In the last weeks of pregnancy, a fetus normally moves so the head is positioned to come out of the vagina first during birth. If a fetus presents ‘bottom down,’ so the buttocks, feet, or both are in place to come out first during birth, this is called a breech presentation. About 3 to 4 percent of full-term births are breech.
What Are the Breech Positions?
There are three main types of breech presentation:
- Frank (extended) breech
- Both legs are flexed at the hip and extended at the knee
- The most common breech presentation
- Complete (flexed) breech
- Both legs are flexed at the hips and knees (fetus appears to be sitting cross-legged)
- Footling breech
- One or both legs extended at the hip, so that the foot is the presenting part
Can You Deliver Vaginally for a Breech Presentation?
In general, attempting a vaginal delivery for a breech presentation is avoided due to risks to the baby. Usually, the doctor will attempt to turn the fetus into the head down position to prepare for a vaginal birth, or a Caesarean (C-section) will be recommended. Situations in which a breech delivery may be considered include:
- A breech labor progresses too quickly, in which a vaginal birth may be the only option
- During a twin birth in which the first twin is head-down and the second twin is breech, both babies may be delivered vaginally
What Are the Risks for Breech Delivery?
Risks to the baby if delivered breech include:
- The baby’s body may not stretch the cervix enough to allow room for the baby’s head to come out easily, and the baby’s head or shoulders may become wedged against the bones of the mother’s pelvis
- Prolapsed umbilical cord, in which the umbilical cord drops down below the presenting part of the baby, and becomes compressed, which can decrease the flow of blood and oxygen through the cord to the baby
- Premature rupture of membranes
- Suffocation, due to a delay in delivery
- Brain hemorrhage due to rapid compression of the head during delivery
What Are Symptoms of Breech Delivery?
Symptoms of carrying a fetus in breech presentation may include:
- Discomfort just below the ribs
- Feeling of kicking in the lower abdomen
What Causes Breech Delivery?
It is not always known what causes a breech presentation. Factors that may contribute to a breech presentation include:
- Previous pregnancy
- Pregnancy with multiples (twins or more)
- Too much or too little amniotic fluid
- Abnormal shape to the uterus
- Abnormal growths such as fibroids in the uterus
- Placenta covers all or part of the opening of the uterus (placenta previa)
- Preterm fetus
- The fetus has certain birth defects
How Is Breech Delivery Diagnosed?
A doctor may be able to diagnose the fetus is in a breech presentation by palpating certain points on the abdomen to feel where the fetus's head, back, and buttocks are.
A transabdominal/transvaginal ultrasound exam or pelvic exam may be used to confirm the diagnosis.
What Is the Treatment for Breech Delivery?
In general, attempting a vaginal delivery for a breech presentation is avoided due to risks to the baby.
Usually, the doctor will try to turn the fetus so that he or she is head down in what is called the external cephalic version (ECV).
Most of the time, fetuses that are breech are born by planned Cesarean delivery (C-section). There are risks to both vaginal delivery and Cesarean birth when a fetus is in breech presentation but the risk of complications is higher with a planned vaginal breech delivery than with a planned cesarean delivery.
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