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What Is Breech?

When a fetus is delivered buttocks or feet first

Types of Presentation

Risk Factors

Complications.

Breech concerns the position of the fetus before labor . Typically, the fetus comes out headfirst, but in a breech delivery, the buttocks or feet come out first. This type of delivery is risky for both the pregnant person and the fetus.

This article discusses the different types of breech presentations, risk factors that might make a breech presentation more likely, treatment options, and complications associated with a breech delivery.

Verywell / Jessica Olah

Types of Breech Presentation

During the last few weeks of pregnancy, a fetus usually rotates so that the head is positioned downward to come out of the vagina first. This is called the vertex position.

In a breech presentation, the fetus does not turn to lie in the correct position. Instead, the fetus’s buttocks or feet are positioned to come out of the vagina first.

At 28 weeks of gestation, approximately 20% of fetuses are in a breech position. However, the majority of these rotate to the proper vertex position. At full term, around 3%–4% of births are breech.

The different types of breech presentations include:

Complete : The fetus’s knees are bent, and the buttocks are presenting first.
Frank : The fetus’s legs are stretched upward toward the head, and the buttocks are presenting first.
Footling : The fetus’s foot is showing first.

Signs of Breech

There are no specific symptoms associated with a breech presentation.

Diagnosing breech before the last few weeks of pregnancy is not helpful, since the fetus is likely to turn to the proper vertex position before 35 weeks gestation.

A healthcare provider may be able to tell which direction the fetus is facing by touching a pregnant person’s abdomen. However, an ultrasound examination is the best way to determine how the fetus is lying in the uterus.

Most breech presentations are not related to any specific risk factor. However, certain circumstances can increase the risk for breech presentation.

These can include:

Previous pregnancies
Multiple fetuses in the uterus
An abnormally shaped uterus
Uterine fibroids , which are noncancerous growths of the uterus that usually appear during the childbearing years
Placenta previa, a condition in which the placenta covers the opening to the uterus
Preterm labor or prematurity of the fetus
Too much or too little amniotic fluid (the liquid that surrounds the fetus during pregnancy)
Fetal congenital abnormalities

Most fetuses that are breech are born by cesarean delivery (cesarean section or C-section), a surgical procedure in which the baby is born through an incision in the pregnant person’s abdomen.

In rare instances, a healthcare provider may plan a vaginal birth of a breech fetus. However, there are more risks associated with this type of delivery than there are with cesarean delivery.

Before cesarean delivery, a healthcare provider might utilize the external cephalic version (ECV) procedure to turn the fetus so that the head is down and in the vertex position. This procedure involves pushing on the pregnant person’s belly to turn the fetus while viewing the maneuvers on an ultrasound. This can be an uncomfortable procedure, and it is usually done around 37 weeks gestation.

ECV reduces the risks associated with having a cesarean delivery. It is successful approximately 40%–60% of the time. The procedure cannot be done once a pregnant person is in active labor.

Complications related to ECV are low and include the placenta tearing away from the uterine lining, changes in the fetus’s heart rate, and preterm labor.

ECV is usually not recommended if the:

Pregnant person is carrying more than one fetus
Placenta is in the wrong place
Healthcare provider has concerns about the health of the fetus
Pregnant person has specific abnormalities of the reproductive system

Recommendations for Previous C-Sections

The American College of Obstetricians and Gynecologists (ACOG) says that ECV can be considered if a person has had a previous cesarean delivery.

During a breech delivery, the umbilical cord might come out first and be pinched by the exiting fetus. This is called cord prolapse and puts the fetus at risk for decreased oxygen and blood flow. There’s also a risk that the fetus’s head or shoulders will get stuck inside the mother’s pelvis, leading to suffocation.

Complications associated with cesarean delivery include infection, bleeding, injury to other internal organs, and problems with future pregnancies.

A healthcare provider needs to weigh the risks and benefits of ECV, delivering a breech fetus vaginally, and cesarean delivery.

In a breech delivery, the fetus comes out buttocks or feet first rather than headfirst (vertex), the preferred and usual method. This type of delivery can be more dangerous than a vertex delivery and lead to complications. If your baby is in breech, your healthcare provider will likely recommend a C-section.

A Word From Verywell

Knowing that your baby is in the wrong position and that you may be facing a breech delivery can be extremely stressful. However, most fetuses turn to have their head down before a person goes into labor. It is not a cause for concern if your fetus is breech before 36 weeks. It is common for the fetus to move around in many different positions before that time.

At the end of your pregnancy, if your fetus is in a breech position, your healthcare provider can perform maneuvers to turn the fetus around. If these maneuvers are unsuccessful or not appropriate for your situation, cesarean delivery is most often recommended. Discussing all of these options in advance can help you feel prepared should you be faced with a breech delivery.

American College of Obstetricians and Gynecologists. If your baby is breech .

TeachMeObGyn. Breech presentation .

MedlinePlus. Breech birth .

Hofmeyr GJ, Kulier R, West HM. External cephalic version for breech presentation at term . Cochrane Database Syst Rev . 2015 Apr 1;2015(4):CD000083. doi:10.1002/14651858.CD000083.pub3

By Christine Zink, MD Dr. Zink is a board-certified emergency medicine physician with expertise in the wilderness and global medicine.

Pregnancy Classes

Breech Births

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

What are the different types of breech birth presentations?

Complete breech: Here, the buttocks are pointing downward with the legs folded at the knees and feet near the buttocks.
Frank breech: In this position, the baby’s buttocks are aimed at the birth canal with its legs sticking straight up in front of his or her body and the feet near the head.
Footling breech: In this position, one or both of the baby’s feet point downward and will deliver before the rest of the body.

What causes a breech presentation?

The causes of breech presentations are not fully understood. However, the data show that breech birth is more common when:

You have been pregnant before
In pregnancies of multiples
When there is a history of premature delivery
When the uterus has too much or too little amniotic fluid
When there is an abnormally shaped uterus or a uterus with abnormal growths, such as fibroids
The placenta covers all or part of the opening of the uterus placenta previa

How is a breech presentation diagnosed?

A few weeks prior to the due date, the health care provider will place her hands on the mother’s lower abdomen to locate the baby’s head, back, and buttocks. If it appears that the baby might be in a breech position, they can use ultrasound or pelvic exam to confirm the position. Special x-rays can also be used to determine the baby’s position and the size of the pelvis to determine if a vaginal delivery of a breech baby can be safely attempted.

Can a breech presentation mean something is wrong?

Even though most breech babies are born healthy, there is a slightly elevated risk for certain problems. Birth defects are slightly more common in breech babies and the defect might be the reason that the baby failed to move into the right position prior to delivery.

Can a breech presentation be changed?

It is preferable to try to turn a breech baby between the 32nd and 37th weeks of pregnancy . The methods of turning a baby will vary and the success rate for each method can also vary. It is best to discuss the options with the health care provider to see which method she recommends.

Medical Techniques

External Cephalic Version (EVC) is a non-surgical technique to move the baby in the uterus. In this procedure, a medication is given to help relax the uterus. There might also be the use of an ultrasound to determine the position of the baby, the location of the placenta and the amount of amniotic fluid in the uterus.

Gentle pushing on the lower abdomen can turn the baby into the head-down position. Throughout the external version the baby’s heartbeat will be closely monitored so that if a problem develops, the health care provider will immediately stop the procedure. ECV usually is done near a delivery room so if a problem occurs, a cesarean delivery can be performed quickly. The external version has a high success rate and can be considered if you have had a previous cesarean delivery.

ECV will not be tried if:

You are carrying more than one fetus
There are concerns about the health of the fetus
You have certain abnormalities of the reproductive system
The placenta is in the wrong place
The placenta has come away from the wall of the uterus ( placental abruption )

Complications of EVC include:

Prelabor rupture of membranes
Changes in the fetus’s heart rate
Placental abruption
Preterm labor

Vaginal delivery versus cesarean for breech birth?

Most health care providers do not believe in attempting a vaginal delivery for a breech position. However, some will delay making a final decision until the woman is in labor. The following conditions are considered necessary in order to attempt a vaginal birth:

The baby is full-term and in the frank breech presentation
The baby does not show signs of distress while its heart rate is closely monitored.
The process of labor is smooth and steady with the cervix widening as the baby descends.
The health care provider estimates that the baby is not too big or the mother’s pelvis too narrow for the baby to pass safely through the birth canal.
Anesthesia is available and a cesarean delivery possible on short notice

What are the risks and complications of a vaginal delivery?

In a breech birth, the baby’s head is the last part of its body to emerge making it more difficult to ease it through the birth canal. Sometimes forceps are used to guide the baby’s head out of the birth canal. Another potential problem is cord prolapse . In this situation the umbilical cord is squeezed as the baby moves toward the birth canal, thus slowing the baby’s supply of oxygen and blood. In a vaginal breech delivery, electronic fetal monitoring will be used to monitor the baby’s heartbeat throughout the course of labor. Cesarean delivery may be an option if signs develop that the baby may be in distress.

When is a cesarean delivery used with a breech presentation?

Most health care providers recommend a cesarean delivery for all babies in a breech position, especially babies that are premature. 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.

Want to Know More?

Creating Your Birth Plan
Labor & Birth Terms to Know
Cesarean Birth After Care

Compiled using information from the following sources:

ACOG: If Your Baby is Breech
William’s Obstetrics Twenty-Second Ed. Cunningham, F. Gary, et al, Ch. 24.
Danforth’s Obstetrics and Gynecology Ninth Ed. Scott, James R., et al, Ch. 21.

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Breech presentation

Highlights & basics, diagnostic approach, risk factors, history & exam, differential diagnosis.

Tx Approach

Emerging Tx

Complications.

PATIENT RESOURCES

Patient Instructions

Breech presentation refers to the baby presenting for delivery with the buttocks or feet first rather than head.

Associated with increased morbidity and mortality for the mother in terms of emergency cesarean section and placenta previa; and for the baby in terms of preterm birth, small fetal size, congenital anomalies, and perinatal mortality.

Incidence decreases as pregnancy progresses and by term occurs in 3% to 4% of singleton term pregnancies.

Treatment options include external cephalic version to increase the likelihood of vaginal birth or a planned cesarean section, the optimal gestation being 37 and 39 weeks, respectively.

Planned cesarean section is considered the safest form of delivery for infants with a persisting breech presentation at term.

Quick Reference

Key Factors

buttocks or feet as the presenting part

Fetal head under costal margin, fetal heartbeat above the maternal umbilicus.

Other Factors

subcostal tenderness

Pelvic or bladder pain.

Diagnostics Tests

1st Tests to Order

transabdominal/transvaginal ultrasound

Treatment options.

presumptive

<37 weeks' gestation

specialist evaluation

corticosteroid

magnesium sulfate

≥37 weeks' gestation not in labor

unsuccessful ECV with persistent breech

Classifications

Types of breech presentation

Baby's buttocks lead the way into the birth canal

Hips are flexed, knees are extended, and the feet are in close proximity to the head

65% to 70% of breech babies are in this position.

Baby presents with buttocks first

Both the hips and the knees are flexed; the baby may be sitting cross-legged.

One or both of the baby's feet lie below the breech so that the foot or knee is lowermost in the birth canal

This is rare at term but relatively common with premature fetuses.

Common Vignette

Epidemiology

33% of births less than 28 weeks' gestation

14% of births at 29 to 32 weeks' gestation

9% of births at 33 to 36 weeks' gestation

6% of births at 37 to 40 weeks' gestation.

Pathophysiology

Natasha Nassar, PhD
Christine L. Roberts, MBBS, FAFPHM, DrPH
Jonathan Morris, MBChB, FRANZCOG, PhD
John W. Bachman, MD
Rhona Hughes, MBChB
Brian Peat, MD
Lelia Duley, MBChB
Justus Hofmeyr, MD

Clinical exam

Palpation of the abdomen to determine the position of the baby's head

Palpation of the abdomen to confirm the position of the fetal spine on one side and fetal extremities on the other

Palpation of the area above the symphysis pubis to locate the fetal presenting part

Palpation of the presenting part to confirm presentation, to determine how far the fetus has descended and whether the fetus is engaged.

Ultrasound examination

Premature fetus.

Prematurity is consistently associated with breech presentation. [ 6 ] [ 9 ] This may be due to the smaller size of preterm infants, who are more likely to change their in utero position.

Increasing duration of pregnancy may allow breech-presenting fetuses time to grow, turn spontaneously or by external cephalic version, and remain cephalic-presenting.

Larger fetuses may be forced into a cephalic presentation in late pregnancy due to space or alignment constraints within the uterus.

small for gestational age fetus

Low birth-weight is a risk factor for breech presentation. [ 9 ] [ 11 ] [ 12 ] [ 13 ] [ 14 ] Term breech births are associated with a smaller fetal size for gestational age, highlighting the association with low birth-weight rather than prematurity. [ 6 ]

nulliparity

Women having a first birth have increased rates of breech presentation, probably due to the increased likelihood of smaller fetal size. [ 6 ] [ 9 ]

Relaxation of the uterine wall in multiparous women may reduce the odds of breech birth and contribute to a higher spontaneous or external cephalic version rate. [ 10 ]

fetal congenital anomalies

Congenital anomalies in the fetus may result in a small fetal size or inappropriate fetal growth. [ 9 ] [ 12 ] [ 14 ] [ 15 ]

Anencephaly, hydrocephaly, Down syndrome, and fetal neuromuscular dysfunction are associated with breech presentation, the latter due to its effect on the quality of fetal movements. [ 9 ] [ 14 ]

previous breech delivery

The risk of recurrent breech delivery is 8%, the risk increasing from 4% after one breech delivery to 28% after three. [ 16 ]

The effects of recurrence may be due to recurring specific causal factors, either genetic or environmental in origin.

uterine abnormalities

Women with uterine abnormalities have a high incidence of breech presentation. [ 14 ] [ 17 ] [ 18 ] [ 19 ]

female fetus

Fifty-four percent of breech-presenting fetuses are female. [ 14 ]

abnormal amniotic fluid volume

Both oligohydramnios and polyhydramnios are associated with breech presentation. [ 1 ] [ 12 ] [ 14 ]

Low amniotic fluid volume decreases the likelihood of a fetus turning to a cephalic position; an increased amniotic fluid volume may facilitate frequent change in position.

placental abnormalities

An association between placental implantation in the cornual-fundal region and breech presentation has been reported, although some studies have not found it a risk factor. [ 8 ] [ 20 ] [ 21 ] [ 22 ] [ 10 ] [ 14 ]

The association with placenta previa is also inconsistent. [ 8 ] [ 9 ] [ 22 ] Placenta previa is associated with preterm birth and may be an indirect risk factor.

Pelvic or vaginal examination reveals the buttocks and/or feet, felt as a yielding, irregular mass, as the presenting part. [ 26 ] In cephalic presentation, a hard, round, regular fetal head can be palpated. [ 26 ]

The Leopold maneuver on examination suggests breech position by palpation of the fetal head under the costal margin. [ 26 ]

The baby's heartbeat should be auscultated using a Pinard stethoscope or a hand-held Doppler to indicate the position of the fetus. The fetal heartbeat lies above the maternal umbilicus in breech presentation. [ 1 ]

Tenderness under one or other costal margin as a result of pressure by the harder fetal head.

Pain due to fetal kicks in the maternal pelvis or bladder.

breech position

Visualizes the fetus and reveals its position.

Used to confirm a clinically suspected breech presentation. [ 28 ]

Should be performed by practitioners with appropriate skills in obstetric ultrasound.

Establishes the type of breech presentation by imaging the fetal femurs and their relationship to the distal bones.

Transverse lie

Differentiating Signs/Symptoms

Fetus lies horizontally across the uterus with the shoulder as the presenting part.

Similar predisposing factors such as placenta previa, abnormal amniotic fluid volume, and uterine anomalies, although more common in multiparity. [ 1 ] [ 2 ] [ 29 ]

Differentiating Tests

Clinical examination and fetal auscultation may be indicative.

Ultrasound confirms presentation.

Treatment Approach

Breech presentation <37 weeks' gestation.

The UK Royal College of Obstetricians and Gynaecologists (RCOG) recommends that corticosteroids should be offered to women between 24 and 34+6 weeks' gestation, in whom imminent preterm birth is anticipated. Corticosteroids should only be considered after discussion of risks/benefits at 35 to 36+6 weeks. Given within 7 days of preterm birth, corticosteroids may reduce perinatal and neonatal death and respiratory distress syndrome. [ 32 ] The American College of Obstetricians and Gynecologists (ACOG) recommends a single course of corticosteroids for pregnant women between 24 and 33+6 weeks' gestation who are at risk of preterm delivery within 7 days, including those with ruptured membranes and multiple gestations. It may also be considered for pregnant women starting at 23 weeks' gestation who are at risk of preterm delivery within 7 days. A single course of betamethasone is recommended for pregnant women between 34 and 36+6 weeks' gestation at risk of preterm birth within 7 days, and who have not received a previous course of prenatal corticosteroids. Regularly scheduled repeat courses or serial courses (more than two) are not currently recommended. A single repeat course of prenatal corticosteroids should be considered in women who are less than 34 weeks' gestation, who are at risk of preterm delivery within 7 days, and whose prior course of prenatal corticosteroids was administered more than 14 days previously. Rescue course corticosteroids could be provided as early as 7 days from the prior dose, if indicated by the clinical scenario. [ 33 ]

Magnesium sulfate given before anticipated early preterm birth reduces the risk of cerebral palsy in surviving infants. Physicians electing to use magnesium sulfate for fetal neuroprotection should develop specific guidelines regarding inclusion criteria, treatment regimens, and concurrent tocolysis. [ 34 ]

Breech presentation from 37 weeks' gestation, before labor

ECV is the initial treatment for a breech presentation at term when the patient is not in labor. It involves turning a fetus presenting by the breech to a cephalic (head-down) presentation to increase the likelihood of vaginal birth. [ 35 ] [ 36 ] Where available, it should be offered to all women in late pregnancy, by an experienced clinician, in hospitals with facilities for emergency delivery, and no contraindications to the procedure. [ 35 ] There is no upper time limit on the appropriate gestation for ECV, with success reported at 42 weeks.

There is no general consensus on contraindications to ECV. Contraindications include multiple pregnancy (except after delivery of a first twin), ruptured membranes, current or recent (<1 week) vaginal bleeding, rhesus isoimmunization, other indications for cesarean section (e.g., placenta previa or uterine malformation), or abnormal electronic fetal monitoring. [ 35 ] One systematic review of relative contraindications for ECV highlighted that most contraindications do not have clear empirical evidence. Exceptions include placental abruption, severe preeclampsia/HELLP syndrome, or signs of fetal distress (abnormal cardiotocography and/or Doppler flow). [ 36 ]

The procedure involves applying external pressure and firmly pushing or palpating the mother's abdomen to coerce the fetus to somersault (either forward or backward) into a cephalic position. [ 37 ]

The overall ECV success rate varies but, in a large series, 47% of women following an ECV attempt had a cephalic presentation at birth. [ 35 ] [ 38 ] Various factors influence the success rate. One systematic review found ECV success rates to be 68% overall, with the rate significantly higher for women from African countries (89%) compared with women from non-African countries (62%), and higher among multiparous (78%) than nulliparous women (48%). [ 39 ] Overall, the ECV success rates for nulliparous and multiparous non-African women were 43% and 73%, respectively, while for nulliparous and multiparous African women rates were 79% and 91%, respectively. Another study reported no difference in success rate or rate of cesarean section among women with previous cesarean section undergoing ECV compared with women with previous vaginal birth. However, numbers were small and further studies in this regard are required. [ 40 ]

Women's preference for vaginal delivery is a major contributing factor in their decision for ECV. However, studies suggest women with a breech presentation at term may not receive complete and/or evidence-based information about the benefits and risks of ECV. [ 41 ] [ 42 ] Although up to 60% of women reported ECV to be painful, the majority highlighted the benefits outweigh the risks (71%) and would recommend ECV to their friends or be willing to repeat for themselves (84%). [ 41 ] [ 42 ]

Cardiotocography and ultrasound should be performed before and after the procedure. Tocolysis should be used to facilitate the maneuver, and Rho(D) immune globulin should be administered to women who are Rhesus negative. [ 35 ] Tocolytic agents include adrenergic beta-2 receptor stimulants such as albuterol, terbutaline, or ritodrine (widely used with ECV in some countries, but not yet available in the US). One Cochrane review of tocolytic beta stimulants demonstrates that these are less likely to be associated with failed ECV, and are effective in increasing cephalic presentation and reducing cesarean section. [ 43 ] There is no current evidence to recommend one beta-2 adrenergic receptor agonist over another. Until these data are available, adherence to a local protocol for tocolysis is recommended. The Food and Drug Administration has issued a warning against using injectable terbutaline beyond 48 to 72 hours, or acute or prolonged treatment with oral terbutaline, in pregnant women for the prevention or prolonged treatment of preterm labor, due to potential serious maternal cardiac adverse effects and death. [ 44 ] Whether this warning applies to the subcutaneous administration of terbutaline in ECV is still unclear; however, studies currently support this use. The European Medicines Agency (EMA) recommends that injectable beta agonists should be used for up to 48 hours between the 22nd and 37th week of pregnancy only. They should be used under specialist supervision with continuous monitoring of the mother and unborn baby owing to the risk of adverse cardiovascular effects in both the mother and baby. The EMA no longer recommends oral or rectal formulations for obstetric indications. [ 45 ]

If ECV is successful, pregnancy care should continue as usual for any cephalic presentation. One systematic review assessing the mode of delivery after a successful ECV found that these women were at increased risk for cesarean section and instrumental vaginal delivery compared with women with spontaneous cephalic pregnancies. However, they still had a lower rate of cesarean section following ECV (i.e., 47%) compared with the cesarean section rate for those with a persisting breech (i.e., 85%). With a number needed to treat of three, ECV is still considered to be an effective means of preventing the need for cesarean section. [ 46 ]

Planned cesarean section should be offered as the safest mode of delivery for the baby, even though it carries a small increase in serious immediate maternal complications compared with vaginal birth. [ 24 ] [ 25 ] [ 31 ] In the US, most unsuccessful ECV with persistent breech will be delivered via cesarean section.

A vaginal mode of delivery may be considered by some clinicians as an option, particularly when maternal request is provided, senior and experienced staff are available, there is no absolute contraindication to vaginal birth (e.g., placenta previa, compromised fetal condition), and with optimal fetal growth (estimated weight above the tenth centile and up to 3800 g). Other factors that make planned vaginal birth higher risk include hyperextended neck on ultrasound and footling presentation. [ 24 ]

Breech presentation from 37 weeks' gestation, during labor

The first option should be a planned cesarean section.

There is a small increase in the risk of serious immediate maternal complications compared with vaginal birth (RR 1.29, 95% CI 1.03 to 1.61), including pulmonary embolism, infection, bleeding, damage to the bladder and bowel, slower recovery from the delivery, longer hospitalization, and delayed bonding and breast-feeding. [ 23 ] [ 31 ] [ 47 ] [ 48 ] [ 49 ] [ 50 ] [ 51 ] [ 52 ] [ 53 ] [ 54 ] [ 55 ] [ 56 ] [ 57 ] [ 58 ] Consider using antimicrobial triclosan-coated sutures for wound closure to reduce the risk of surgical site infection. [ 59 ]

Planned cesarean section is safer for babies, but is associated with increased neonatal respiratory distress. The risk is reduced when the section is performed at 39 weeks' gestation. [ 64 ] [ 65 ] [ 66 ] For women undergoing a planned cesarean section, RCOG recommends an informed discussion about the potential risks and benefits of a course of prenatal corticosteroids between 37 and 38+6 weeks' gestation. Although prenatal corticosteroids may reduce admission to the neonatal unit for respiratory morbidity, it is uncertain if there is any reduction in respiratory distress syndrome, transient tachypnea of the newborn, or neonatal unit admission overall. In addition, prenatal corticosteroids may result in harm to the neonate, including hypoglycemia and potential developmental delay. [ 32 ] ACOG does not recommend corticosteroids in women >37 weeks' gestation. [ 33 ]

Undiagnosed breech in labor generally results in cesarean section after the onset of labor, higher rates of emergency cesarean section associated with the least favorable maternal outcomes, a greater likelihood of cord prolapse, and other poor infant outcomes. [ 23 ] [ 67 ] [ 49 ] [ 68 ] [ 69 ] [ 70 ] [ 71 ]

This mode of delivery may be considered by some clinicians as an option for women who are in labor, particularly when delivery is imminent. Vaginal breech delivery may also be considered, where suitable, when delivery is not imminent, maternal request is provided, senior and experienced staff are available, there is no absolute contraindication to vaginal birth (e.g., placenta previa, compromised fetal condition), and with optimal fetal growth (estimated weight above the tenth centile and up to 3800 g). Other factors that make planned vaginal birth higher risk include hyperextended neck on ultrasound and footling presentation. [ 24 ]

Findings from one systematic review of 27 observational studies revealed that the absolute risks of perinatal mortality, fetal neurologic morbidity, birth trauma, 5-minute Apgar score <7, and neonatal asphyxia in the planned vaginal delivery group were low at 0.3%, 0.7%, 0.7%, 2.4%, and 3.3%, respectively. However, the relative risks of perinatal mortality and morbidity were 2- to 5-fold higher in the planned vaginal than in the planned cesarean delivery group. Authors recommend ongoing judicious decision-making for vaginal breech delivery for selected singleton, term breech babies. [ 72 ]

ECV may also be considered an option for women with breech presentation in early labor, when delivery is not imminent, provided that the membranes are intact.

A woman presenting with a breech presentation <37 weeks is an area of clinical controversy. Optimal mode of delivery for preterm breech has not been fully evaluated in clinical trials, and the relative risks for the preterm infant and mother remain unclear. In the absence of good evidence, if diagnosis of breech presentation prior to 37 weeks' gestation is made, prematurity and clinical circumstances should determine management and mode of delivery.

Primary Options

12 mg intramuscularly every 24 hours for 2 doses

6 mg intramuscularly every 12 hours for 4 doses

The UK Royal College of Obstetricians and Gynaecologists recommends that corticosteroids should be offered to women between 24 and 34+6 weeks' gestation, in whom imminent preterm birth is anticipated. Corticosteroids should only be considered after discussion of risks/benefits at 35 to 36+6 weeks. Given within 7 days of preterm birth, corticosteroids may reduce perinatal and neonatal death and respiratory distress syndrome. [ 32 ]

The American College of Obstetricians and Gynecologists recommends a single course of corticosteroids for pregnant women between 24 and 33+6 weeks' gestation who are at risk of preterm delivery within 7 days, including those with ruptured membranes and multiple gestations. It may also be considered for pregnant women starting at 23 weeks' gestation who are at risk of preterm delivery within 7 days. A single course of betamethasone is recommended for pregnant women between 34 and 36+6 weeks' gestation at risk of preterm birth within 7 days, and who have not received a previous course of prenatal corticosteroids. Regularly scheduled repeat courses or serial courses (more than two) are not currently recommended. A single repeat course of prenatal corticosteroids should be considered in women who are less than 34 weeks' gestation, who are at risk of preterm delivery within 7 days, and whose prior course of prenatal corticosteroids was administered more than 14 days previously. Rescue course corticosteroids could be provided as early as 7 days from the prior dose, if indicated by the clinical scenario. [ 33 ]

consult specialist for guidance on dose

external cephalic version (ECV)

There is no upper time limit on the appropriate gestation for ECV; it should be offered to all women in late pregnancy by an experienced clinician in hospitals with facilities for emergency delivery and no contraindications to the procedure. [ 35 ] [ 36 ]

ECV involves applying external pressure and firmly pushing or palpating the mother's abdomen to coerce the fetus to somersault (either forward or backward) into a cephalic position. [ 37 ]

Cardiotocography and ultrasound should be performed before and after the procedure.

If ECV is successful, pregnancy care should continue as usual for any cephalic presentation. A systematic review assessing the mode of delivery after a successful ECV found that these women were at increased risk for cesarean section and instrumental vaginal delivery compared with women with spontaneous cephalic pregnancies. However, they still had a lower rate of cesarean section following ECV (i.e., 47%) compared with the cesarean section rate for those with a persisting breech (i.e., 85%). With a number needed to treat of 3, ECV is still considered to be an effective means of preventing the need for cesarean section. [ 46 ]

tocolytic agents

see local specialist protocol for dosing guidelines

Tocolytic agents include adrenergic beta-2 receptor stimulants such as albuterol, terbutaline, or ritodrine (widely used with external cephalic version [ECV] in some countries, but not yet available in the US). They are used to delay or inhibit labor and increase the success rate of ECV. There is no current evidence to recommend one beta-2 adrenergic receptor agonist over another. Until these data are available, adherence to a local protocol for tocolysis is recommended.

The Food and Drug Administration has issued a warning against using injectable terbutaline beyond 48-72 hours, or acute or prolonged treatment with oral terbutaline, in pregnant women for the prevention or prolonged treatment of preterm labor, due to potential serious maternal cardiac adverse effects and death. [ 44 ] Whether this warning applies to the subcutaneous administration of terbutaline in ECV is still unclear; however, studies currently support this use. The European Medicines Agency (EMA) recommends that injectable beta agonists should be used for up to 48 hours between the 22nd and 37th week of pregnancy only. They should be used under specialist supervision with continuous monitoring of the mother and unborn baby owing to the risk of adverse cardiovascular effects in both the mother and baby. The EMA no longer recommends oral or rectal formulations for obstetric indications. [ 45 ]

A systematic review found there was no evidence to support the use of nifedipine for tocolysis. [ 73 ]

There is insufficient evidence to evaluate other interventions to help ECV, such as fetal acoustic stimulation in midline fetal spine positions, or epidural or spinal analgesia. [ 43 ]

Rho(D) immune globulin

300 micrograms intramuscularly as a single dose

Nonsensitized Rh-negative women should receive Rho(D) immune globulin. [ 35 ]

The indication for its administration is to prevent rhesus isoimmunization, which may affect subsequent pregnancy outcomes.

Rho(D) immune globulin needs to be given at the time of external cephalic version and should be given again postpartum to those women who give birth to an Rh-positive baby. [ 74 ]

It is best administered as soon as possible after the procedure, usually within 72 hours.

Dose depends on brand used. Dose given below pertains to most commonly used brands. Consult specialist for further guidance on dose.

elective cesarean section/vaginal breech delivery

Mode of delivery (cesarean section or vaginal breech delivery) should be based on the experience of the attending clinician, hospital policies, maternal request, and the presence or absence of complicating factors. In the US, most unsuccessful external cephalic version (ECV) with persistent breech will be delivered via cesarean section.

Cesarean section, at 39 weeks or greater, has been shown to significantly reduce perinatal mortality and neonatal morbidity compared with vaginal breech delivery (RR 0.33, 95% CI 0.19 to 0.56). [ 31 ] Although safer for these babies, there is a small increase in serious immediate maternal complications compared with vaginal birth (RR 1.29, 95% CI 1.03 to 1.61), as well as long-term risks for future pregnancies, including pulmonary embolism, bleeding, infection, damage to the bladder and bowel, slower recovery from the delivery, longer hospitalization, and delayed bonding and breast-feeding. [ 23 ] [ 31 ] [ 47 ] [ 48 ] [ 49 ] [ 50 ] [ 51 ] [ 52 ] [ 53 ] [ 54 ] [ 55 ] [ 56 ] [ 57 ] [ 58 ] Consider using antimicrobial triclosan-coated sutures for wound closure to reduce the risk of surgical site infection. [ 59 ]

Vaginal delivery may be considered by some clinicians as an option, particularly when maternal request is provided, when senior and experienced staff are available, when there is no absolute contraindication to vaginal birth (e.g., placenta previa, compromised fetal condition), and with optimal fetal growth (estimated weight above the tenth centile and up to 3800 g). Other factors that make planned vaginal birth higher risk include hyperextended neck on ultrasound and footling presentation. [ 24 ]

For women undergoing a planned cesarean section, the UK Royal College of Obstetricians and Gynaecologists recommends an informed discussion about the potential risks and benefits of a course of prenatal corticosteroids between 37 and 38+6 weeks' gestation. Although prenatal corticosteroids may reduce admission to the neonatal unit for respiratory morbidity, it is uncertain if there is any reduction in respiratory distress syndrome, transient tachypnea of the newborn, or neonatal unit admission overall. In addition, prenatal corticosteroids may result in harm to the neonate, including hypoglycemia and potential developmental delay. [ 32 ] The American College of Obstetricians and Gynecologists does not recommend corticosteroids in women >37 weeks' gestation. [ 33 ]

It is best administered as soon as possible after delivery, usually within 72 hours.

Administration of postpartum Rho (D) immune globulin should not be affected by previous routine prenatal prophylaxis or previous administration for a potentially sensitizing event. [ 74 ]

≥37 weeks' gestation in labor: no imminent delivery

planned cesarean section

For women with breech presentation in labor, planned cesarean section at 39 weeks or greater has been shown to significantly reduce perinatal mortality and neonatal morbidity compared with vaginal breech delivery (RR 0.33, 95% CI 0.19 to 0.56). [ 31 ]

Although safer for these babies, there is a small increase in serious immediate maternal complications compared with vaginal birth (RR 1.29, 95% CI 1.03 to 1.61), as well as long-term risks for future pregnancies, including pulmonary embolism, infection, bleeding, damage to the bladder and bowel, slower recovery from the delivery, longer hospitalization, and delayed bonding and breast-feeding. [ 23 ] [ 31 ] [ 47 ] [ 48 ] [ 49 ] [ 50 ] [ 51 ] [ 52 ] [ 53 ] [ 54 ] [ 55 ] [ 56 ] [ 57 ] [ 58 ] Consider using antimicrobial triclosan-coated sutures for wound closure to reduce the risk of surgical site infection. [ 59 ]

Continuous cardiotocography monitoring should continue until delivery. [ 24 ] [ 25 ]

vaginal breech delivery

This mode of delivery may be considered by some clinicians as an option, particularly when maternal request is provided, when senior and experienced staff are available, when there is no absolute contraindication to vaginal birth (e.g., placenta previa, compromised fetal condition), and with optimal fetal growth (estimated weight above the tenth centile and up to 3800 g). Other factors that make planned vaginal birth higher risk include hyperextended neck on ultrasound and footling presentation. [ 24 ]

For women with persisting breech presentation, planned cesarean section has, however, been shown to significantly reduce perinatal mortality and neonatal morbidity compared with vaginal breech delivery (RR 0.33, 95% CI 0.19 to 0.56). [ 31 ]

ECV may also be considered an option for women with breech presentation in early labor, provided that the membranes are intact.

There is no upper time limit on the appropriate gestation for ECV. [ 35 ]

Involves applying external pressure and firmly pushing or palpating the mother's abdomen to coerce the fetus to somersault (either forward or backward) into a cephalic position. [ 37 ]

Relative contraindications include placental abruption, severe preeclampsia/HELLP syndrome, and signs of fetal distress (abnormal cardiotocography and/or abnormal Doppler flow). [ 35 ] [ 36 ]

Rho(D) immune globulin needs to be given at the time of ECV and should be given again postpartum to those women who give birth to an Rh-positive baby. [ 74 ]

≥37 weeks' gestation in labor: imminent delivery

cesarean section

For women with persistent breech presentation, planned cesarean section has been shown to significantly reduce perinatal mortality and neonatal morbidity compared with vaginal breech delivery (RR 0.33, 95% CI 0.19 to 0.56). [ 31 ] Although safer for these babies, there is a small increase in serious immediate maternal complications compared with vaginal birth (RR 1.29, 95% CI 1.03 to 1.61), as well as long-term risks for future pregnancies, including pulmonary embolism, infection, bleeding, damage to the bladder and bowel, slower recovery from the delivery, longer hospitalization, and delayed bonding and breast-feeding. [ 23 ] [ 31 ] [ 47 ] [ 48 ] [ 49 ] [ 50 ] [ 51 ] [ 52 ] [ 53 ] [ 54 ] [ 55 ] [ 56 ] [ 57 ] [ 58 ] Consider using antimicrobial triclosan-coated sutures for wound closure to reduce the risk of surgical site infection. [ 59 ]

This mode of delivery may be considered by some clinicians as an option, particularly when delivery is imminent, maternal request is provided, when senior and experienced staff are available, when there is no absolute contraindication to vaginal birth (e.g., placenta previa, compromised fetal condition), and with optimal fetal growth (estimated weight above the tenth centile and up to 3800 g). Other factors that make planned vaginal birth higher risk include hyperextended neck on ultrasound and footling presentation. [ 24 ]

It is best administered as soon as possible after the delivery, usually within 72 hours.

External cephalic version before term

Moxibustion, postural management, follow-up overview, perinatal complications.

Compared with cephalic presentation, persistent breech presentation has increased frequency of cord prolapse, abruptio placentae, prelabor rupture of membranes, perinatal mortality, fetal distress (heart rate <100 bpm), preterm delivery, lower fetal weight. [ 10 ] [ 11 ] [ 67 ]

complications of cesarean section

The long-term risks include potential compromise of future obstetric performance, increased risk of repeat cesarean section, infertility, uterine rupture, placenta accreta, placental abruption, and emergency hysterectomy. [ 60 ] [ 61 ] [ 62 ] [ 63 ] The evidence suggests that using sutures, rather than staples, for wound closure after cesarean section reduces the incidence of wound dehiscence. [ 59 ]

Emergency cesarean section, compared with planned cesarean section, has demonstrated a higher risk of severe obstetric morbidity, intra-operative complications, postoperative complications, infection, blood loss >1500 mL, fever, pain, tiredness, and breast-feeding problems. [ 23 ] [ 48 ] [ 50 ] [ 70 ] [ 81 ]

Key Articles

Impey LWM, Murphy DJ, Griffiths M, et al; Royal College of Obstetricians and Gynaecologists. Management of breech presentation: green-top guideline no. 20b. BJOG. 2017 Jun;124(7):e151-77. [Full Text]

Hofmeyr GJ, Hannah M, Lawrie TA. Planned caesarean section for term breech delivery. Cochrane Database Syst Rev. 2015 Jul 21;(7):CD000166. [Abstract] [Full Text]

Royal College of Obstetricians and Gynaecologists. External cephalic version and reducing the incidence of term breech presentation. March 2017 [internet publication]. [Full Text]

Cluver C, Gyte GM, Sinclair M, et al. Interventions for helping to turn term breech babies to head first presentation when using external cephalic version. Cochrane Database Syst Rev. 2015 Feb 9;(2):CD000184. [Abstract] [Full Text]

de Hundt M, Velzel J, de Groot CJ, et al. Mode of delivery after successful external cephalic version: a systematic review and meta-analysis. Obstet Gynecol. 2014 Jun;123(6):1327-34. [Abstract]

Referenced Articles

1. Cunningham F, Gant N, Leveno K, et al. Williams obstetrics. 21st ed. New York: McGraw-Hill; 1997.

2. Kish K, Collea JV. Malpresentation and cord prolapse. In: DeCherney AH, Nathan L, eds. Current obstetric and gynecologic diagnosis and treatment. New York: McGraw-Hill Professional; 2002.

3. Scheer K, Nubar J. Variation of fetal presentation with gestational age. Am J Obstet Gynecol. 1976 May 15;125(2):269-70. [Abstract]

4. Nassar N, Roberts CL, Cameron CA, et al. Diagnostic accuracy of clinical examination for detection of non-cephalic presentation in late pregnancy: cross sectional analytic study. BMJ. 2006 Sep 16;333(7568):578-80. [Abstract] [Full Text]

5. Roberts CL, Peat B, Algert CS, et al. Term breech birth in New South Wales, 1990-1997. Aust N Z J Obstet Gynaecol. 2000 Feb;40(1):23-9. [Abstract]

6. Roberts CL, Algert CS, Peat B, et al. Small fetal size: a risk factor for breech birth at term. Int J Gynaecol Obstet. 1999 Oct;67(1):1-8. [Abstract]

7. Brar HS, Platt LD, DeVore GR, et al. Fetal umbilical velocimetry for the surveillance of pregnancies complicated by placenta previa. J Reprod Med. 1988 Sep;33(9):741-4. [Abstract]

8. Kian L. The role of the placental site in the aetiology of breech presentation. J Obstet Gynaecol Br Commonw. 1963 Oct;70:795-7. [Abstract]

9. Rayl J, Gibson PJ, Hickok DE. A population-based case-control study of risk factors for breech presentation. Am J Obstet Gynecol. 1996 Jan;174(1 Pt 1):28-32. [Abstract]

10. Westgren M, Edvall H, Nordstrom L, et al. Spontaneous cephalic version of breech presentation in the last trimester. Br J Obstet Gynaecol. 1985 Jan;92(1):19-22. [Abstract]

11. Brenner WE, Bruce RD, Hendricks CH. The characteristics and perils of breech presentation. Am J Obstet Gynecol. 1974 Mar 1;118(5):700-12. [Abstract]

12. Hall JE, Kohl S. Breech presentation. Am J Obstet Gynecol. 1956 Nov;72(5):977-90. [Abstract]

13. Morgan HS, Kane SH. An analysis of 16,327 breech births. JAMA. 1964 Jan 25;187:262-4. [Abstract]

14. Luterkort M, Persson P, Weldner B. Maternal and fetal factors in breech presentation. Obstet Gynecol. 1984 Jul;64(1):55-9. [Abstract]

15. Braun FH, Jones KL, Smith DW. Breech presentation as an indicator of fetal abnormality. J Pediatr. 1975 Mar;86(3):419-21. [Abstract]

16. Albrechtsen S, Rasmussen S, Dalaker K, et al. Reproductive career after breech presentation: subsequent pregnancy rates, interpregnancy interval, and recurrence. Obstet Gynecol. 1998 Sep;92(3):345-50. [Abstract]

17. Zlopasa G, Skrablin S, Kalafatić D, et al. Uterine anomalies and pregnancy outcome following resectoscope metroplasty. Int J Gynaecol Obstet. 2007 Aug;98(2):129-33. [Abstract]

18. Acién P. Breech presentation in Spain, 1992: a collaborative study. Eur J Obstet Gynecol Reprod Biol. 1995 Sep;62(1):19-24. [Abstract]

19. Michalas SP. Outcome of pregnancy in women with uterine malformation: evaluation of 62 cases. Int J Gynaecol Obstet. 1991 Jul;35(3):215-9. [Abstract]

20. Fianu S, Vaclavinkova V. The site of placental attachment as a factor in the aetiology of breech presentation. Acta Obstet Gynecol Scand. 1978;57(4):371-2. [Abstract]

21. Haruyama Y. Placental implantation as the cause of breech presentation [in Japanese]. Nihon Sanka Fujinka Gakkai Zasshi. 1987 Jan;39(1):92-8. [Abstract]

22. Filipov E, Borisov I, Kolarov G. Placental location and its influence on the position of the fetus in the uterus [in Bulgarian]. Akush Ginekol (Sofiia). 2000;40(4):11-2. [Abstract]

23. Waterstone M, Bewley S, Wolfe C. Incidence and predictors of severe obstetric morbidity: case-control study. BMJ. 2001 May 5;322(7294):1089-93. [Abstract] [Full Text]

24. Impey LWM, Murphy DJ, Griffiths M, et al; Royal College of Obstetricians and Gynaecologists. Management of breech presentation: green-top guideline no. 20b. BJOG. 2017 Jun;124(7):e151-77. [Full Text]

25. American College of Obstetricians and Gynecologists Committee on Obstetric Practice. ACOG committee opinion no. 745: mode of term singleton breech delivery. Obstet Gynecol. 2018 Aug;132(2):e60-3. [Abstract] [Full Text]

26. Beischer NA, Mackay EV, Colditz P, eds. Obstetrics and the newborn: an illustrated textbook. 3rd ed. London: W.B. Saunders; 1997.

27. Royal College of Obstetricians and Gynaecologists. Antepartum haemorrhage: green-top guideline no. 63. November 2011 [internet publication]. [Full Text]

28. American College of Obstetricians and Gynecologists. Practice bulletin no. 175: ultrasound in pregnancy. Obstet Gynecol. 2016 Dec;128(6):e241-56. [Abstract]

29. Enkin M, Keirse MJNC, Neilson J, et al. Guide to effective care in pregnancy and childbirth. 3rd ed. Oxford: Oxford University Press; 2000.

30. Hofmeyr GJ, Kulier R, West HM. External cephalic version for breech presentation at term. Cochrane Database Syst Rev. 2012 Oct 17;(10):CD000083. [Abstract] [Full Text]

31. Hofmeyr GJ, Hannah M, Lawrie TA. Planned caesarean section for term breech delivery. Cochrane Database Syst Rev. 2015 Jul 21;(7):CD000166. [Abstract] [Full Text]

32. Stock SJ, Thomson AJ, Papworth S, et al. Antenatal corticosteroids to reduce neonatal morbidity and mortality: Green-top Guideline No. 74. BJOG. 2022 Jul;129(8):e35-60. [Abstract] [Full Text]

33. American College of Obstetricians and Gynaecologists Committee on Obstetric Practice. Committee opinion no. 713: antenatal corticosteroid therapy for fetal maturation. August 2017 (reaffirmed 2020) [internet publication]. [Full Text]

34. American College of Obstetricians and Gynecologists Committee on Obstetric Practice. Committee opinion no. 455: magnesium sulfate before anticipated preterm birth for neuroprotection. March 2010 (reaffirmed 2020) [internet publication]. [Full Text]

35. Royal College of Obstetricians and Gynaecologists. External cephalic version and reducing the incidence of term breech presentation. March 2017 [internet publication]. [Full Text]

36. Rosman AN, Guijt A, Vlemmix F, et al. Contraindications for external cephalic version in breech position at term: a systematic review. Acta Obstet Gynecol Scand. 2013 Feb;92(2):137-42. [Abstract]

37. Hofmeyr GJ. Effect of external cephalic version in late pregnancy on breech presentation and caesarean section rate: a controlled trial. Br J Obstet Gynaecol. 1983 May;90(5):392-9. [Abstract]

38. Beuckens A, Rijnders M, Verburgt-Doeleman GH, et al. An observational study of the success and complications of 2546 external cephalic versions in low-risk pregnant women performed by trained midwives. BJOG. 2016 Feb;123(3):415-23. [Abstract]

39. Nassar N, Roberts CL, Barratt A, et al. Systematic review of adverse outcomes of external cephalic version and persisting breech presentation at term. Paediatr Perinat Epidemiol. 2006 Mar;20(2):163-71. [Abstract]

40. Sela HY, Fiegenberg T, Ben-Meir A, et al. Safety and efficacy of external cephalic version for women with a previous cesarean delivery. Eur J Obstet Gynecol Reprod Biol. 2009 Feb;142(2):111-4. [Abstract]

41. Pichon M, Guittier MJ, Irion O, et al. External cephalic version in case of persisting breech presentation at term: motivations and women's experience of the intervention [in French]. Gynecol Obstet Fertil. 2013 Jul-Aug;41(7-8):427-32. [Abstract]

42. Nassar N, Roberts CL, Raynes-Greenow CH, et al. Evaluation of a decision aid for women with breech presentation at term: a randomised controlled trial [ISRCTN14570598]. BJOG. 2007 Mar;114(3):325-33. [Abstract] [Full Text]

43. Cluver C, Gyte GM, Sinclair M, et al. Interventions for helping to turn term breech babies to head first presentation when using external cephalic version. Cochrane Database Syst Rev. 2015 Feb 9;(2):CD000184. [Abstract] [Full Text]

44. US Food & Drug Administration. FDA Drug Safety Communication: new warnings against use of terbutaline to treat preterm labor. Feb 2011 [internet publication]. [Full Text]

45. European Medicines Agency. Restrictions on use of short-acting beta-agonists in obstetric indications - CMDh endorses PRAC recommendations. October 2013 [internet publication]. [Full Text]

46. de Hundt M, Velzel J, de Groot CJ, et al. Mode of delivery after successful external cephalic version: a systematic review and meta-analysis. Obstet Gynecol. 2014 Jun;123(6):1327-34. [Abstract]

47. Lydon-Rochelle M, Holt VL, Martin DP, et al. Association between method of delivery and maternal rehospitalisation. JAMA. 2000 May 10;283(18):2411-6. [Abstract]

48. Yokoe DS, Christiansen CL, Johnson R, et al. Epidemiology of and surveillance for postpartum infections. Emerg Infect Dis. 2001 Sep-Oct;7(5):837-41. [Abstract]

49. van Ham MA, van Dongen PW, Mulder J. Maternal consequences of caesarean section. A retrospective study of intra-operative and postoperative maternal complications of caesarean section during a 10-year period. Eur J Obstet Gynecol Reprod Biol. 1997 Jul;74(1):1-6. [Abstract]

50. Murphy DJ, Liebling RE, Verity L, et al. Early maternal and neonatal morbidity associated with operative delivery in second stage of labour: a cohort study. Lancet. 2001 Oct 13;358(9289):1203-7. [Abstract]

51. Lydon-Rochelle MT, Holt VL, Martin DP. Delivery method and self-reported postpartum general health status among primiparous women. Paediatr Perinat Epidemiol. 2001 Jul;15(3):232-40. [Abstract]

52. Wilson PD, Herbison RM, Herbison GP. Obstetric practice and the prevalence of urinary incontinence three months after delivery. Br J Obstet Gynaecol. 1996 Feb;103(2):154-61. [Abstract]

53. Persson J, Wolner-Hanssen P, Rydhstroem H. Obstetric risk factors for stress urinary incontinence: a population-based study. Obstet Gynecol. 2000 Sep;96(3):440-5. [Abstract]

54. MacLennan AH, Taylor AW, Wilson DH, et al. The prevalence of pelvic disorders and their relationship to gender, age, parity and mode of delivery. BJOG. 2000 Dec;107(12):1460-70. [Abstract]

55. Thompson JF, Roberts CL, Currie M, et al. Prevalence and persistence of health problems after childbirth: associations with parity and method of birth. Birth. 2002 Jun;29(2):83-94. [Abstract]

56. Australian Institute of Health and Welfare. Australia's mothers and babies 2015 - in brief. October 2017 [internet publication]. [Full Text]

57. Mutryn CS. Psychosocial impact of cesarean section on the family: a literature review. Soc Sci Med. 1993 Nov;37(10):1271-81. [Abstract]

58. DiMatteo MR, Morton SC, Lepper HS, et al. Cesarean childbirth and psychosocial outcomes: a meta-analysis. Health Psychol. 1996 Jul;15(4):303-14. [Abstract]

59. National Institute for Health and Care Excellence. Caesarean birth. Mar 2021 [internet publication]. [Full Text]

60. Greene R, Gardeit F, Turner MJ. Long-term implications of cesarean section. Am J Obstet Gynecol. 1997 Jan;176(1 Pt 1):254-5. [Abstract]

61. Coughlan C, Kearney R, Turner MJ. What are the implications for the next delivery in primigravidae who have an elective caesarean section for breech presentation? BJOG. 2002 Jun;109(6):624-6. [Abstract]

62. Hemminki E, Merilainen J. Long-term effects of cesarean sections: ectopic pregnancies and placental problems. Am J Obstet Gynecol. 1996 May;174(5):1569-74. [Abstract]

63. Gilliam M, Rosenberg D, Davis F. The likelihood of placenta previa with greater number of cesarean deliveries and higher parity. Obstet Gynecol. 2002 Jun;99(6):976-80. [Abstract]

64. Morrison JJ, Rennie JM, Milton PJ. Neonatal respiratory morbidity and mode of delivery at term: influence of timing of elective caesarean section. Br J Obstet Gynaecol. 1995 Feb;102(2):101-6. [Abstract]

65. Annibale DJ, Hulsey TC, Wagner CL, et al. Comparative neonatal morbidity of abdominal and vaginal deliveries after uncomplicated pregnancies. Arch Pediatr Adolesc Med. 1995 Aug;149(8):862-7. [Abstract]

66. Hook B, Kiwi R, Amini SB, et al. Neonatal morbidity after elective repeat cesarean section and trial of labor. Pediatrics. 1997 Sep;100(3 Pt 1):348-53. [Abstract]

67. Nassar N, Roberts CL, Cameron CA, et al. Outcomes of external cephalic version and breech presentation at term: an audit of deliveries at a Sydney tertiary obstetric hospital, 1997-2004. Acta Obstet Gynecol Scand. 2006;85(10):1231-8. [Abstract]

68. Nwosu EC, Walkinshaw S, Chia P, et al. Undiagnosed breech. Br J Obstet Gynaecol. 1993 Jun;100(6):531-5. [Abstract]

69. Flamm BL, Ruffini RM. Undetected breech presentation: impact on external version and cesarean rates. Am J Perinatol. 1998 May;15(5):287-9. [Abstract]

70. Cockburn J, Foong C, Cockburn P. Undiagnosed breech. Br J Obstet Gynaecol. 1994 Jul;101(7):648-9. [Abstract]

71. Leung WC, Pun TC, Wong WM. Undiagnosed breech revisited. Br J Obstet Gynaecol. 1999 Jul;106(7):638-41. [Abstract]

72. Berhan Y, Haileamlak A. The risks of planned vaginal breech delivery versus planned caesarean section for term breech birth: a meta-analysis including observational studies. BJOG. 2016 Jan;123(1):49-57. [Abstract] [Full Text]

73. Wilcox C, Nassar N, Roberts C. Effectiveness of nifedipine tocolysis to facilitate external cephalic version: a systematic review. BJOG. 2011 Mar;118(4):423-8. [Abstract]

74. Qureshi H, Massey E, Kirwan D, et al. BCSH guideline for the use of anti-D immunoglobulin for the prevention of haemolytic disease of the fetus and newborn. Transfus Med. 2014 Feb;24(1):8-20. [Abstract] [Full Text]

75. Hutton EK, Hofmeyr GJ, Dowswell T. External cephalic version for breech presentation before term. Cochrane Database Syst Rev. 2015 Jul 29;(7):CD000084. [Abstract] [Full Text]

76. Coyle ME, Smith CA, Peat B. Cephalic version by moxibustion for breech presentation. Cochrane Database Syst Rev. 2012 May 16;(5):CD003928. [Abstract] [Full Text]

77. Hofmeyr GJ, Kulier R. Cephalic version by postural management for breech presentation. Cochrane Database Syst Rev. 2012 Oct 17;(10):CD000051. [Abstract] [Full Text]

78. Hannah ME, Whyte H, Hannah WJ, et al. Maternal outcomes at 2 years after planned cesarean section versus planned vaginal birth for breech presentation at term: the International Randomized Term Breech Trial. Am J Obstet Gynecol. 2004 Sep;191(3):917-27. [Abstract]

79. Eide MG, Oyen N, Skjaerven R, et al. Breech delivery and Intelligence: a population-based study of 8,738 breech infants. Obstet Gynecol. 2005 Jan;105(1):4-11. [Abstract]

80. Whyte H, Hannah ME, Saigal S, et al. Outcomes of children at 2 years after planned cesarean birth versus planned vaginal birth for breech presentation at term: the International Randomized Term Breech Trial. Am J Obstet Gynecol. 2004 Sep;191(3):864-71. [Abstract]

81. Brown S, Lumley J. Maternal health after childbirth: results of an Australian population based survey. Br J Obstet Gynaecol. 1998 Feb;105(2):156-61. [Abstract]

Published by

American College of Obstetricians and Gynecologists

2016 (reaffirmed 2022)

Royal College of Obstetricians and Gynaecologists (UK)

National Institute for Health and Care Excellence (UK)

Topic last updated: 2024-03-05

Natasha Nassar , PhD

Associate Professor

Menzies Centre for Health Policy

Sydney School of Public Health

University of Sydney

Christine L. Roberts , MBBS, FAFPHM, DrPH

Research Director

Clinical and Population Health Division

Perinatal Medicine Group

Kolling Institute of Medical Research

Jonathan Morris , MBChB, FRANZCOG, PhD

Professor of Obstetrics and Gynaecology and Head of Department

Peer Reviewers

John W. Bachman , MD

Consultant in Family Medicine

Department of Family Medicine

Mayo Clinic

Rhona Hughes , MBChB

Lead Obstetrician

Lothian Simpson Centre for Reproductive Health

The Royal Infirmary

Brian Peat , MD

Director of Obstetrics

Women's and Children's Hospital

North Adelaide

South Australia

Lelia Duley , MBChB

Professor of Obstetric Epidemiology

University of Leeds

Bradford Institute of Health Research

Temple Bank House

Bradford Royal Infirmary

Justus Hofmeyr , MD

Head of the Department of Obstetrics and Gynaecology

East London Private Hospital

East London

South Africa

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Fetal Presentation, Position, and Lie (Including Breech Presentation)

Key Points |

Abnormal fetal lie or presentation may occur due to fetal size, fetal anomalies, uterine structural abnormalities, multiple gestation, or other factors. Diagnosis is by examination or ultrasonography. Management is with physical maneuvers to reposition the fetus, operative vaginal delivery , or cesarean delivery .

Terms that describe the fetus in relation to the uterus, cervix, and maternal pelvis are

Fetal presentation: Fetal part that overlies the maternal pelvic inlet; vertex (cephalic), face, brow, breech, shoulder, funic (umbilical cord), or compound (more than one part, eg, shoulder and hand)

Fetal position: Relation of the presenting part to an anatomic axis; for transverse presentation, occiput anterior, occiput posterior, occiput transverse

Fetal lie: Relation of the fetus to the long axis of the uterus; longitudinal, oblique, or transverse

Normal fetal lie is longitudinal, normal presentation is vertex, and occiput anterior is the most common position.

Abnormal fetal lie, presentation, or position may occur with

Fetopelvic disproportion (fetus too large for the pelvic inlet)

Fetal congenital anomalies

Uterine structural abnormalities (eg, fibroids, synechiae)

Multiple gestation

Several common types of abnormal lie or presentation are discussed here.

Transverse lie

Fetal position is transverse, with the fetal long axis oblique or perpendicular rather than parallel to the maternal long axis. Transverse lie is often accompanied by shoulder presentation, which requires cesarean delivery.

Breech presentation

There are several types of breech presentation.

Frank breech: The fetal hips are flexed, and the knees extended (pike position).

Complete breech: The fetus seems to be sitting with hips and knees flexed.

Single or double footling presentation: One or both legs are completely extended and present before the buttocks.

Types of breech presentations

Breech presentation makes delivery difficult ,primarily because the presenting part is a poor dilating wedge. Having a poor dilating wedge can lead to incomplete cervical dilation, because the presenting part is narrower than the head that follows. The head, which is the part with the largest diameter, can then be trapped during delivery.

Additionally, the trapped fetal head can compress the umbilical cord if the fetal umbilicus is visible at the introitus, particularly in primiparas whose pelvic tissues have not been dilated by previous deliveries. Umbilical cord compression may cause fetal hypoxemia.

Predisposing factors for breech presentation include

Preterm labor

Uterine abnormalities

Fetal anomalies

If delivery is vaginal, breech presentation may increase risk of

Umbilical cord prolapse

Birth trauma

Perinatal death

Face or brow presentation

In face presentation, the head is hyperextended, and position is designated by the position of the chin (mentum). When the chin is posterior, the head is less likely to rotate and less likely to deliver vaginally, necessitating cesarean delivery.

Brow presentation usually converts spontaneously to vertex or face presentation.

Occiput posterior position

The most common abnormal position is occiput posterior.

The fetal neck is usually somewhat deflexed; thus, a larger diameter of the head must pass through the pelvis.

Progress may arrest in the second phase of labor. Operative vaginal delivery or cesarean delivery is often required.

Position and Presentation of the Fetus

If a fetus is in the occiput posterior position, operative vaginal delivery or cesarean delivery is often required.

In breech presentation, the presenting part is a poor dilating wedge, which can cause the head to be trapped during delivery, often compressing the umbilical cord.

For breech presentation, usually do cesarean delivery at 39 weeks or during labor, but external cephalic version is sometimes successful before labor, usually at 37 or 38 weeks.

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Learn more about the types, causes, and risks of breech presentation, along with how breech babies are typically delivered.

What Is Breech Presentation?

Types of breech presentation, what causes a breech baby, can you turn a breech baby, how are breech babies delivered.

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Toward the end of pregnancy, your baby will start to get into position for delivery, with their head pointed down toward the vagina. This is otherwise known as vertex presentation. However, some babies turn inside the womb so that their feet or buttocks are poised to be delivered first, which is commonly referred to as breech presentation, or a breech baby.

As you near the end of your pregnancy journey, an OB-GYN or health care provider will check your baby's positioning. You might find yourself wondering: What causes breech presentation? Are there risks involved? And how are breech babies delivered? We turned to experts and research to answer some of the most common questions surrounding breech presentation, along with what causes this positioning in the first place.

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 , MD, an OB-GYN in New York City. Approximately 3-4% of babies end up “upside-down” in breech presentation, with their feet or buttocks near the cervix.

Breech presentation is typically diagnosed during a visit to an OB-GYN, midwife, or health care provider. Your physician 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 ultimately be confirmed via an ultrasound, after which you and your provider would have a discussion about delivery options, potential issues, and risks.

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

Frank Breech

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

Footling Breech

Like its name suggests, a footling breech is when one (single footling) or both (double footling) of the baby's feet are in the birth canal, where they’re positioned to be delivered first .

Complete Breech

In a complete breech presentation, 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.

Breech Baby

What is a breech position.

A breech baby happens when the baby is positioned in the birth canal with feet down (or bottom-down). This position is perfectly safe for the baby to be in inside the birth canal, until it is time for delivery. Typically, by 36 weeks, most babies move into a head-down position for delivery. However, if the baby remains in a breech position, it can sometimes make for a more difficult or complicated delivery. If the doctor determines the risk is too great to have a vaginal delivery, often times, a C-section will be performed.

There are 3 primary types of breech positions. They include:

Frank breech. This is when the baby’s buttocks is positioned lowest in the birth canal. In this position, the knees are extended toward the abdomen and hips are flexed (legs are straight up in front of the body, with feet near the head). This is the most common breech position.
Complete breech. In this position, the baby’s knees and hips are flexed, and folded under each other.
Footling breech. This happens sometimes when one or both feet of the baby are pointed down toward the birth canal.

There are not usually symptoms associated with a breech baby. However, if you are 36 weeks pregnant and notice the baby’s head is pressing higher up in your abdomen or feel kicking in your lower abdomen, you may want to consult your doctor at your next appointment.

To determine whether your baby is breech, a routine exam later in the pregnancy will help to assess this. During the exam, your doctor will feel the lower and upper abdomen to determine if the baby is breech, and may use an ultrasound or perform a pelvic exam to check the baby's position.

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Most of the time, doctors don’t know the exact cause of having a breech baby. However, there are reasons that correlate to a higher likelihood of a baby being breech. These reasons include:

Pregnancy with multiples
Premature birth in the past
Second, or more, pregnancy

Treatment

There is no scientific studies to suggest that the following suggestions will help but you can try sitting on a birthing ball or child pose as used in Yoga may help the baby change position. Also walking every day if ok by your doctor as gravity may help.

Breech deliveries require the mother to have a cesarean section in order to deliver the baby safely. Want to know more about Caesarean section deliveries? Attend a caesarean section class at Baptist Health. Select a location on our Patient Education Classes page to view classes at each of our hospitals.

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Breech presentation: diagnosis and management

Key messages.

All women with a breech presentation should be offered an external cephalic version (ECV) from 37 weeks, if there are no contraindications.
Elective caesarean section (ELCS) for a singleton breech at term has been shown to reduce perinatal and neonatal mortality rates.
Planning for vaginal breech birth requires careful assessment of suitability criteria, contraindications and the ability of the service to provide experienced personnel.

In June 2023, we commenced a project to review and update the Maternity and Neonatal eHandbook guidelines, with a view to targeting completion in 2024. Please be aware that pending this review, some of the current guidelines may be out of date. In the meantime, we recommend that you also refer to more contemporaneous evidence.

Breech and external cephalic version

Breech presentation is when the fetus is lying longitudinally and its buttocks, foot or feet are presenting instead of its head.

Figure 1. Breech presentations

Breech presentation occurs in three to four per cent of term deliveries and is more common in nulliparous women.
External cephalic version (ECV) from 37 weeks has been shown to decrease the incidence of breech presentation at term and the subsequent elective caesarean section (ELCS) rate.
Vaginal breech birth increases the risk of low Apgar scores and more serious short-term complications, but evidence has not shown an increase in long-term morbidity.
Emergency caesarean section (EMCS) is needed in approximately 40 per cent of women planning a vaginal breech birth.
0.5/1000 with ELCS for breech >39 weeks gestation
2.0/1000 planned vaginal breech birth >39/40
1.0/1000 with planned cephalic birth.
A reduction in planned vaginal breech birth followed publication of the Term Breech Trial (TBT) in 2001.
Acquisition of skills necessary to manage breech presentation (for example, ECV) is important to optimise outcomes.

Clinical suspicion of breech presentation

Abdominal palpation: if the presenting part is irregular and not ballotable or if the fetal head is ballotable at the fundus
Pelvic examination: head not felt in the pelvis
Cord prolapse
Very thick meconium after rupture of membranes
Fetal heart heard higher in the abdomen

In cases of extended breech, the breech may not be ballotable and the fetal heart may be heard in the same location as expected for a cephalic presentation.

If breech presentation is suspected, an ultrasound examination will confirm diagnosis.

Cord prolapse is an obstetric emergency. Urgent delivery is indicated after confirming gestation and fetal viability.

Diagnosis: preterm ≤36+6 weeks

Breech presentation is a normal finding in preterm pregnancy.
If diagnosed at the 35-36 week antenatal visit, refer the woman for ultrasound scan to enable assessment prior to ECV.
Mode of birth in a breech preterm delivery depends on the clinical circumstances.

Diagnosis: ≥37+0 weeks

determine type of breech presentation
determine extension/flexion of fetal head
locate position of placenta and exclude placenta praevia
exclude fetal congenital abnormality
calculate amniotic fluid index
estimate fetal weight.

Practice points

Offer ECV if there are no contraindications.
If ECV is declined or unsuccessful, provide counselling on risks and benefits of a planned vaginal birth versus an ELCS.
Inform the woman that there are fewer maternal complications with a successful vaginal birth, however the risk to the woman increases significantly if there is a need for an EMCS.
Inform the woman that caesarean section increases the risk of complication in future pregnancies, including the risk of a repeat caesarean section and the risk of invasive placentation.
If the woman chooses an ELCS, document consent and organise booking for 39 weeks gestation.

Information and decision making

Women with a breech presentation should have the opportunity to make informed decisions about their care and treatment, in partnership with the clinicians providing care.

Planning for birth requires careful assessment for risk of poor outcomes relating to planned vaginal breech birth. If any risk factors are identified, inform the woman that an ELCS is recommended due to increased perinatal risk.

Good communication between clinicians and women is essential. Treatment, care and information provided should:

take into account women's individual needs and preferences
be supported by evidence-based, written information tailored to the needs of the individual woman
be culturally appropriate
be accessible to women, their partners, support people and families
take into account any specific needs, such as physical or cognitive disabilities or limitations to their ability to understand spoken or written English.

Documentation

The following should be documented in the woman's hospital medical record and (where applicable) in her hand-held medical record:

discussion of risks and benefits of vaginal breech birth and ELCS
discussion of the woman's questions about planned vaginal breech birth and ELCS
discussion of ECV, if applicable
consultation, referral and escalation

External cephalic version (ECV)

ECV can be offered from 37 weeks gestation
The woman must provide written consent prior to the procedure
The success rate of ECV is 40-60 per cent
Approximately one in 200 ECV attempts will lead to EMCS
ECV should only be performed by a suitably trained, experienced clinician
continuous electronic fetal monitoring (EFM)
capability to perform an EMCS.

Contraindications

Table 1. Contraindications to ECV

Precautions

Hypertension
Oligohydramnios
Nuchal cord

Escalate care to a consultant obstetrician if considering ECV in these circumstances.

Perform a CTG prior to the procedure - continue until RANZCOG criteria for a normal antenatal CTG are met.
250 microg s/c, 30 minutes prior to the procedure.
Administer Anti-D immunoglobulin if the woman is rhesus negative.
Do not make more than four attempts at ECV, for a suggested maximum time of ten minutes in total.
Undertake CTG monitoring post-procedure until RANZCOG criteria for a normal antenatal CTG are met.

Emergency management

Urgent delivery is indicated in the event of the following complications:

abnormal CTG
vaginal bleeding
unexplained pain.

Initiate emergency response as per local guidelines.

Alternatives to ECV

There is a lack of evidence to support the use of moxibustion, acupuncture or postural techniques to achieve a vertex presentation after 35 weeks gestation.

Criteria for a planned vaginal breech birth

Documented evidence of counselling regarding mode of birth
Documentation of informed consent, including written consent from the woman
Estimated fetal weight of 2500-4000g
Flexed fetal head
Emergency theatre facilities available on site
Availability of suitably skilled healthcare professional
Frank or complete breech presentation
No previous caesarean section.
Cord presentation
Fetal growth restriction or macrosomia
Any presentation other than a frank or complete breech
Extension of the fetal head
Fetal anomaly incompatible with vaginal delivery
Clinically inadequate maternal pelvis
Previous caesarean section
Inability of the service to provide experienced personnel.

If an ELCS is booked

Confirm presentation by ultrasound scan when a woman presents for ELCS.
If fetal presentation is cephalic on admission for ELCS, plan ongoing management with the woman.

Intrapartum management

Fetal monitoring.

Advise the woman that continuous EFM may lead to improved neonatal outcomes.
Where continuous EFM is declined, perform intermittent EFM or intermittent auscultation, with conversion to EFM if an abnormality is detected.
A fetal scalp electrode can be applied to the breech.

Position of the woman

The optimal maternal position for birth is upright.
Lithotomy may be appropriate, depending on the accoucheur's training and experience.

Pain relief

Epidural analgesia may increase the risk of intervention with a vaginal breech birth.
Epidural analgesia may impact on the woman's ability to push spontaneously in the second stage of labour.

Induction of labour (IOL)

See the IOL eHandbook page for more detail.

IOL may be offered if clinical circumstances are favourable and the woman wishes to have a vaginal birth.
Augmentation (in the absence of an epidural) should be avoided as adequate progress in the absence of augmentation may be the best indicator of feto-pelvic proportions.

The capacity to offer IOL will depend on clinician experience and availability and service capability.

First stage

Manage with the same principles as a cephalic presentation.
Labour should be expected to progress as for a cephalic presentation.
If progress in the first stage is slow, consider a caesarean section.
If an epidural is in situ and contractions are less than 4:10, consult with a senior obstetrician.
Avoid routine amniotomy to avoid the risk of cord prolapse or cord compression.

Second stage

Allow passive descent of the breech to the perineum prior to active pushing.
If breech is not visible within one hour of passive descent, a caesarean section is normally recommended.
Active second stage should be ½ hour for a multigravida and one hour for a primipara.
All midwives and obstetricians should be familiar with the techniques and manoeuvres required to assist a vaginal breech birth.
Ensure a consultant obstetrician is present for birth.
Ensure a senior paediatric clinician is present for birth.

VIDEO: Maternity Training International - Vaginal Breech Birth

Encouragement of maternal pushing (if at all) should not begin until the presenting part is visible.
A hands-off approach is recommended.
Significant cord compression is common once buttocks have passed the perineum.
Timely intervention is recommended if there is slow progress once the umbilicus has delivered.
Allow spontaneous birth of the trunk and limbs by maternal effort as breech extraction can cause extension of the arms and head.
Grasp the fetus around the bony pelvic girdle, not soft tissue, to avoid trauma.
Assist birth if there is a delay of more than five minutes from delivery of the buttocks to the head, or of more than three minutes from the umbilicus to the head.
Signs that delivery should be expedited also include lack of tone or colour or sign of poor fetal condition.
Ensure fetal back remains in the anterior position.
Routine episiotomy not recommended.
Lovset's manoeuvre for extended arms.
Reverse Lovset's manoeuvre may be used to reduce nuchal arms.
Supra-pubic pressure may aide flexion of the fetal head.
Maricueau-Smellie-Veit manoeuvre or forceps may be used to deliver the after coming head.

Undiagnosed breech in labour

This occurs in approximately 25 per cent of breech presentations.
Management depends on the stage of labour when presenting.
Assessment is required around increased complications, informed consent and suitability of skilled expertise.
Do not routinely offer caesarean section to women in active second stage.
If there is no senior obstetrician skilled in breech delivery, an EMCS is the preferred option.
If time permits, a detailed ultrasound scan to estimate position of fetal neck and legs and estimated fetal weight should be made and the woman counselled.

Entrapment of the fetal head

This is an extreme emergency

This complication is often due to poor selection for vaginal breech birth.

A vaginal examination (VE) should be performed to ensure that the cervix is fully dilated.
If a lip of cervix is still evident try to push the cervix over the fetal head.
If the fetal head has entered the pelvis, perform the Mauriceau-Smellie-Veit manoeuvre combined with suprapubic pressure from a second attendant in a direction that maintains flexion and descent of the fetal head.
Rotate fetal body to a lateral position and apply suprapubic pressure to flex the fetal head; if unsuccessful consider alternative manoeuvres.
Reassess cervical dilatation; if not fully dilated consider Duhrssen incision at 2, 10 and 6 o'clock.
A caesarean section may be performed if the baby is still alive.

Neonatal management

Paediatric review.
Routine observations as per your local guidelines, recorded on a track and trigger chart.
Observe for signs of jaundice.
Observe for signs of tissue or nerve damage.
Hip ultrasound scan to be performed at 6-12 weeks post birth to monitor for developmental dysplasia of the hip (DDH). See Neonatal eHandbook - Developmental dysplasia of the hip .

More information

Audit and performance improvement.

All maternity services should have processes in place for:

auditing clinical practice and outcomes
providing feedback to clinicians on audit results
addressing risks, if identified
implementing change, if indicated.

Potential auditable standards are:

number of women with a breech presentation offered ECV
success rate of ECV
ECV complications
rate of planned vaginal breech birth
breech birth outcomes for vaginal and caesarean birth.

For more information or assistance with auditing, please contact us via [email protected]

Bue and Lauszus 2016, Moxibustion did not have an effect in a randomised clinical trial for version of breech position. Danish Medical Journal 63(2), A599
Coulon et.al. 2014, Version of breech fetuses by moxibustion with acupuncture. Obstetrics and Gynecology 124(1), 32-39. DOI: 10.1097/AOG.0000000000000303
Coyle ME, Smith CA, Peat B 2012, Cephalic version by moxibustion for breech presentation. Cochrane Database of Systematic Reviews 2012, Issue 5. Art. No.: CD003928. DOI: 10.1002/14651858.CD003928.pub3
Evans J 2012, Essentially MIDIRS Understanding Physiological Breech Birth Volume 3. Number 2. February 2012
Hoffmann J, Thomassen K, Stumpp P, Grothoff M, Engel C, Kahn T, et al. 2016, New MRI Criteria for Successful Vaginal Breech Delivery in Primiparae. PLoS ONE 11(8): e0161028. doi:10.1371/journal.pone.0161028
Hofmeyr GJ, Kulier R 2012, Cephalic version by postural management for breech presentation. Cochrane Database of Systematic Reviews 2012, Issue 10. Art. No.: CD000051. DOI: 10.1002/14651858.CD000051.pub2
New South Wales Department of Health 2013, Maternity: Management of Breech Presentation HNELHD CG 13_01, NSW Government; 2013
Royal College of Obstetricians and Gynaecologists 2017, External Cephalic Version and Reducing the Incidence of Term Breech Presentation. Green-top Guideline No. 20a . London: RCOG; 2017
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) 2016, Management of breech presentation at term , July 2016 C-Obs-11:
The Royal Women's Hospital 2015, Management of Breech - Clinical Guideline
Women's and Newborn Health Service, King Edward Memorial Hospital 2015, Complications of Pregnancy Breech Presentation

Abbreviations

Get in touch, version history.

First published: November 2018 Due for review: November 2021

Uncontrolled when downloaded

Fetal Presentation, Position, and Lie (Including Breech Presentation)

Key Points |

Terms that describe the fetus in relation to the uterus, cervix, and maternal pelvis are

Fetal position: Relation of the presenting part to an anatomic axis; for transverse presentation, occiput anterior, occiput posterior, occiput transverse

Fetal lie: Relation of the fetus to the long axis of the uterus; longitudinal, oblique, or transverse

Normal fetal lie is longitudinal, normal presentation is vertex, and occiput anterior is the most common position.

Abnormal fetal lie, presentation, or position may occur with

Fetopelvic disproportion (fetus too large for the pelvic inlet)

Fetal congenital anomalies

Uterine structural abnormalities (eg, fibroids, synechiae)

Multiple gestation

Several common types of abnormal lie or presentation are discussed here.

Transverse lie

Breech presentation

There are several types of breech presentation.

Frank breech: The fetal hips are flexed, and the knees extended (pike position).

Complete breech: The fetus seems to be sitting with hips and knees flexed.

Single or double footling presentation: One or both legs are completely extended and present before the buttocks.

Types of breech presentations

Predisposing factors for breech presentation include

Preterm labor

Uterine abnormalities

Fetal anomalies

If delivery is vaginal, breech presentation may increase risk of

Umbilical cord prolapse

Birth trauma

Perinatal death

Face or brow presentation

Brow presentation usually converts spontaneously to vertex or face presentation.

Occiput posterior position

The most common abnormal position is occiput posterior.

The fetal neck is usually somewhat deflexed; thus, a larger diameter of the head must pass through the pelvis.

Progress may arrest in the second phase of labor. Operative vaginal delivery or cesarean delivery is often required.

Position and Presentation of the Fetus

If a fetus is in the occiput posterior position, operative vaginal delivery or cesarean delivery is often required.

In breech presentation, the presenting part is a poor dilating wedge, which can cause the head to be trapped during delivery, often compressing the umbilical cord.

For breech presentation, usually do cesarean delivery at 39 weeks or during labor, but external cephalic version is sometimes successful before labor, usually at 37 or 38 weeks.

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10 Signs of a Breech Baby: How to Tell if Your Baby is Breech

A mother’s instincts are strong. For the last 9 months, you’ve become well-acquainted with your baby. You’ve felt his movements, you know his habits.

Now, things feel off. Your gut is telling you that your baby isn’t where he should be.

How to Tell if Your Baby is Breech - 10 Signs of a Breech Baby

If you’re wondering how to tell if your baby is breech, you’re not alone. During my first pregnancy, I searched for the signs of a breech baby all over the internet and could only find forum posts by other women that were just as confused.

If you’re having the same trouble, this post is for you.

This article describes the most commonly reported signs of a breech baby and how to tell if your baby is breech. Hopefully, by the end, you will either find peace of mind or confirmation that a doctor’s visit is in order.

How to Tell if Your Baby is Breech: 10 Signs of a Breech Baby

This post may contai n affiliate links . If you make a purchase from one of the links I will make a small commission at no charge to you. I only recommend what I trust. Blunders in Babyland does not diagnose, treat, or give out any professional advice for any medical conditions.

First things, first. Let’s talk about the differences between a cephalic baby and a breech baby . When your baby is cephalic, he’s head down. The optimal position for giving birth is anterior cephalic. Basically, in this position, your baby’s head will fit nicely into the birth canal.

If your baby’s head is near your ribs and his feet are in your pelvis, he’s breech . There are several different types of breech positions, but we’ll get to that in another post .

Breech births are possible , but they are generally more difficult and, at times, can be dangerous. Generally speaking, most providers do not want to mess with a vaginal breech birth.

Now, you should know that the only way to know that your baby is breech is to confirm with your provider .

The information below is based on the experiences of other mothers, midwives, and myself. It’s important to be aware of these signs, especially later in your pregnancy, because it will give you the chance to take the necessary steps to correct it.

Signs Your Baby is NOT Breech

If you don’t know already, here are some pretty strong indicators that your baby is head down:

Kicks near the rib cage
Fluttering in the pelvis (baby’s fingers)
Punches to pelvis
Pressure or heaviness in the pelvis ( sign of engagement )
Small, pliable bulge near the rib cage (the baby’s butt)
Hiccups below the belly button

If you’re seeing these signs then congratulations ! There’s a good chance your baby is head down.

How to Tell if Your Baby is Breech With Belly Mapping

Before we dive into the signs of a breech baby, let’s talk about one more important concept: belly mapping. My first pregnancy, I had no idea what belly mapping is. Now, I love using this technique to give me some peace of mind that my baby is head down.

In case you’re new to the concept, belly mapping uses a combination of light palpitation, drawing, and tracking your baby’s movements to gauge his position. If your baby is vertex, belly mapping is a great tool to make sure your baby is in the optimal birthing position.

Belly mapping a breech baby can be tricky since your baby’s butt feels a lot like his head. The success of belly mapping largely depends on you and your baby’s physiology. For example, if you’re overweight or have an anterior placenta, belly mapping will be less reliable.

Belly mapping is also a great way to check your baby’s progress if your provider diagnoses him as breech . Just take into account the special movements and characteristics of a breech baby.

10 Most Common Signs of a Breech Baby

Hard bulge near rib cage.

This is the most common sign of a breech baby, but it’s also the most difficult to verify. Many moms mistake their baby’s butt for a head. It can be really difficult to feel the difference from the outside. Generally speaking, if you press on the bulge and it moves or you get a nice kick, that’s a good indication that it’s your baby’s butt.

Personally, I noticed that the head was much more prominent and less mobile. Meanwhile, her butt could be pushed around and would disappear for a few hours.

Baby Will Not Engage

Lightening, engaging, or dropping.

This magical transition happens sometime during your last few weeks of pregnancy. Your baby’s head migrates into your pelvis, giving your poor lungs a small break. You can tell that your baby has engaged when you feel pressure on your pelvis or you need to pee more frequently.

Many breech babies do not engage until labor or until he has flipped head down.

Just keep in mind that your baby may not be engaging for several reasons; some babies simply don’t engage until labor (especially with new moms) and others won’t engage because they are posterior.

Light Kicks or Punches to the Upper Abdomen

This was a huge sign for me. After a terrible night of twisting and turning, I felt a hard bulge by my rib cage and only small kicks into my side. Considering my baby had been an amateur soccer player until this point, this was definitely a red flag.

A few days later, an ultrasound established that I had a Frank Breech.

If you have a particularly feisty baby, it can be difficult to tell the difference between kicks and punches. A kick should feel more pronounced, with a larger footprint. A punch is often lighter.

Keep in mind that an anterior head down baby (the optimal birthing position) will not kick your front upper abdomen either. You’ll feel those kicks behind your ribs.

SHORT ON TIME? PIN IT FOR LATER!

Signs of a Breech Baby You Need to Know About

Kicks to Pelvis or Cervix (Footling Breech)

You’ll know when your baby kicks your cervix. It’ll feel like a kick to the crotch…from the inside. This is not to be confused with a punch to the cervix. When a baby’s hands are near your pelvis, you might feel a slight tickling or butterfly from her fingers. That’s a great indication that your baby is NOT breech.

Unusual or Fetal Painful Movement

The further you are in your gestation, the more snug your baby’s quarters. You will be much more likely to feel your baby flip. For some women, this is just mildly uncomfortable; for others, it’s very, very painful.

In my case, flipping was very painful. The night she turned breech it felt like my insides were being churned. I felt a similar experience during the night (I suspect) she turned head down. However, many women do not experience pain when their baby turns. This symptom largely depends on your amniotic fluid, your baby’s size, and your physiology.

If you do feel prolonged pain, go to your doctor, if only for your peace of mind.

Related Post: 8 Sneaky Ways to Relieve Pregnancy Back Pain

Pressure on Your Rib Cage

Your baby’s head is the largest part of her body. When she’s engaged, all of that pressure rests not-so-comfortably on your pelvic bone. One sign of a breech baby is pressure on your lungs and rib cage. This can make it difficult to breathe, sleep, or even sit.

High Heartbeat Location

Some moms report finding their breech baby’s heartbeat above their belly button. If you get these results, try not to panic. Your amniotic liquid may transfer the sound, giving an inaccurate representation.

Head Can’t be Found in Pelvis During a Palpitation

This is how most women discover that their baby is breech. At your weekly checkup, your doctor may palpitate to feel your baby’s head. If your baby is breech, your pelvis will feel unusually squishy (as opposed to a hard lump where the head is).

However, many doctors will not rely on palpitation alone to determine if a baby is breech. Most likely, he will schedule an ultrasound visit to confirm your baby’s position.

Hiccups Above the Belly Button

One of the most commonly reported (though thankfully inaccurate) signs of a breech baby is tiny hiccups above the belly button.

This was actually one of the clues I noticed when my baby was breech. After my baby turned head down, I felt hiccups in my pelvis again. If your only symptom of a breech baby is high hiccups, try not to worry. Like your baby’s heartbeat, you may be feeling the vibrations travel or his little feet twitching.

Discomfort and Soreness

When your baby is breech, your upper torso may feel very, very uncomfortable and, in some cases, tender.

Your baby is designed to nestle into your pelvis, preparing the birth canal and allowing his little body to grow. When your baby is breech, the biggest part of him is sitting on your lungs and ribs. You’re not feeling the same relief that you might for a head down baby. In fact, you might feel very stretched and the constant pressure can feel like a deep bruise.

How to Tell if Your Baby is Actually Breech - Signs of a Breech Baby

What do I do if I Think My Baby is Breech?

Only 3-4% of babies reach full-term breech. Even if you’re feeling a couple of these symptoms, chances are, your baby is still head-down. However, you should always trust your gut (literally, in this case). If you’re beginning to notice changes in your baby’s position, visit your doctor. At the very least, you’ll find some reassurance.

If you do discover that your baby is breech, don’t panic . It’s never too late to flip a baby, even this late in the third trimester. My baby turned at 39 weeks! It is possible, I promise.

Related Post: Turning a Breech Baby: 10 Ways to Turn Your Breech Baby Naturally

If you find that your baby is head-down, it may be a good idea to belly map to check which direction your baby is facing. Some of the signs of a breech baby are also indicative of a posterior baby. Depending on you and your baby, a posterior presentation can mean a harder, longer labor.

The good news is, even if your baby is posterior , there are plenty of methods to encourage him into the optimal birthing position.

That’s it, Mama!

Most of all, I hope these signs either reassure you or convince you to visit your doctor. Remember, if you do find out that your baby is breech, it’s not the end of the world–even after 36 weeks.

Did I miss something? If you’ve found out that your baby is breech and you experienced signs not on this list, please let us know in the comments below!

I'm a mom of two, writer, and small business owner. I love giving new and expecting moms the tips they need to overcome the challenges of early motherhood. Check out the About page to learn more!

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11 Comments

Hi my name is Caren, I’m 33 weeks pregnant with twins and they are both breech Im so concerned, the kicks at my lower belly are very painful sometimes Im out out of breath please advice what can I do to turn the babies please.

Hey Caren, I’m so sorry you’re having painful kicks. Definitely speak to your provider about these concerns. They will be able to check the your twins’ positioning and give you the medical advice and peace of mind you need. But, from one mom to another, let me encourage you: I felt a ton of kicks/punches that “took my breath away” during my pregnancies…while my girls were head down and breech! Both girls turned head down by 39 weeks and the birth went great. There’s an article linked above that details which positions/techniques I used. Once again, not medical advice, just tips that I used in my personal situation 🙂 Much love to you and your beautiful babies!

I am 35weeks and my baby is breech, the doctor ask me to prepare for CS and am sad… I hope the baby still turn

I’m so sorry to hear that. I hope your baby did end up turning. If not, your birth story is unique and beautiful whether it ends in a c-section or natural birth <3

Just coming back from the clinic and they say my baby is breech at 36 weeks

I’m 36 weeks and I had expressed concern to my OBGYN at a much earlier date about the possiblity of having a breech baby. She told me then that there was still plenty of time for him to flip, and to try not to worry too much about it until closer to delivery. Well, I’m almost 37 weeks now and she still hasn’t checked his position. Most days I notice a firm bulge on my right side by my ribs and experience movements all across the center of my abdomen. Occasionally there will be pressure in my pelvic region, but by the end of the night it’s all back to the center. I dont know what to do since this is my 1st child, and as time dwindles I get more and more uneasy.

Hey Brooke, I can definitely understand your concern here! Honestly, from your description it sounds like it could go either way. It’s SO hard to FEEL the difference between a breech baby and head down baby, the only real way to know for sure is by your provider. I definitely would NOT worry (not many babies are breech) but I would also mention your concerns to your OBGYN again. Maybe she can feel around, perform an unofficial ultrasound (if she has a portable ultrasound handy) or she can check the heartbeat location. At the very least, it will give you peace of mind!

I am 32weeks, and my baby is in breech, pls I pray he or she will turn.and my left abdomen is paining me, mostly when ever am walking, pls I want to know the reason for that.

Annita, I’m sorry to hear that. Try not to worry though, 32 weeks is still plenty of time for her to turn! Don’t lose hope! I would definitely speak to your provider about the abdomen pain. I experienced this as well and it was simply because my daughter’s position was the worst (at one point, she was transverse…ouch!). Your pain could be completely normal, but I would double-check just in case 🙂

I found out at 37 weeks my baby was breech. The medical professional did not recognize this, I ask for the ultrasound which made the late determination. The breech doctor saw me at 38 weeks and told me my baby was too big and could not flip. I diligently did not listen and did all breech remedies to flip her. I slept on inverted board upside down, did pelvic floor excersizes, ate foods to induce labor. I even did not show up for my scheduled C section because I believed I could get her into position. So 5 days after missed C section I went into natural labor, I checked into the hospital. I spent 8 hours in labor, all the while the head midwife pleaded with me to get C section. So I caved and was tired. The doctor said my baby was at risk and we were both declining. I am still sad about this birth birth and delivery. Though my daughter is now two years of age and is healthy. I guess live and learn is all I can take from this experience. Good luck to any woman with breech births.

Aw, Shay thank you for sharing your story. I’ve heard a few stories where the babies were able to flip head down just in the nick of time and others, like yours, where that baby just would not flip! I know it can be such a bummer, but who knows what might be going on behind the scenes! Maybe the baby instinctively knew that flipping could be more dangerous than her current position. In any case, I am so, so glad that your little one is healthy and completely oblivious to her little prenatal adventure!

Comments are closed.

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Cover of Identification of breech presentation

Identification of breech presentation

Evidence review L

NICE Guideline, No. 201

National Guideline Alliance (UK) .

Review question

What is the effectiveness of routine scanning between 36+0 and 38+6 weeks of pregnancy compared to standard care regarding breech presentation?

Introduction

Breech presentation in late pregnancy may result in prolonged or obstructed labour for the woman. There are interventions that can correct or assist breech presentation which are important for the woman’s and the baby’s health. This review aims to determine the most effective way of identifying a breech presentation in late pregnancy.

Summary of the protocol

Please see Table 1 for a summary of the Population, Intervention, Comparison and Outcome (PICO) characteristics of this review.

Summary of the protocol (PICO table).

For further details see the review protocol in appendix A .

Methods and process

This evidence review was developed using the methods and process described in Developing NICE guidelines: the manual 2014 . Methods specific to this review question are described in the review protocol in appendix A .

Declarations of interest were recorded according to NICE’s conflicts of interest policy .

Clinical evidence

Included studies.

One single centre randomised controlled trial (RCT) was included in this review ( McKenna 2003 ). The study was carried out in Northern Ireland, UK. The study compared ultrasound examination at 30-32 and 36-37 weeks with maternal abdomen palpation during the same gestation period. The intervention group in the study had the ultrasound scans in addition to the abdomen palpation, while the control group had only the abdomen palpation. Clinical management options reported in the study based on the ultrasound scan or the abdomen palpation include referral for full biophysical assessment which included umbilical artery Doppler ultrasound, early antenatal review, admission to antenatal ward, and induction of labour.

The included study is summarised in Table 2 .

See the literature search strategy in appendix B and study selection flow chart in appendix C .

Excluded studies

Studies not included in this review are listed, and reasons for their exclusion are provided in appendix K .

Summary of clinical studies included in the evidence review

Summaries of the studies that were included in this review are presented in Table 2 .

Summary of included studies.

See the full evidence tables in appendix D . No meta-analysis was conducted (and so there are no forest plots in appendix E ).

Quality assessment of clinical outcomes included in the evidence review

See the evidence profiles in appendix F .

Economic evidence

One study, a cost utility analysis was included ( Wastlund 2019 ).

See the literature search strategy in appendix B and economic study selection flow chart in appendix G .

Studies not included in this review with reasons for their exclusions are provided in appendix K .

Summary of studies included in the economic evidence review

For full details of the economic evidence, see the economic evidence tables in appendix H and economic evidence profiles in appendix I .

Wastlund (2019) assessed the cost effectiveness of universal ultrasound scanning for breech presentation at 36 weeks’ gestational age in nulliparous woman (N=3879). The comparator was selective ultrasound scanning which was reported as current practice. In this instance, fetal presentation was assessed by palpation of the abdomen by a midwife, obstetrician or general practitioner. The sensitivity of this method ranges between 57%-70% whereas ultrasound scanning is detected with 100% sensitivity and 100% specificity. Women in the selective ultrasound scan arm only received an ultrasound scan after detection of a breech presentation by abdominal palpation. Where a breech was detected, a woman was offered external cephalic version (ECV). The structure of the model undertook a decision tree, with end states being the mode of birth; either vaginal, elective or emergency caesarean section. Long term health outcomes were modelled based on the mortality risk associated with each mode of birth. Average lifetime quality-adjusted life years (QALYs) were estimated from Euroqol general UK population values.

Only the probabilistic results (n=100000 simulations) were reported which showed that on average, universal ultrasound resulted in an absolute decrease in breech deliveries by 0.39% compared with selective ultrasound scanning. The expected cost per person with breech presentation of universal ultrasound was £2957 (95% Credibility Interval [CrI]: £2922 to £2991), compared to £2,949 (95%CrI: £2915 to £2984) from selective ultrasound. The expected QALYs per person was 24.27615 in the universal ultrasound cohort and 24.27582 in the selective ultrasound cohort. The incremental cost effectiveness ratio (ICER) from the probabilistic analysis was £23611 (95%CrI: £8184 to £44851).

A series of one-way sensitivity analysis were conducted which showed that the most important cost parameter was the unit cost of a universal ultrasound scan. This parameter is particularly noteworthy as the study costed this scan at a much lower value than the ‘standard antenatal ultrasound’ scan in NHS reference costs on the basis that such a scan can be performed by a midwife during a routine antenatal care visit in primary care. According to the NICE guideline manual economic evaluation checklist this model was assessed as being directly applicable with potentially severe limitations. The limitations were mostly attributable to the limitations of the clinical inputs.

Economic model

No economic modelling was undertaken for this review because the committee agreed that other topics were higher priorities for economic evaluation.

Evidence statements

Clinical evidence statements, comparison 1. routine ultrasound scan versus selective ultrasound scan, critical outcomes, unexpected breech presentation in labour.

No evidence was identified to inform this outcome.

Mode of birth

Moderate quality evidence from 1 RCT (N=1993) showed that there is no clinically important difference between routine ultrasound scan at 36-37 weeks and selective ultrasound scan on the number of women who had elective caesarean section: RR 1.22 (95% CI 0.91 to 1.63).
Moderate quality evidence from 1 RCT (N=1993) showed that there is no clinically important difference between routine ultrasound scan at 36-37 weeks and selective ultrasound scan on number of women who had emergency caesarean section: RR 1.20 (95% CI 0.90 to 1.60).
High quality evidence from 1 RCT (N=1993) showed that there is no clinically important difference between routine ultrasound scan at 36-37 weeks and selective ultrasound scan on number of women who had vaginal birth: RR 0.95 (95% CI 0.89 to 1.01).

Important outcomes

Maternal anxiety, women’s experience and satisfaction of care, gestational age at birth.

High quality evidence from 1 RCT (N=1993) showed that there is no clinically important difference between routine ultrasound scan at 36-37 weeks and selective ultrasound scan on the number of babies’ born between 39-42 gestational weeks: RR 0.98 (95% CI 0.94 to 1.02).

Admission to neonatal unit

Low quality evidence from 1 RCT (N=1993) showed that there is no clinically important difference between routine ultrasound scan at 36-37 weeks and selective ultrasound scan on the number of babies admitted into the neonatal unit: RR 0.83 (95% CI 0.51 to 1.35).

Economic evidence statements

One directly applicable cost-utility analysis from the UK with potentially serious limitations compared universal ultrasound scanning for breech presentation at 36 weeks’ gestational age with selective ultrasound scanning, stated as current practice. Universal ultrasound scanning was found to be borderline cost effective; the incremental cost-effectiveness ratio was £23611 per QALY gained. The cost of the scan was seen to be a key driver in the cost effectiveness result.

The committee’s discussion of the evidence

Interpreting the evidence, the outcomes that matter most.

Unexpected breech presentation in labour and mode of birth were prioritised as critical outcomes by the committee. This reflects the different options available to women with a known breech presentation in pregnancy and the different choices that women make. There are some women and/or clinicians who may feel uncomfortable with the risks of aiming for vaginal breech birth, and for these women and/or clinicians avoiding an unexpected breech presentation in labour would be the preferred option.

As existing evidence suggests that aiming for vaginal breech birth carries greater risk to the fetus than planned caesarean birth, it is important to consider whether earlier detection of the breech presentation would reduce the risk of these outcomes.

The committee agreed that maternal anxiety and women’s experience and satisfaction of care were important outcomes to consider as the introduction of an additional routine scan during pregnancy could have a treatment burden for women. Gestational age at birth and admission to neonatal unit were also chosen as important outcomes as the committee wanted to find out whether earlier detection of breech presentation would have an impact on whether the baby was born preterm, and as a consequence admitted to the neonatal unit. These outcomes were agreed to be important rather than critical as they are indirect outcomes of earlier detection of breech presentation.

The quality of the evidence

The quality of the evidence ranged from low to high. Most of the evidence was rated high or moderate, with only 1 outcome rated as low. The quality of the evidence was downgraded due to imprecision around the effect estimates for emergency caesarean section, elective caesarean section and admissions to neonatal unit.

No evidence was identified for the following outcomes: unexpected breech presentation in labour, maternal anxiety, women’s experiences and satisfaction of care.

The committee had hoped to find evidence that would inform whether early identification of breech presentation had an impact on preterm births, and although the review reported evidence for gestational age as birth, the available evidence was for births 39-42 weeks of gestation.

Benefits and harms

The available evidence compared routine ultrasound scanning with selective ultrasound scanning, and found no clinically important differences for mode of birth, gestational age at birth, or admissions to the neonatal unit. However, the committee discussed that it was important to note that the study did not focus on identifying breech presentation. The committee discussed the differences between the intervention in the study, which was an ultrasound scan to assess placental maturity, liquor volume, and fetal weight, to an ultrasound scan used to detect breech presentation. Whilst the ultrasound scan in the study has the ability to determine breech presentation, there are additional and costlier training required for the assessment of the other criteria. As such, it is important to separate the interventions. The committee also highlighted that the study did not look at whether an identification of breech presentation had an impact on the outcomes which were selected for this review.

In light of this, the committee felt that they were unable to reach a conclusion as to whether routine scanning to identify breech presentation, was associated with any benefits or harms. The committee agreed that while this review suggests routine ultrasound scanning to be no more effective than selective scanning, it does not definitively establish equivalence. Therefore, the committee agreed to recommend a continuation of the current practice with selective scanning and make a research recommendation to compare the clinical and cost effectiveness of routine ultrasound scanning versus selective ultrasound scanning from 36 weeks to identify fetal breech presentation.

Cost effectiveness and resource use

The committee acknowledged that there was included economic evidence on the effectiveness of routine scanning between 36+0 and 38+6 weeks of pregnancy compared to standard care regarding breech presentation.

The 1 included study suggested that offering a routine scan for breech is borderline cost effective. A key driver of cost effectiveness was the cost of the scan, which was substantially lower in the economic model than the figure quoted in NHS reference costs for routine ultrasound scanning. The committee noted that a scan for breech presentation only is a simpler technique and uses a cheaper machine. The committee agreed that the other costing assumptions presented in the study seemed appropriate.

However, the committee expressed concerns about the cohort study which underpinned the economic analysis which had a high risk of bias. The committee noted that a number of assumptions in the model which were key drivers of cost effectiveness, including the palpation diagnosis rates and prevalence of breech position, were from this 1 cohort study. This increased the uncertainty around the cost effectiveness of the routine scan. The committee also noted that, whilst the cost of the scan was fairly inexpensive, the resource impact would be substantial if a routine scan for breech presentation was offered to all pregnant women.

Overall, the committee felt that the clinical and cost effectiveness evidence presented was not strong enough to recommend offering a routine ultrasound scan given the potential for a significant resource impact. The recommendation to offer abdominal palpation to all pregnant women, and to offer an ultrasound scan where breech is suspected reflects current practice and so no substantial resource impact is anticipated.

McKenna 2003

Wastlund 2019

Appendix A. Review protocols

Review protocol for review question: What is the effectiveness of routine scanning between 36+0 and 38+6 weeks of pregnancy compared to standard care regarding breech presentation? (PDF, 244K)

Appendix B. Literature search strategies

Literature search strategies for review question: What is the effectiveness of routine scanning between 36+0 and 38+6 weeks of pregnancy compared to standard care regarding breech presentation? (PDF, 370K)

Appendix C. Clinical evidence study selection

Clinical study selection for review question: What is the effectiveness of routine scanning between 36+0 and 38+6 weeks of pregnancy compared to standard care regarding breech presentation? (PDF, 117K)

Appendix D. Clinical evidence tables

Clinical evidence tables for review question: What is the effectiveness of routine scanning between 36+0 and 38+6 weeks of pregnancy compared to standard care regarding breech presentation? (PDF, 213K)

Appendix E. Forest plots

Forest plots for review question: what is the effectiveness of routine scanning between 36+0 and 38+6 weeks of pregnancy compared to standard care regarding breech presentation.

This section includes forest plots only for outcomes that are meta-analysed. Outcomes from single studies are not presented here, but the quality assessment for these outcomes is provided in the GRADE profiles in appendix F .

Appendix F. GRADE tables

GRADE tables for review question: What is the effectiveness of routine scanning between 36+0 and 38+6 weeks of pregnancy compared to standard care regarding breech presentation? (PDF, 196K)

Appendix G. Economic evidence study selection

Economic evidence study selection for review question: what is the effectiveness of routine scanning between 36+0 and 38+6 weeks of pregnancy compared to standard care regarding breech presentation.

A single economic search was undertaken for all topics included in the scope of this guideline. One economic study was identified which was applicable to this review question. See supplementary material 2 for details.

Appendix H. Economic evidence tables

Economic evidence tables for review question: What is the effectiveness of routine scanning between 36+0 and 38+6 weeks of pregnancy compared to standard care regarding breech presentation? (PDF, 143K)

Appendix I. Economic evidence profiles

Economic evidence profiles for review question: What is the effectiveness of routine scanning between 36+0 and 38+6 weeks of pregnancy compared to standard care regarding breech presentation? (PDF, 129K)

Appendix J. Economic analysis

Economic evidence analysis for review question: what is the effectiveness of routine scanning between 36+0 and 38+6 weeks of pregnancy compared to standard care regarding breech presentation.

No economic analysis was conducted for this review question.

Appendix K. Excluded studies

Excluded clinical and economic studies for review question: what is the effectiveness of routine scanning between 36+0 and 38+6 weeks of pregnancy compared to standard care regarding breech presentation, clinical studies, table 8 excluded studies and reasons for their exclusion.

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Economic studies

A single economic search was undertaken for all topics included in the scope of this guideline. No economic studies were identified which were applicable to this review question. See supplementary material 2 for details.

Appendix L. Research recommendations

Research recommendations for review question: What is the effectiveness of routine scanning between 36+0 and 38+6 weeks of pregnancy compared to standard care regarding breech presentation? (PDF, 164K)

Evidence reviews underpinning recommendations 1.2.36 to 1.2.37

These evidence reviews were developed by the National Guideline Alliance, which is a part of the Royal College of Obstetricians and Gynaecologists

Disclaimer : The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.

Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.

NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the Welsh Government , Scottish Government , and Northern Ireland Executive . All NICE guidance is subject to regular review and may be updated or withdrawn.

Cite this Page National Guideline Alliance (UK). Identification of breech presentation: Antenatal care: Evidence review L. London: National Institute for Health and Care Excellence (NICE); 2021 Aug. (NICE Guideline, No. 201.)
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What happens if your baby is breech?

Babies often twist and turn during pregnancy, but most will have moved into the head-down (also known as head-first) position by the time labour begins. However, that does not always happen, and a baby may be:

bottom first or feet first (breech position)
lying sideways (transverse position)

Bottom first or feet first (breech baby)

If your baby is lying bottom or feet first, they are in the breech position. If they're still breech at around 36 weeks' gestation, the obstetrician and midwife will discuss your options for a safe delivery.

Turning a breech baby

If your baby is in a breech position at 36 weeks, you'll usually be offered an external cephalic version (ECV). This is when a healthcare professional, such as an obstetrician, tries to turn the baby into a head-down position by applying pressure on your abdomen. It's a safe procedure, although it can be a bit uncomfortable.

Giving birth to a breech baby

If an ECV does not work, you'll need to discuss your options for a vaginal birth or caesarean section with your midwife and obstetrician.

If you plan a caesarean and then go into labour before the operation, your obstetrician will assess whether it's safe to proceed with the caesarean delivery. If the baby is close to being born, it may be safer for you to have a vaginal breech birth.

The Royal College of Obstetricians and Gynaecologists (RCOG) website has more information on what to expect if your baby is still breech at the end of pregnancy .

The RCOG advises against a vaginal breech delivery if:

your baby's feet are below its bottom – known as a "footling breech"
your baby is larger or smaller than average – your healthcare team will discuss this with you
your baby is in a certain position – for example, their neck is very tilted back, which can make delivery of the head more difficult
you have a low-lying placenta (placenta praevia)
you have pre-eclampsia

Lying sideways (transverse baby)

If your baby is lying sideways across the womb, they are in the transverse position. Although many babies lie sideways early on in pregnancy, most turn themselves into the head-down position by the final trimester.

Giving birth to a transverse baby

Depending on how many weeks pregnant you are when your baby is in a transverse position, you may be admitted to hospital. This is because of the very small risk of the umbilical cord coming out of your womb before your baby is born (cord prolapse). If this happens, it's a medical emergency and the baby must be delivered very quickly.

Sometimes, it's possible to manually turn the baby to a head-down position, and you may be offered this.

But, if your baby is still in the transverse position when you approach your due date or by the time labour begins, you'll most likely be advised to have a caesarean section.

Video: My baby is breech. What help will I get?

In this video, a midwife describes what a breech position is and what can be done if your baby is breech.

Page last reviewed: 1 November 2023 Next review due: 1 November 2026

Medical Information

Breech Presentation and Breech Birth

What are the other names for this condition (also known as/synonyms).

Breech Birth
Breech Position

What is Breech Presentation and Breech Birth? (Definition/Background Information)

A pregnancy is referred to as breech when the baby is not in a ‘head down’ position by the 36 th week of pregnancy. The exact cause of breech presentation is unknown
The breech presentation (also called butt down position) is common throughout pregnancy; however, it is not the ideal position for vaginal delivery
Frank breech - with legs straight with feet by head and butt facing the birth canal
Footling breech - with one leg facing down that will be delivered first
Complete breech - when the legs are folded at the knee, with feet near the butt (facing down)
Breech presentation is common in women with multiple pregnancies (multiple babies in the womb)
Healthcare providers generally maneuver the fetus to change the position from breech to vertex (‘head down’ position)
The prognosis of breech presentation is generally good

Who gets Breech Presentation and Breech Birth? (Age and Sex Distribution)

Breech presentation is most common in women who are pregnant with multiple babies.

What are the Risk Factors for Breech Presentation and Breech Birth? (Predisposing Factors)

Risk factors associated with breech position pregnancy may include:

Multiple babies in the womb
Women with multiple pregnancies (more than one fetus in the womb)
Preterm labor
The presence of an abnormally-shaped uterus
Uterus with abnormal growths such as fibroids
Placenta previa, when the cervix is blocked by the placenta

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Breech Presentation and Breech Birth? (Etiology)

The exact cause of breech presentation is not known
However a few factors, such as multiple pregnancies, abnormal uterus condition, and labor before the designated delivery period, are commonly associated with breech position or breech presentation

What are the Signs and Symptoms of Breech Presentation and Breech Birth?

Common signs and symptoms associated with breech presentation include:

Kicking may be felt in the lower abdomen in women with breech presentation
Upward position of fetus’ head
Bottom of the fetus facing the birth canal

How is Breech Presentation and Breech Birth Diagnosed?

Diagnosis of breech presentation includes:

Breech presentation is diagnosed through physical examination along with evaluation of medical history
The diagnosis may be confirmed by an ultrasound examination of the abdomen

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Breech Presentation and Breech Birth?

Complications associated with breech presentation include:

Birth hypoxia: Insufficient supply of oxygen to baby’s brain and other organs after birth
Compression of umbilical cord results in obstruction of blood through the umbilical cord

How is Breech Presentation and Breech Birth Treated?

The treatment of breech presentation includes:

The healthcare provider shall initially attempt to reverse the breech position by giving relaxation medication and then turning the baby’s head down
The procedure of turning the baby into the correct position is referred to as external cephalic version. If the baby can be successfully turned, a normal vaginal delivery typically follows
In some cases, vaginal delivery is possible even if the baby is still in a breech position. In these cases forceps, a special tool used to pull the baby out, will more than likely be used
Generally, if the baby is still in breech position at the time of labor, a cesarean section will be performed. Commonly known as a C-section, this surgical procedure delivers the baby through an incision made in the mother’s lower abdomen

How can Breech Presentation and Breech Birth be Prevented?

In some cases, breech presentation may be prevented by reducing the risk for premature birth
Ensuring proper antenatal care is also essential to prevent complications during labor

What is the Prognosis of Breech Presentation and Breech Birth? (Outcomes/Resolutions)

The prognosis of Breech Presentation and Breech Birth is generally good.

Additional and Relevant Useful Information for Breech Presentation and Breech Birth:

Cesarean section (or C-section) is a surgical procedure where an incision is made in the lower abdomen, carried down through the muscle, and then through the uterus of the mother, to deliver the baby

The following article link will help you understand the Cesarean section surgical procedure:

http://www.dovemed.com/common-procedures/procedures-surgical/cesarean-section/

On the Article

Krish Tangella MD, MBA

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Signs and symptoms of neuroblastoma vary depending on what part of the body is affected.

Neuroblastoma in the abdomen — the most common form — may cause signs and symptoms such as:

Abdominal pain
A mass under the skin that isn't tender when touched
Changes in bowel habits, such as diarrhea or constipation

Neuroblastoma in the chest may cause signs and symptoms such as:

Changes to the eyes, including drooping eyelids and unequal pupil size

Other signs and symptoms that may indicate neuroblastoma include:

Lumps of tissue under the skin
Eyeballs that seem to protrude from the sockets (proptosis)
Dark circles, similar to bruises, around the eyes
Unexplained weight loss

When to see a doctor

Contact your child's doctor if your child has any signs or symptoms that worry you. Mention any changes in your child's behavior or habits.

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In general, cancer begins with a genetic mutation that allows normal, healthy cells to continue growing without responding to the signals to stop, which normal cells do. Cancer cells grow and multiply out of control. The accumulating abnormal cells form a mass (tumor).

Neuroblastoma begins in neuroblasts — immature nerve cells that a fetus makes as part of its development process.

As the fetus matures, neuroblasts eventually turn into nerve cells and fibers and the cells that make up the adrenal glands. Most neuroblasts mature by birth, though a small number of immature neuroblasts can be found in newborns. In most cases, these neuroblasts mature or disappear. Others, however, form a tumor — a neuroblastoma.

It isn't clear what causes the initial genetic mutation that leads to neuroblastoma.

Risk factors

Children with a family history of neuroblastoma may be more likely to develop the disease. Yet, familial neuroblastoma is thought to comprise a very small number of neuroblastoma cases. In most cases of neuroblastoma, a cause is never identified.

Complications

Complications of neuroblastoma may include:

Spread of the cancer (metastasis). Neuroblastoma may spread (metastasize) to other parts of the body, such as the lymph nodes, bone marrow, liver, skin and bones.
Spinal cord compression. Tumors may grow and press on the spinal cord, causing spinal cord compression. Spinal cord compression may cause pain and paralysis.
Signs and symptoms caused by tumor secretions. Neuroblastoma cells may secrete certain chemicals that irritate other normal tissues, causing signs and symptoms called paraneoplastic syndromes. One paraneoplastic syndrome that occurs rarely in people with neuroblastoma causes rapid eye movements and difficulty with coordination. Another rare syndrome causes abdominal swelling and diarrhea.

Neuroblastoma care at Mayo Clinic

Living with neuroblastoma?

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Shohet J, et al. Clinical presentation, diagnosis, and staging evaluation of neuroblastoma. https://www.uptodate.com/contents/search. Accessed Oct. 12, 2018.
Shohet J, et al. Treatment and prognosis of neuroblastoma. https://www.uptodate.com/contents/search. Accessed Oct. 12, 2018.
Hay WW, et al., eds. Neoplastic disease. In: Current Diagnosis & Treatment: Pediatrics. 24th ed. New York, N.Y.: McGraw-Hill Education; 2018. https://accessmedicine.mhmedical.com. Accessed Oct. 12, 2018.
Neuroblastoma treatment (PDQ). National Cancer Institute. https://www.cancer.gov/types/neuroblastoma/patient/neuroblastoma-treatment-pdq. Accessed Oct. 12, 2018.
National Library of Medicine. Neuroblastoma. Genetics Home Reference. https://ghr.nlm.nih.gov/condition/neuroblastoma. Accessed Oct. 12, 2018.
Kliegman RM, et al. Neuroblastoma. In: Nelson Textbook of Pediatrics. 20th ed. Philadelphia, Pa.: Elsevier; 2016. https://www.clinicalkey.com. Accessed June 26, 2018.
Niederhuber JE, et al., eds. Pediatric solid tumors. In: Abeloff's Clinical Oncology. 5th ed. Philadelphia, Pa.: Churchill Livingstone Elsevier; 2014. https://www.clinicalkey.com. Accessed June 26, 2018.
Types of cancer treatment. National Cancer Institute. https://www.cancer.gov/about-cancer/treatment/types. Accessed Oct. 16, 2018.

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IMAGES

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Breech baby causes, what does it mean and how to turn a breech baby
Three Types of Breech Presentations
Breech Definition
Breech Presentation
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VIDEO

Breech delivery/उल्टे बच्चे की डिलीवरी। डा० कल्पना अग्रवाल
Breech Presentation
breech presentation
breech presentation #cow#calf#viral
Breech Delivery story #bestgynecologist #drkshilpireddy #breechbaby #breechdelivery #normaldelivery
Malpresentation

COMMENTS

Breech Baby: Causes, Complications, Turning & Delivery
Some breech births can happen vaginally, but there are risks. The risks of a vaginal breech birth include: Injuries to your baby's legs or arms such as dislocated or broken bones. Your baby's head can get stuck or trapped. Umbilical cord problems. The umbilical cord can flatten or twist during delivery.
Breech: Types, Risk Factors, Treatment, Complications
At full term, around 3%-4% of births are breech. The different types of breech presentations include: Complete: The fetus's knees are bent, and the buttocks are presenting first. Frank: The fetus's legs are stretched upward toward the head, and the buttocks are presenting first. Footling: The fetus's foot is showing first.
Breech Presentation
Breech Births. In the last weeks of pregnancy, a baby usually moves so his or her head is positioned to come out of the vagina first during birth. This is called a vertex presentation. A breech presentation occurs when the baby's buttocks, feet, or both are positioned to come out first during birth. This happens in 3-4% of full-term births.
Breech presentation
Summary. Breech presentation refers to the baby presenting for delivery with the buttocks or feet first rather than head. Associated with increased morbidity and mortality for the mother in terms of emergency cesarean section and placenta previa; and for the baby in terms of preterm birth, small fetal size, congenital anomalies, and perinatal ...
Breech Presentation
Breech presentation refers to the fetus in the longitudinal lie with the buttocks or lower extremity entering the pelvis first. The three types of breech presentation include frank breech, complete breech, and incomplete breech. In a frank breech, the fetus has flexion of both hips, and the legs are straight with the feet near the fetal face, in a pike position. The complete breech has the ...
Fetal Presentation, Position, and Lie (Including Breech Presentation
In face presentation, the baby's neck arches back so that the face presents first rather than the top of the head.. In brow presentation, the neck is moderately arched so that the brow presents first.. Usually, fetuses do not stay in a face or brow presentation. These presentations often change to a vertex (top of the head) presentation before or during labor.
Overview of breech presentation
The main types of breech presentation are: Frank breech - Both hips are flexed and both knees are extended so that the feet are adjacent to the head ( figure 1 ); accounts for 50 to 70 percent of breech fetuses at term. Complete breech - Both hips and both knees are flexed ( figure 2 ); accounts for 5 to 10 percent of breech fetuses at term.
Breech presentation
Anencephaly, hydrocephaly, Down syndrome, and fetal neuromuscular dysfunction are associated with breech presentation, the latter due to its effect on the quality of fetal movements. [ 9] [ 14] The risk of recurrent breech delivery is 8%, the risk increasing from 4% after one breech delivery to 28% after three.
Fetal Presentation, Position, and Lie (Including Breech Presentation
In breech presentation, the presenting part is a poor dilating wedge, which can cause the head to be trapped during delivery, often compressing the umbilical cord. For breech presentation, usually do cesarean delivery at 39 weeks or during labor, but external cephalic version is sometimes successful before labor, usually at 37 or 38 weeks.
Breech Presentation: Types, Causes, Risks
Learn more about the types, causes, and risks of breech presentation, along with how breech babies are typically delivered. By Elizabeth Stein, CNM and Laura Riley, M.D.
What to Know About a Breech Baby
A breech baby does not cause more or less nausea, vomiting, or other pregnancy symptoms. But you will feel your baby's kicks lower in your belly. You may feel your baby's head as a hard swelling ...
Breech Presentation
Definition. Most babies move into a head-down position in the uterus before labor. The baby is in a breech position when its buttocks or feet are in place to come out first. There are three types: Frank breech—the baby's buttocks are down and the legs extend straight up in front of the body with the feet up near the head. Complete breech ...
Breech Baby: Symptoms, Causes & Treatment
This is the most common breech position. Complete breech. In this position, the baby's knees and hips are flexed, and folded under each other. Footling breech. This happens sometimes when one or both feet of the baby are pointed down toward the birth canal. Symptoms. There are not usually symptoms associated with a breech baby.
Breech presentation: diagnosis and management
Breech and external cephalic version. Breech presentation is when the fetus is lying longitudinally and its buttocks, foot or feet are presenting instead of its head. Figure 1. Breech presentations. Breech presentation occurs in three to four per cent of term deliveries and is more common in nulliparous women.
Breech Presentation: Overview, Vaginal Breech Delivery ...
Overview. Breech presentation is defined as a fetus in a longitudinal lie with the buttocks or feet closest to the cervix. This occurs in 3-4% of all deliveries. The percentage of breech deliveries decreases with advancing gestational age from 22-25% of births prior to 28 weeks' gestation to 7-15% of births at 32 weeks' gestation to 3-4% of ...
Breech Presentation
Breech presentation is a type of malpresentation and occurs when the fetal head lies over the uterine fundus and fetal buttocks or feet present over the maternal pelvis (instead of cephalic/head presentation). The incidence in the United Kingdom of breech presentation is 3-4% of all fetuses. 1.
Fetal Presentation, Position, and Lie (Including Breech Presentation
Breech presentation makes delivery difficult ,primarily because the presenting part is a poor dilating wedge. Having a poor dilating wedge can lead to incomplete cervical dilation, because the presenting part is narrower than the head that follows. The head, which is the part with the largest diameter, can then be trapped during delivery.
10 Signs of a Breech Baby: How to Tell if Your Baby is Breech
Some of the signs of a breech baby are also indicative of a posterior baby. Depending on you and your baby, a posterior presentation can mean a harder, longer labor. The good news is, even if your baby is posterior, there are plenty of methods to encourage him into the optimal birthing position. That's it, Mama!
Identification of breech presentation
Only the probabilistic results (n=100000 simulations) were reported which showed that on average, universal ultrasound resulted in an absolute decrease in breech deliveries by 0.39% compared with selective ultrasound scanning. The expected cost per person with breech presentation of universal ultrasound was £2957 (95% Credibility Interval [CrI ...
Management of Breech Presentation
Labour with a preterm breech should be managed as with a term breech. C. Where there is head entrapment, incisions in the cervix (vaginal birth) or vertical uterine D incision extension (caesarean section) may be used, with or without tocolysis. Evidence concerning the management of preterm labour with a breech presentation is lacking.
What happens if your baby is breech?
Turning a breech baby. If your baby is in a breech position at 36 weeks, you'll usually be offered an external cephalic version (ECV). This is when a healthcare professional, such as an obstetrician, tries to turn the baby into a head-down position by applying pressure on your abdomen. It's a safe procedure, although it can be a bit uncomfortable.
Breech Presentation and Breech Birth
Frank breech - with legs straight with feet by head and butt facing the birth canal. Footling breech - with one leg facing down that will be delivered first. Complete breech - when the legs are folded at the knee, with feet near the butt (facing down) Breech presentation is common in women with multiple pregnancies (multiple babies in the womb)
Neuroblastoma
Changes in bowel habits, such as diarrhea or constipation. Neuroblastoma in the chest may cause signs and symptoms such as: Wheezing. Chest pain. Changes to the eyes, including drooping eyelids and unequal pupil size. Other signs and symptoms that may indicate neuroblastoma include: Lumps of tissue under the skin.

What Is Breech?

Risk Factors

Types of Breech Presentation

Signs of Breech

Recommendations for Previous C-Sections

A Word From Verywell

Breech Births

What are the different types of breech birth presentations?

What causes a breech presentation?

How is a breech presentation diagnosed?

Can a breech presentation mean something is wrong?

Can a breech presentation be changed?

Medical Techniques

ECV will not be tried if:

Complications of EVC include:

Vaginal delivery versus cesarean for breech birth?

What are the risks and complications of a vaginal delivery?

When is a cesarean delivery used with a breech presentation?

Want to Know More?

Compiled using information from the following sources:

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Fetal Presentation, Position, and Lie (Including Breech Presentation)

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