What is Breech Presentation?

In typical pregnancies, the baby's head is positioned near the pregnant person's cervix. During delivery, the head comes out first. This is called vertex presentation and applies to approximately 96 percent of full-term pregnancies. The remaining 4 percent of babies are in the breech presentation, which means that the buttocks and/or feet are closest to the cervix. Learn more about what a breech presentation is, its causes, and how a breech baby is delivered.

What is a Breech Baby?

During your pregnancy, your baby constantly moves around the uterus. Indeed, most babies do somersaults up until the 36th week of pregnancy, when they pick their final position in the womb, says Laura Riley, M.D, an OB-GYN in New York City. A small percentage end up “upside-down” in breech presentation, with their feet or buttocks near the cervix.

How do you diagnose breech presentation? Your midwife or doctor can feel the position of your baby's head through your abdominal wall—or they can conduct a vaginal exam if your cervix is open. A suspected breech presentation should be confirmed through ultrasound, then you’ll have a full discussion about delivery options, potential issues, and risks.

Types of Breech Presentation

There are three types of breech babies: frank, footling, and complete. Learn about the differences between these breech presentations.

Frank breech

The baby’s bottom faces the cervix and their legs are straight up. This is the most common type of breech presentation.

Footling breech

One or both of the baby's feet are in the birth canal, where they’re positioned to be delivered first.

Complete breech

The baby’s bottom faces the cervix. Their legs are bent at the knees, and their feet are near their bottom. A complete breech is the least common type of breech presentation.

The baby can also be in a transverse breech position, meaning that they're sideways in the uterus. Oblique breech means they're pointing toward one of the pregnant person’s hips.

Breech Baby Causes

Typically, the baby and the shape of your uterus determine presentation. You can’t control either of these factors, so breech presentation usually isn’t preventable. And while the cause often isn't known, there are certain risk factors that may increase your risk of a breech baby:

• The fetus has abnormalities involving the muscular or central nervous system
  
• The uterus has abnormal growths or fibroids
• There’s insufficient amniotic fluid in the uterus (too much or too little)
• This isn’t your first pregnancy
• You have a history of premature delivery
  
• You have placenta previa (the placenta partially or fully covers the cervix)
  
• You’re pregnant with multiples
• You’ve had a previous breech baby
  

The Dangers of Breech Presentation

Your baby's presentation is extremely important during labor. It's both difficult and risky to deliver a breech baby vaginally. That’s because the baby's feet and umbilical cord can get tangled. Also, on rare occasions, the baby's smaller parts (legs, body, arms) may slide out before the cervix is fully dilated, but the larger head may get stuck. During a difficult, stressful delivery, your baby could be injured or even die.

How Are Upside-Down Babies Delivered?

A baby can be breech off and on throughout pregnancy without causing concern. But around 36 or 37 weeks, your doctor may recommend a version (also called an external cephalic version), which is the manual turning of the baby into the head-down position, says Dr. Riley. Using ultrasound, your doctor will place their hands on your abdomen and apply pressure, pushing the baby's bottom up and guiding the head to encourage a somersault. “She is literally trying to turn the baby upside down,” says Dr. Riley.

Risks of a version include premature rupture of the membranes, placental abruption, tangling of the cord, or starting labor. The procedure works about half the time; the success rate is higher if the pregnant person has had a baby before. Some babies will move back into the breech position even after the version, and if this is the case, you’ll need a cesarean delivery.

The majority of breech babies are born through C-sections. These are usually scheduled between 38 and 39 weeks, before labor can begin naturally. However, with a doctor experienced in delivering breech babies vaginally, a natural delivery might be a safe option for some people. In fact, a 2017 study showed similar complication and success rates with vaginal and C-section deliveries of breech babies.

That said, your doctor will consider your specific medical condition and the position of your baby to determine which type of delivery will be the safest option for you and your baby. And, often, for breech babies, that will be a C-section.