Breech presentation is when a baby enters the birth canal feet or buttocks first. The frank breech position is the most common type, and prematurity is the main cause. Diagnosis requires a fetal ultrasound, and an external cephalic version may be attempted to turn the baby. Vaginal delivery is possible, but a caesarean section may be necessary if the baby shows signs of distress.
A breech presentation is a birthing position in which a baby enters the birth canal feet or buttocks first, as opposed to head-down or “vertex” presentation. The frank breech position is the most common of the four types of breech presentations. In free breech, the baby’s rear is facing the mother’s cervix, with the legs extended at the knees and the feet placed on either side of the head. The frank breech position is present in 65-70% of all breech deliveries.
In more than 50% of breech deliveries, there is no obvious cause for the baby’s inability to position in the normal head-down presentation. In the remaining cases, there are specific factors that encourage free breech and other breech positions. Prematurity is the main cause of breech births. Abnormal amniotic fluid volume, history of premature birth, and previous cesarean delivery are other common causes of breech placement.
Based on symptoms alone, it is difficult to determine whether a child is in the free breech position. Most breech presentations don’t seem out of the ordinary for the mother. However, women who are more than 36 weeks pregnant and experience pressure or kicks in the lower abdomen should visit a doctor for an examination. During this visit, your doctor may examine your cervix and feel your upper and lower abdomen to ascertain their placement. A conclusive diagnosis of frank breech presentation requires fetal ultrasound.
Normally, as a baby increases in size, a head-down presentation will naturally occur. At 32 weeks gestation, nearly 25% of babies are in the breech position. This number drops to 3% forward. If a woman is nearing term and the baby remains in the breech free position, a midwife or doctor may attempt to turn the baby by manually manipulating the uterus. This procedure is known as an external cephalic version or ECV. Many times this technique is successful. In other cases, the baby may be too big to move or may return to the breech position.
About 30-50% of breech babies are delivered vaginally. In frank breech presentation, vaginal delivery is favored. The deciding factors for the method of delivery depend on the estimated weight of the baby and the experience of the midwife or doctor. Fetal monitoring will be used throughout the labor process if a vaginal birth is attempted. If the baby shows any signs of distress, a caesarean section will be considered.
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