Have you been told that your baby is in a breech presentation anytime during the latter part of your pregnancy? Do you know what it means?

In the last few weeks of pregnancy, most babies will move into a final position in preparation for birth, ideally with the head moving closer to the birth canal (Cephalic presentation). But sometimes, the baby’s buttocks and/or feet will be positioned closer to the birth canal. This is referred to as Breech presentation.

It may be seen in 3 – 5% of all pregnancies around 37 weeks. It is much more common than this earlier in pregnancy. Your baby could be in any of the following, depending on the position of the baby’s legs:

Complete or Flexed breech baby:

Your baby’s knees are bent, while its buttocks and feet are pointing downwards towards the birth canal.

Frank breech baby:

In this position, your baby’s buttocks are downwards. While the legs are straight up, feet near his or her ears. It is the most common type of breech that constitutes approximately 65 – 70% of total breech births.

Footling breech baby:

Either one or both the feet of your baby may come out first during childbirth. The footling breech is common in premature babies.

How would you know if you have a Breech baby?

If you have a breech baby, you may feel more of the kicks in your lower belly. Your obstetrician or midwife can also tell by feeling your upper and lower abdomen and try to pinpoint where your baby’s head is. An ultrasound can confirm more precisely what position your baby is in.

What could possibly cause a baby to be breech?

Volume of amniotic fluid-

Too little or too much amniotic fluid can cause your baby to be in the breech position. Not having enough fluid may make it more difficult for your baby to “swim” around while having too much fluid can cause the baby to flip between breech and a head-down position.

You are pregnant with twins or more –

If you are pregnant with multiples, one or more of the babies may not be able to get in the head-down position since there is less space to move around.

The position of the placenta –

If your placenta is low-lying, covering the cervix, it may prevent the baby to get its head into the right place.

Uterine abnormalities –

Usually, the uterus is shaped like an upside-down pear, but sometimes it develops differently or is misshapen, not giving the baby enough room to flip.

An imbalance or asymmetry in your pelvis or soft tissues –

This “imbalance” may simply be a result of our common day-to-day activities and lifestyles like crossing our legs while sitting, carrying a toddler on a hip, improper sitting positions, using recliners, etc. predisposing your baby to become breech.

All of these can cause a twist in the pelvis and in-turn twist the uterus, resulting in asymmetry. When any part of the pelvis is crooked, then the elastic structures (ligaments) supporting the uterus are pulled and twisted too. The shape of the lower uterus can be altered by this. The baby then has to find a way to fit that predisposes it to turn head-up.

Despite the aforementioned list, we do not know why the majority of babies choose a breech presentation and does it indicate any problems with the mother or baby.

What can be done if a baby is Breech?

Before 30 weeks, many babies are in the breech position. By 30-32 weeks, most of the babies flip head down and bottom up. If your baby continues to remain in the breech position after that, you could try simple exercises and positions (spinning babies techniques) which will help align the pelvis, relax the tight elastic structures (ligaments) near the pelvis and may help a breech baby flip to a head-down position.

If your baby continues to be in the breech position close to term, your obstetrician may offer you a procedure called “External Cephalic Version” (ECV) under ultrasound guidance, a manual attempt may be made to turn your baby into head-down position. Your baby’s heart rate will be monitored before and after the ECV procedure.

If any problems arise with you or the baby, the procedure will be stopped right away. If a problem occurs, a caesarean can be performed quickly, if necessary. Most mothers find this a straightforward procedure and it is not harmful to the baby, but your obstetrician can discuss your individual circumstances with you. Research suggests that ECV works to turn the baby in about 50% of cases.

What are your birthing options if the baby continues to remain breech?

Vaginal breech birth:

After discussing with your obstetrician, you can opt for a vaginal breech birth. You will be looked after by an experienced team who help women birth breech babies vaginally.

Your obstetrician will not advise you for a vaginal breech birth if:

• You are thought to have a narrow pelvis
• Your baby is too large (> 3800 grams) or too small (<2000 grams)
• You have a low lying placenta

Elective Caesarean section:

For breech babies, C-section is more common than a vaginal breech birth. If a caesarean is planned you would have to arrive at the hospital on or a day before the procedure. But if you go into labour before the surgery, your obstetrician will assess if it is safe to proceed with caesarean or it may be safer to have a vaginal breech birth.

Will your baby have any complications?

There could be a very small possibility that your baby is in a breech presentation due to some developmental abnormality. However, often this is picked up on an ultrasound scan. Around 7% of babies in the breech position may have other complications which may be noted before or sometimes after birth. Babies who have been in a breech position towards the end of your pregnancy are more likely to have hip problems so these will be checked during the first couple of days after birth.

As a mother-to-be, it is natural for you to be worried about your baby’s position. It is advisable for you to see your obstetrician or midwife regularly through pregnancy as they will be able to suggest and advise (when required) on what is best for you and your breech baby.