully assess the type and position of the breech baby before making a delivery plan.

 

How Does a Breech Baby Affect Pregnancy?

Breech babies can potentially affect the course of pregnancy in several ways. Here are a few potential effects:

• Potentially increased discomfort for the mother. Depending on the position of the baby, a breech presentation can cause discomfort or pain for the mother during pregnancy. This is because the baby's head may be pressing on the mother's organs, ribs, or diaphragm.
• Increased monitoring during pregnancy. If a breech presentation is detected during pregnancy, healthcare providers may monitor the baby's position more closely to ensure that they are growing and developing normally. This may involve more frequent ultrasounds or other types of fetal monitoring to assess the baby's health and position.

 

How Does a Breech Baby Affect Delivery?

A breech baby can significantly affect the delivery process, potentially increasing the risks of complications and affecting the options available for delivery. Here are some ways a breech baby can affect delivery:

• Increased risk of complications. A breech baby can present challenges during delivery, particularly during vaginal birth, which can lead to an increased risk of complications such as umbilical cord prolapse, head entrapment, and birth asphyxia.
• Need for cesarean delivery. A breech baby increases the likelihood of cesarean delivery. Cesarean delivery is often recommended for safety reasons, particularly when the baby is in a footling breech presentation or if other risk factors are present, such as premature birth or if the baby is very large.
• Different techniques for vaginal delivery. In some cases, healthcare providers may attempt a vaginal delivery for a breech baby. However, this requires a skilled and experienced healthcare provider, and the delivery may require different techniques, such as using forceps or vacuum extraction, to ensure the safety of both the baby and the mother.
• Longer labor. A breech presentation can potentially prolong labor, particularly if the baby's legs or feet are present first, as this can make it more difficult for the baby's head to descend through the birth canal.
• Increased need for monitoring. During a breech delivery, healthcare providers may need to monitor the baby's position and heart rate more closely to ensure that they are not in distress.

 

What Causes a Breech Baby?

The exact causes of breech presentation are not fully understood, but several factors may contribute to it. Here are some possible causes of breech presentation:

• Premature birth. Breech presentation is more common in premature babies, as they may not have had enough time to turn their heads down before delivery.
• Uterine abnormalities. Certain uterine abnormalities, such as an abnormally shaped uterus or uterine fibroids, can make it difficult for the baby to turn its head down.
• Placenta previa. Placenta previa, a condition where the placenta partially or completely covers the cervix, can make it difficult for the baby to turn its head down.
• Multiple pregnancies. In multiple pregnancies, such as with twins or triplets, one or more of the babies may be breech due to the lack of space in the uterus.
• Polyhydramnios. Excessive amniotic fluid around the baby, known as polyhydramnios, can make it more difficult for the baby to turn its head down.
• Fetal abnormalities. Certain fetal abnormalities, such as those affecting the nervous system or musculoskeletal system, can make it difficult for the baby to turn its head down.
• Maternal factors. Maternal factors such as an abnormally shaped pelvis or a history of premature births or multiple pregnancies may increase the likelihood of breech presentation.

In most cases, there is no identifiable cause of breech presentation. While some factors may increase the likelihood of a breech presentation, it is still relatively common and can occur in otherwise healthy pregnancies.

 

How is a Breech Baby Diagnosed?

Breech presentation can often be diagnosed by a healthcare provider during a prenatal visit. The provider will typically perform a physical exam to determine the baby's position. Here are some common methods for diagnosing a breech baby:

• Abdominal exam. During a physical exam, the healthcare provider will palpate the mother's abdomen to feel for the baby's position. If the provider is unable to feel the baby's head or buttocks in the mother's pelvis, this may suggest a breech presentation.
• Internal exam. In some cases, the healthcare provider may perform an internal exam to determine the baby's position. This involves inserting a gloved hand into the vagina to feel for the baby's head or buttocks in the pelvis.
• Ultrasound. An ultrasound can be used to confirm the baby's position and determine if they are in a breech presentation. This is often done in the later stages of pregnancy to ensure that the baby has turned its head down.

These methods can help diagnose a breech presentation, but it is not always possible to determine the baby's position with 100% accuracy. In some cases, a baby may be incorrectly diagnosed as breech when they are head down, or vice versa. If there is uncertainty about the baby's position, additional testing or monitoring may be recommended to ensure that the baby is in the safest possible position for delivery.

 

What are the Options for Treating a Breech Baby?

When a baby is diagnosed with a breech presentation, there are several options for managing the condition. The best course of action will depend on a variety of factors, including the mother's health, the baby's health, and the stage of pregnancy. Here are some of the options for treating a breech baby:

• External cephalic version (ECV). ECV is a procedure in which a healthcare provider applies pressure to the mother's abdomen to attempt to turn the baby’s head down. This procedure is typically done after 36 weeks of pregnancy when the baby is fully grown and more likely to stay in the head-down position. ECV has a success rate of around 50-60%, and it is generally considered safe for both the mother and the baby.
• Vaginal breech delivery. In some cases, vaginal delivery of a breech baby may be possible. This option is typically only recommended if the mother has had a previous successful vaginal breech delivery or if the baby is in a favorable position (such as a frank breech presentation) and there are no other complicating factors. Vaginal breech delivery can carry some risks, including injury to the baby during delivery, so it is important to discuss the risks and benefits with a healthcare provider.
• Planned cesarean section (C-section). In many cases, a planned C-section is the safest option for delivering a breech baby. This is especially true if the baby is in an unfavorable position (such as a footling breech) or if there are other complicating factors, such as a small pelvis or other health concerns for the mother or baby. Planned C-sections are typically scheduled for around 39 weeks of pregnancy and are considered safe for both the mother and the baby.

The decision of how to manage a breech presentation should be made in consultation with a healthcare provider. They can guide the best course of action based on the individual circumstances of the pregnancy.

 

7 Ways to Turn a Breech Baby

Several techniques have been suggested to help encourage a breech baby to turn into the head-down position before delivery. Here are seven of the most commonly recommended methods:

• Forward-leaning inversion. This technique involves getting down on your hands and knees and then lowering your upper body so that your head is lower than your hips. This position can help to create more room in the pelvis and may encourage the baby to turn.
• Acupuncture or moxibustion. Acupuncture and moxibustion are complementary therapies that involve the use of needles or heat to stimulate specific points in the body. Some studies have suggested that these techniques may be effective in encouraging a breech baby to turn.
• Chiropractic care. Chiropractic care may involve the use of the Webster technique, which is a specific method designed to help balance the pelvis and encourage the baby to turn its head down.
• Yoga poses. Certain yoga poses, such as the cat-cow pose, the downward-facing dog, and the warrior pose, can help to create more space in the pelvis and encourage the baby to turn.
• Swimming. Spending time in the water can help to relax the muscles and may encourage the baby to turn.
• Music or sound therapy. Playing music or other sounds near the mother's pelvis may encourage the baby to turn toward the source of the sound.
• Talking to the baby. Some parents have found that talking to the baby and encouraging them to turn can be effective in encouraging a breech baby to move into the head-down position.

These techniques may help encourage a breech baby to turn, but they are not always effective. It's also important to consult with a healthcare provider before attempting any of these techniques to ensure that they are safe and appropriate for your circumstances.

 

What are the Complications of a Breech Baby?

Breech presentation can carry some risks for both the mother and the baby. Here are some of the potential complications associated with a breech baby:

• Umbilical cord prolapse. In a breech presentation, the baby's head is not engaged in the pelvis, which means that there is a greater risk of the umbilical cord slipping through the cervix and becoming compressed during delivery. This can reduce the baby's oxygen supply and can be life-threatening if not addressed promptly.
• Birth injuries. Breech delivery carries a higher risk of birth injuries, particularly if the baby's head gets stuck during delivery. These injuries can include fractures, nerve damage, and other trauma.
• Delayed delivery. Breech delivery can take longer than a head-down delivery, which can increase the risk of complications for both the mother and the baby.
• C-section complications. If a planned C-section is required, there are potential complications associated with this type of surgery, including bleeding, infection, and anesthesia-related issues.
• Premature birth. Breech presentation can sometimes be associated with premature birth, which can carry its own set of risks.

Not all breech presentations will result in complications, and many breech babies are delivered safely and without incident. However, it is important to work closely with a healthcare provider to monitor the baby's position and to discuss the risks and benefits of different delivery options. In some cases, a planned C-section may be the safest option for both the mother and the baby.

 

What are the Risks of Turning my Breech Baby?

There are some risks associated with attempting to turn a breech baby, also known as an external cephalic version (ECV). Here are some of the potential risks:

• Fetal distress. During an ECV, there is a risk of the baby becoming distressed due to the manipulation of the uterus. This can be seen on the fetal heart monitor, and if it occurs, the procedure will be stopped.
• Premature labor. ECV can cause uterine contractions, which can lead to premature labor. In some cases, labor may need to be induced if the contractions do not stop.
• Placental abruption. In rare cases, ECV can cause the placenta to detach from the uterine wall, which can cause heavy bleeding and can be life-threatening for both the mother and the baby.
• Rupture of the amniotic sac. ECV can cause the amniotic sac to rupture, which can increase the risk of infection and premature labor.

 

How Can I Reduce my Risk of Having a Breech Baby?

There is no surefire way to prevent a breech presentation, but there are some steps you can take to reduce your risk. Here are some suggestions:

• Maintain a healthy pregnancy. Eating a balanced diet, getting regular exercise, and staying hydrated can all help to support a healthy pregnancy and may reduce the risk of complications.
• Stay active. Being physically active throughout your pregnancy can help to encourage the baby to settle into the head-down position.
• Avoid smoking and alcohol. Smoking and alcohol use can increase the risk of complications during pregnancy, including a breech presentation.
• Seek prenatal care. Regular prenatal checkups can help to identify potential issues early on and allow for appropriate intervention if needed.
• Consider chiropractic care. Some women have reported success with chiropractic care to help turn a breech baby. However, it's important to work with a qualified practitioner who has experience with prenatal care.
• Consider acupuncture. Acupuncture may also help to encourage the baby to turn. Again, it's important to work with a qualified practitioner who has experience with prenatal care.
• Be aware of your baby's position. Pay attention to the baby's movements and ask your healthcare provider to check the baby's position at each prenatal visit. If the baby is in a breech presentation, there may be interventions that can be done to encourage a head-down position.

 

FAQs about Breech Baby

 

Do Birth Defects Cause Breech Position?

No, birth defects do not cause breech position. Breech position is when a baby is positioned to come out feet first, rather than the head. However, certain birth defects may increase the likelihood of a breech position. For example, congenital diaphragmatic hernia (CDH) is a birth defect that can affect the development of the diaphragm, which separates the chest cavity from the abdomen. CDH can cause the organs in the abdomen to push up into the chest, making it difficult for the lungs to develop properly. This can increase the risk of a breech position, as the baby may not have enough room to turn head-down in the womb.

 

How Does Labor Start If your Baby is Breech?

If your baby is in a breech position, the onset of labor may not be very different from that of a head-down baby. Typically, labor starts when the body releases hormones that trigger contractions of the uterus, which then cause the cervix to dilate and the baby to move down through the birth canal. In a breech birth, the baby's feet or bottom will be the presenting part that enters the pelvis first. The baby's legs will be stretched out in front of its body, and its head will be tucked under its chin.

 

Can you Deliver Vaginally with a Baby Breech?

Yes, it is possible to deliver a baby vaginally when they are in a breech position, but it carries some additional risks compared to a head-down delivery. In some cases, a healthcare provider may recommend a cesarean section delivery to ensure the safety of both the mother and the baby.

 

Will I Need a C-Section If my Baby is Breech?

Whether or not you will need a cesarean section (C-section) delivery if your baby is breech will depend on several factors, such as the position of the baby, your overall health, and the policy of your healthcare provider or the hospital where you plan to deliver.
In general, if your baby is in a breech position, a healthcare provider may recommend a C-section delivery to reduce the risks of complications during birth. A C-section delivery involves making a surgical incision in the abdomen and uterus to deliver the baby.

 

Conclusion

A breech baby is a baby that is positioned with its bottom or feet down in the uterus instead of its head. Breech position occurs in around 3-4% of full-term pregnancies. While a head-down position is the optimal position for birth, a breech baby can still be safely delivered with proper management and care. Whether a breech baby is delivered vaginally or via a C-section will depend on several factors, such as the position of the baby, the mother's overall health, and the healthcare provider's experience and expertise. A vaginal breech delivery carries some additional risks compared to a head-down delivery, and not all healthcare providers are trained and experienced in performing vaginal breech deliveries. A C-section delivery may be recommended in some cases to reduce the risks of complications during birth.