Breech presentation is a type of abnormal labor that occurs when a baby is not in the normal head-down position in the mother’s uterus during delivery. Instead, the baby’s buttocks and/or feet are positioned to enter the birth canal first, with the head of the baby either tilted back or down near its chest. This type of presentation can lead to more complicated childbirth and can even be dangerous for both mother and child if not handled properly. In order to ensure a safe delivery, it is important for doctors to be aware and prepared for breech presentation as soon as it is detected during prenatal ultrasounds or other tests. Regular monitoring throughout pregnancy can help identify potential problems early on, allowing medical professionals to come up with an appropriate plan of action before labor begins. While some cases will require cesarean sections, there are still a number of ways that breech presentations can be managed successfully through medical intervention or alternative methods. Please keep reading for details on the following topics:

Types of breech presentation

Signs that a baby is in breech presentation

How a breech presentation is diagnosed

How a breech baby appears inside the mother’s womb

TYPES OF BREECH POSITION

• Frank Breech:
  • The baby’s buttocks are pointing downward, with the legs straight up and the feet near the baby’s head.
  • This is the most common type of breech presentation.
• Complete Breech:
  • The baby’s buttocks are pointing downward, with the knees bent, and the feet near the buttocks (in a “cross-legged” position).
• Footling Breech:
  • One or both feet are positioned to come out first. This is more common in premature babies.
• Kneeling Breech:
  • The baby is in a kneeling position, with one or both knees coming out first (rare).

Causes of Breech Presentation

Several factors can increase the likelihood of breech presentation, including:

• Premature delivery: The baby may not have turned head-down yet.

• Uterine abnormalities: Such as fibroids or a bicornuate uterus (abnormally shaped uterus).

• Placenta previa: When the placenta is covering the cervix.

• Excess or insufficient amniotic fluid: Affecting the baby’s ability to move into the head-down position.

• Multiple pregnancies: Twins or more.

• Previous breech birth: Increases the likelihood of recurrence.

• Short umbilical cord: May restrict the baby’s movement.

• Baby’s abnormalities: Certain conditions, such as hydrocephalus, can prevent the baby from turning head-down.

Signs that baby is in breech position

There are several signs and symptoms that may indicate a baby is in a breech position. However, the most accurate confirmation requires medical examination and imaging. Here are the signs to look for:

Maternal Perception of Fetal Movement

1. Kicks felt lower in the abdomen:

   • If the baby is in a breech position, you may feel stronger kicks lower in your pelvis, as the baby’s legs and feet are positioned downward.

2. Pressure or discomfort under the ribs:

   • The baby’s head, which is harder and larger than its buttocks, may press against your ribcage, causing discomfort or pain.

Abdominal Shape

• Irregular shape of the belly:

  • The baby’s head in the upper abdomen might create a different contour compared to a head-down position.

Physical Symptoms

1. Difficulty breathing or rib discomfort:

   • If the baby’s head is pressing against the diaphragm or ribs, you may experience shortness of breath or discomfort.

2. Pelvic pressure or discomfort:

   • Pressure in the lower pelvis may be less pronounced because the softer buttocks, rather than the harder head, are positioned downward.

Doppler Heartbeat Location

• During prenatal checkups, the location of the baby’s heartbeat may provide clues:

  • A heartbeat detected higher in the abdomen may suggest a breech presentation.

HOW A BREECH PRESENTATION IS DIAGNOSED

Breech presentation is typically diagnosed through:

1. Physical Examination:
   • Feeling the baby’s position through the mother’s abdomen.
   • Identifying the position of the baby’s head and buttocks.
2. Ultrasound:
   • The most reliable way to confirm a breech position is through an ultrasound scan. This imaging provides a clear view of the baby’s position.
3. Leopold’s Maneuvers:
   • A series of palpation techniques used by healthcare providers to determine fetal position.
   • Your doctor or midwife may feel for the baby’s position by palpating your abdomen. In breech cases:
     • The head is felt higher in the uterus.
     • The softer buttocks may be felt near the pelvis.
4. Pelvic Exam:
   • In late labor, a vaginal exam may reveal the baby’s buttocks, feet, or knees presenting first.

HOW A BREECH PRESENTATION IS MANAGED

1. External Cephalic Version (ECV):
   • A manual procedure performed at 37 weeks of gestation to try to turn the baby into the head-down position.
   • Performed under ultrasound guidance and with monitoring of the baby’s heart rate.
   • Success rate: ~50-60%.
2. Planned Cesarean Section:
   • Often recommended for breech presentation to reduce risks associated with vaginal delivery, such as cord prolapse or head entrapment.
3. Vaginal Breech Delivery:
   • May be an option under specific conditions:
     • The baby is in frank breech position.
     • The labor is progressing well, and the healthcare team is experienced.
     • There are no other risk factors (e.g., placenta previa or fetal distress).
4. Monitoring:
   • If breech presentation is identified earlier in pregnancy (before 37 weeks), close monitoring is done as many babies spontaneously turn head-down closer to term.
5. Postural management– adopting various positions to assist with turning the fetus

Complications of Breech Presentation

• Cord Prolapse: The umbilical cord slips into the birth canal ahead of the baby, cutting off oxygen supply.
• Birth Injuries: Increased risk of trauma to the baby during delivery.
• Delayed Progression of Labor: Due to the baby’s position.
• Hypoxia: If delivery takes too long, the baby may not get enough oxygen.

When to Seek Medical Advice

• If you suspect your baby is in a breech position, or if you’re past 36 weeks of pregnancy, consult your healthcare provider.
• If you feel unusual fetal movements or changes in the baby’s position.
• If you suspect labor is starting while your baby is still in breech presentation.

Disclaimer: The information provided in this content is for general informational purposes only. It is not intended as medical or healthcare advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare professional with any questions you may have regarding a medical condition or healthcare decisions.