What is a breech presentation?
By 3–4 weeks before the due date, most babies move so their heads are down near the birth canal (vagina). If this does not happen, the buttocks, the feet, or both may be in place to come out first during birth. This is called a breech presentation. It happens in 3–4% of full-term births and requires special planning for how the baby will be born. If your baby is in a breech presentation, your doctor may recommend cesarean delivery.
What factors increase the chance of breech presentation?
It is not always known why a baby is in a breech position. Breech is more common when
- the woman has had more than one pregnancy
- there is more than one fetus in the uterus (twins or more)
- the uterus has too much or too little amniotic fluid (the liquid around the fetus inside the uterus)
- the uterus is not normal in shape or has abnormal growths, such as fibroids
- the placenta covers all or part of the opening of the uterus (placenta previa)
- the baby is preterm
How can my health care provider tell if my baby is in a breech presentation?
One way for your health care provider to tell which way your baby is facing is by doing a physical exam. Placing his or her hands at certain points on your abdomen, the health care provider feels the shape of the baby. By feeling where the baby’s head, back, and buttocks are, he or she can tell the position of the baby.
An ultrasound exam may be used to confirm the position. In this test, a device is moved across the abdomen. The sound waves it produces make an image of the baby that can be seen on a screen.
What is external cephalic version (ECV)?
If the baby is breech, your health care provider may suggest external cephalic version (ECV). ECV is a procedure in which the health care provider lifts and turns the baby from the outside. It can improve your chance of having a vaginal birth.
How is ECV performed?
To turn the baby, the health care provider places his or her hands at certain positions on your abdomen, then lifts and turns. In some cases, a second person helps turn the baby.
When is ECV done?
Most often, ECV is not tried until you are at least 36 weeks pregnant. If it is done before then, the baby may still change position.
Can ECV be done for all breech presentations?
Your health care provider will assess your health and the state of your pregnancy to see if ECV is an option for you. Certain conditions may increase the risks associated with ECV or decrease the chance of its success. If you or your baby has any of these conditions, ECV may not be recommended.
How successful is ECV?
More than one half of ECV attempts succeed. Some babies, however, move back into a breech presentation. If that happens, ECV may be tried again. ECV tends to be harder to do as the time for birth gets closer. As the baby grows bigger, there is less room for him or her to move.
How are most breech babies born?
Most breech babies are born by planned cesarean delivery (see the FAQ Cesarean Birth). Like any major surgery, cesarean birth involves risks. These problems occur in a small number of women and usually are easily treated:
- Problems from pain relief medication
It is not always possible to plan for cesarean birth. The baby may move into the breech position just before labor begins. In that case, you will not know that you are going to have a cesarean delivery until you are in labor.
What are the risks of having a vaginal breech birth?
The risk of harm to the baby may be increased in a vaginal breech birth. There also is more chance of a prolapsed umbilical cord. That is when the umbilical cord slips through the cervix into the birth canal before the baby does. This can cause the cord to be pinched, which can stop the flow of blood through the cord to the baby.
Cesarean Delivery: Birth of a baby through an incision made in the mother’s abdomen and uterus.
External Cephalic Version (ECV): A technique, performed late in pregnancy, in which the doctor manually attempts to move a breech baby into the head-down position.
Placenta: Tissue that provides nourishment to and takes waste away from the fetus.
Preterm: Born before 37 weeks of pregnancy.
Ultrasound: A test in which sound waves are used to examine internal structures. During pregnancy, it can be used to examine the fetus.
Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.
If you have further questions, contact your obstetrician–gynecologist.
FAQ079: Designed as an aid to patients, this document sets forth current information and opinions related to women’s health. The information does not dictate an exclusive course of treatment or procedure to be followed and should not be construed as excluding other acceptable methods of practice. Variations, taking into account the needs of the individual patient, resources, and limitations unique to institution or type of practice, may be appropriate.
Copyright August 2011 by the American College of Obstetricians and Gynecologists. No part of this publication may be reproduced, stored in a retrieval system, posted on the Internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.