TV medical dramas have done a whiz-bang job at making breech births seem pretty dramatic with their depictions. But what is a breech baby and is this condition something to worry about? Deep breath. What Hollywood does not show you is that only 3 to 4% of babies present as breech, making breech babies a rare event. To put any concerns further at ease, let us review the facts about breech babies.

What does it mean if a baby is breech?

In the last weeks of pregnancy, a baby usually moves so their head is positioned to come out of the vagina first during birth. This is called a vertex presentation. A breech presentation occurs when the fetus’s buttocks, feet, or both are in place to come out first during birth. This happens in 3 to 4% of full-term births.

It is not always known why a baby is breech. Some factors that may contribute to a fetus being in a breech presentation include the following:

  • You have been pregnant before.
  • There is more than one fetus in the uterus (twins or more).
  • There is too much or too little amniotic fluid.
  • The uterus is not normal in shape or has abnormal growths such as fibroids.
  • The placenta covers all or part of the opening of the uterus (placenta previa).
  • The baby is preterm.

What are the different breech positions?

There are a few different ways a baby might present as breech:

  • Frank breech: The most common form of breech position, which is when the baby’s buttocks is down while its legs are folded up enough to place the feet by the head. Great for a future yogi, not so much for birth.
  • Footling breech: The fancy-sounding footling breech is when the baby is positioned with one or both feet facing down.
  • Complete breech: This breech position happens when a baby is sitting criss-cross applesauce. The butt is facing down; the head is facing up.
  • Transverse breech: This breech position occurs when the baby is laying sideways across the uterus instead of vertically.
  • Oblique breech: In this awkward breech position, the baby’s head is positioned downward, but turned sideways toward the mother’s hip.

What’s the harm of having a breech baby?

Breech births can pose serious risk during a vaginal birth and could lead to an emergency cesarean. If the baby’s body tries to come out before the head, then the cervix could potentially not stretch enough for the head to emerge, placing the baby in distress. The umbilical cord could potentially prolapse, meaning it can be birthed through the vagina before the baby’s head, which can cut off the supply of oxygen to the baby. But again, breech babies are rare, and there are interventions a healthcare provider can do to prevent a breech birth and ensure a safe, healthy delivery!

Can a breech baby be turned around?

At week 37 of pregnancy, a doctor may intervene if the baby has not yet found the correct birthing position. To flip or move a baby that is in breech a doctor will likely use a technique called external cephalic version (ECV) or a 'version.' By placing hands on the mother’s belly, a doctor can push the baby toward the goal position of head down. It will likely be an uncomfortable experience for the mum but not overly painful and will not harm the baby. 

More than 50% of versions succeed. However, some babies who are successfully turned move back into a breech presentation. If this happens, a version may be tried again, but this tends to be harder to do as the time for birth gets closer. As the fetus grows bigger, there is less room for them to move.

What if my baby is still breech?

Most babies that are breech are born by planned cesarean delivery. A planned vaginal birth of a single breech fetus may be considered in some situations. Both vaginal birth and cesarean birth carry certain risks when a fetus is breech. However, the risk of complications is higher with a planned vaginal delivery than with a planned cesarean delivery. 

Toward the end of your pregnancy, your healthcare provider will see you and your baby at least once a week. They will be able to advise you on your baby’s position, general health, and recommendations for delivery, whether your baby presents head-first or breech. Knowledge is power, and your healthcare team will be your partner in delivering a healthy baby!

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