A breech presentation is when the baby is positioned in the uterus so that their bottom or feet will come out first instead of their head during delivery.
If you are pregnant, then you may have heard the term “breech presentation.” Breech presentation can cause some concerns for expectant mothers, but it does not always mean that there will be problems during birth. In this blog post, we will discuss everything you need to know about breech presentation: what causes it, how to tell if your baby is in a breech position, and what your options are if your baby is in a breech position.
What is a breech presentation?
A breech presentation is when the baby is positioned in the uterus so that their bottom or feet will come out first during delivery.
This type of positioning happens in about 3-4% percent of pregnancies. While a breech presentation doesn’t always mean there are complications, it can make labor and delivery more difficult.
Breech deliveries carry higher perinatal mortality and morbidity, largely due to birth asphyxia/trauma, prematurity, and an increased incidence of congenital malformations.
Types of breech presentation
There are mainly two types of breech presentation:
Complete breech:
This is when the baby’s knees are bent, and their feet are positioned up near their bottom. About a quarter of breech babies are in a complete breech position.
Incomplete breech:
- Frank breech: This is when the baby’s bottom is positioned down in the uterus near the birth canal with their legs pointing up towards their head. About half of breech babies are in a frank breech position.
- Footling breech: This is when one or both of the baby’s feet point downward in the uterus with their legs extended. Footling breeches make up about 20% of all breech presentations.
- Knee breech: Thighs are extended, but the knees are flexed, bringing the knees down to present at the pelvic brim. The latter two types are not common.
Causes of breech presentation
There are a few different reasons why a baby may be in a breech position, including:
- The position of the placenta: If the placenta is low in the uterus, it can crowd the baby and cause them to move into a breech position.
- Abnormalities in the uterus: If the uterus is misshapen or has fibroids, it can impact the baby’s ability to move into a head-down position.
- Multiple gestations: If a woman is pregnant with twins or triplets, it’s more likely that at least one of the babies will be in a breech position.
- Prematurity is the commonest cause.
- Too much (polyhydramnios) or too little (oligohydramnios) amniotic fluid around the baby
- Hydrocephalus
- Fetal abnormalities or certain birth defects
Breech presentation can be a cause for concern because it can impact the baby’s ability to move into a head-down position. If the baby is in a breech position, they may not be able to turn on their own and will need assistance from a healthcare provider.
Risk factors
Risk factors for breech presentation include
- Twin pregnancy: If you’re pregnant with more than one baby, your chance of breech presentation increases. That’s because the more babies you have, the more crowded they are in your uterus.
- If you’ve had a breech delivery before, you’re also more likely to have another breech baby.
- Breech presentation can also be caused by intrauterine growth restriction (IUGR).
- Certain uterine and placental abnormalities. These include:
- A bicornuate uterus, which is heart-shaped
- A septate uterus, which has a wall of tissue down the middle
- A uterine tumor
- Placenta previa, where the placenta covers the cervix
Symptoms of breech presentation
There are usually no symptoms of breech presentation. In some cases, the baby’s head may be visible at the opening of the vagina. This is called “engagement” and usually happens late in pregnancy.
If you think you may be experiencing breech presentation, it’s important to speak with your healthcare provider. They will be able to confirm the position of your baby through ultrasound and determine if there are any risks associated with your particular situation.
Diagnosis of breech presentation
Breech presentation is usually diagnosed during a routine prenatal visit. Your healthcare provider will feel your abdomen to determine the position of your baby.
If your baby is in a breech position, your healthcare provider may recommend a pelvic exam and ultrasound. This can help to rule out any potential complications, such as placenta previa or a bicornuate uterus.
Complications of breech presentation
While breech presentation doesn’t always mean there are complications, it can make labor and delivery more difficult.
Breech presentation can impact the baby’s ability to move into a head-down position. If the baby is in a breech position, they may not be able to turn on their own and will need assistance from a healthcare provider.
This can result in longer labor, as well as an increased risk of complications, such as:
- The baby’s head gets stuck during delivery (cephalopelvic disproportion)
- Cord prolapse
- The umbilical cord getting wrapped around the baby’s neck (nuchal cord)
- The placenta tearing away from the uterine wall before delivery (placental abruption)
If you’re pregnant and think you may be experiencing breech presentation, it’s important to speak with your healthcare provider.
Treatment of breech presentation
If you’re pregnant and your baby is breech, your healthcare provider may recommend a procedure called external cephalic version (ECV).
External Cephalic Version
ECV is a procedure that involves manually manipulating the baby into a head-down position. ECV is typically performed after 36 weeks of pregnancy and is considered to be safe for both mother and baby.
However, there is a small risk of complications, such as:
- The umbilical cord getting wrapped around the baby’s neck
- The placenta tearing away from the uterine wall
ECV is not always successful in turning the baby. If ECV is unsuccessful, your healthcare provider may recommend a cesarean delivery (cesarean section).
Vaginal breech delivery
In breech presentation, vaginal delivery is considered in cases with an adequate pelvis, average fetal weight, and flexed head without any complications.
During a vaginal breech birth, the baby’s bottom is born first. The baby’s head is then turned to the side and delivered last. The progress of your labor will be monitored closely. If there is any delay in the descent of your baby, a cesarean section might be recommended.
Cesarean delivery
A C-section is a surgery that involves delivering the baby through an incision in the mother’s abdomen. Cesarean delivery is typically advised for all breech babies, particularly premature ones, by most physicians.
Since premature babies are small and more fragile, and because the head of a premature baby is relatively larger in proportion to its body, the baby is unlikely to stretch the cervix as much as a full-term baby. This means that there might be less room for the head to emerge.
Conclusion
Breech presentation is a common complication during pregnancy. If you think you may be experiencing breech presentation, it’s important to speak with your healthcare provider. There are several treatment options available, including an external cephalic version and cesarean delivery.
Vaginal breech delivery is also an option in some cases. If you have any questions or concerns, be sure to speak with your healthcare provider. They will be able to help you make the best decision for you and your baby.
We hope this article was helpful.
