Breech Babies: Understanding Types, Causes, Management, and Treatment

A breech baby is when the baby's feet or buttocks appear first from the vagina, with the head towards the chest. Ideally, babies are in a head-down (vertex presentation) position at birth for excellent vaginal giving birth.

Most turn naturally, but if a baby remains breech at 37 weeks, delivery options must be reconsidered due to risks.

Breech presentation is typically earlier in gestations, but by 36 weeks, most embryos move head-down. Breech presentations are unique at full-term, happening in only 3% to 4% of cases at 39 to 40 weeks.

4 Types of Breech Positions

• Frank breech: The baby's buttocks are positioned towards the vagina, with the legs extended straight up.
• Complete breech: The baby's buttocks face downwards with the hips and knees bent.
• Footling breech: The baby's feet are present first.
• Transverse lie: The baby lies horizontally across the uterus.

Contributing Factors to Breech Presentation

• Anticipating multiples (twins, triplets, etc.)
• Former pregnancies
• Abnormal levels of amniotic fluid
• Infrequently shaped uterus, potentially due to situations like fibroids or a uterine septum
• Placenta previa is a condition where the placenta incompletely or entirely covers the cervix
• Preterm birth, where the baby may not have had time to turn headfirst
• Fetal conditions that affect the ability to turn the head down

You may notice a breech fetus through sensations like kicks in the pelvis instead of under the ribs, or feeling a distinct lump at the ribs, especially if former gestations involved a head-down position.

Healthcare providers assess fetal positioning through palpation and ultrasound, typically confirming a breech position around 37 weeks if it persists.

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Options When Baby Remains Breech at 37 Weeks

• Attempt to turn the baby between 37 to 38 weeks.
• Plan for a C-section delivery between 39 to 40 weeks.
• Most healthcare providers commonly prevent trying vaginal delivery for breech babies unless the baby is already lowering and ready for birth.

External cephalic version (ECV) is a procedure sometimes used to turn a breech baby, though it carries risks and success isn't assured.

Most babies normally turn head-down by full term, but if not, healthcare providers monitor carefully and may suggest an ECV or C-section based on circumstances.

Methods to encourage fetal repositioning at home include certain positions, music, temperature changes, chiropractic, and acupuncture, although their effectiveness is not well-established.

Are There Proven Methods to Prevent Breech Presentation?

There are no proven methods to prevent breech presentation. While vaginal delivery can be attempted with breech babies, it poses higher risks, including potential harm to the baby's limbs or complications with the umbilical cord and head/shoulder delivery.

Healthcare providers vary in their experience with breech deliveries, and C-sections for breech babies may require specific techniques but are generally manageable by experienced obstetricians.

Most babies born breech do not encounter long-term health concerns linked to their birth presentation, and pediatricians will evaluate the baby's hips and give needed follow-up care.

Contact the healthcare provider promptly if you experience severe pelvic cramping, contractions, vaginal bleeding, or water breaks during pregnancy, as these symptoms require immediate medical attention.

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