Breech Presentation: Causes & Signs of Breech Birth Position

As pregnancy progresses, doctors become attentive to the fetus's position, since it can affect how the baby is delivered. The majority of babies move into a head-down position before delivery. However, there are times when they remain in a breech position (where the buttocks or feet are positioned at the bottom of the uterus). While this is not unusual, particularly in early stages of pregnancy, it can become a concern later on among pregnant women about the health of their child and their own birthing experience.

This guide will help you provide a better understanding of what a breech position is, its types, causes, symptoms and possible delivery options.

What is a Breech Baby Position During Pregnancy?

A breech baby position, commonly referred to as breech presentation, occurs when babies are positioned in a buttocks or feet-first in the birth canal rather than the normal head-down position.

During early pregnancy, breech positions are common, as there is enough space for the fetus to move around, and most babies turn head-down on their own before labour begins.

Statistics highlight that usually:

• 3-4% of full-term pregnancies result in a breech baby position.
• 7% of pregnant women at 32 weeks experience a breech baby position. 
• 25% of pregnant women at 28 weeks or less experience a breech baby position. 

Types of Breech Position in Pregnancy

There are three different types of breech baby positions:

Frank Breech Position:

Here, the buttocks of the fetus are located closer to the birth canal, whereas the legs are raised upwards, and the feet are located near the head.

Complete Breech Position:

The fetus is lying in a sitting position wherein the hips and knees are flexed, and the buttocks lie nearer to the birth canal.

Footling Breech Position:

Either one or two legs are hanging down towards the birth canal and may be positioned to deliver before the buttocks.

Transverse Breech Position:

Not a type of breech presentation, but in this case, the fetus lies sideways across the uterus such that either the shoulder or the back is nearer to the birth canal.

Causes of Breech Baby Position

Finding out the exact reason for breech baby presentation in pregnancy can be challenging for physicians. However, there are specific risk factors that can cause a fetus to remain in a breech position, and these include:

• Pregnancy for the first time
• Premature labour
• Placenta previa (wherein the placenta covers part of the cervix)
• Multiple births, such as twin or triplet births
• Abnormal shape of the uterus and uterine disorders, such as fibroids
• Amniotic fluid excess or deficiency
• History of breech presentation from the mother's previous pregnancy
• Some fetal disorders were turning to the head-first position becomes problematic

Signs and Symptoms of a Breech Baby

If you have been pregnant before, you may be able to tell if your baby is in a breech position. Some possible signs of a breech baby include:

• You feel your baby’s kicks lower in the pelvis instead of the ribs.
• You feel a firm and round lump near your rib cage, which could indicate your baby’s head is upwards.
• A shift in normal patterns of fetal movement from previous pregnancies.
• You feel extra pressure in your upper abdomen.

Even if you see all these symptoms in your baby, it does not mean that your baby is breech for sure. It is always better to visit your doctor to get diagnosed properly.

How Are Breech Babies Diagnosed?

Doctors can ascertain whether babies are in breech positions through a physical examination called Leopold's manoeuvre Leopold's maneuvers. In this process, the doctor places their hand on various parts of your stomach to determine the baby's head, back, and limbs and ascertain the part of the baby that will be delivered first.

The doctor may advise you to undergo a scan in order to determine the baby's position. An ultrasound scan is considered to be the most accurate means of diagnosing the baby's position.

When Does the Breech Baby Position Matter in Pregnancy?

A breech baby position becomes especially important if the baby’s feet are pointed towards the birth canal around 36-37 weeks of pregnancy. By this stage, the baby has grown larger and has less space to move. Therefore, they are less likely to turn to a head-down position before birth.

Before this point, in most cases, babies move around quite a bit within the uterus, so finding yourself in a breech position in the early stages of pregnancy isn’t something to be concerned about.

Risks and Complications of Breech Baby Position

A breech baby is not usually risky for your pregnancy. However, it can raise complications during delivery. Although some breech babies may be delivered vaginally, there are a few complications that can arise in such deliveries:

• The umbilical cord can twist or get compressed during delivery, which can cause oxygen deprivation.
• Your baby may suffer injuries to the legs or arms, such as dislocated or broken bones.
• Your baby’s head can get trapped or stuck in the birth canal (head entrapment).
• Delivery may cause rapid compression of the head, which may raise the risk of bleeding.
• Breech babies are at a higher risk of developing developmental dysplasia of the hip (previously known as congenital hip dislocation).

It is always better to consult your doctor and follow their instructions.

Breech Delivery Options

• Vaginal delivery:

In some situations, around 37-38 weeks pregnant, your doctor may attempt to turn the baby to a head-down position using a technique known as external cephalic version (ECV). In this, the doctor would place their hands on your belly and apply firm pressure to try to help the baby turn.

However, it should be noted that ECV does not always work, and there are certain risks associated with it, such as:

• Premature rupture of the membrane
• Vaginal bleeding
• Placental abruption

• Caesarean or C-section delivery:

Generally, a C-section is safer in case of a breech baby. In fact, about 40% [2] of attempted vaginal breech deliveries result in emergency C-section, in which 41% [2] of women are first-time mothers.

If you are living in Hyderabad and have concerns about your baby’s health or delivery, consult a trusted OB-GYN at Apollo Cradle and Children’s Hospital, one of the best hospitals for pregnancy and a leading paediatric hospital in Hyderabad for proper medical guidance and support to help ensure a healthy outcome for both mother and baby.