Breech Babies

October 10, 2008

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Breech Babies

by Marjorie Greenfield, M.D.
reviewed and revised by Marjorie Greenfield, M.D.

More than 95 percent of full-term babies are positioned "head down" (cephalic presentation) in the uterus; 3-4 percent are breech, meaning that they are buttocks or feet first; and a few lie crossways (transverse lie). By the end of the third trimester, a fetus that is in the cephalic presentation usually stays that way, while breech or transverse babies will continue to change positions. In this way, most fetuses that have been in numerous different positions will eventually get headfirst and stay there.

How to tell if a baby is breech
Often where a pregnant woman feels the most fetal movement is where the baby's feet are. If you feel kicks near the top of your uterus, the baby is more likely to be headfirst. If the kicks are all down low, it may be breech. Also, some women experience more shortness of breath or discomfort under their ribs when the baby is breech and the head is pressing up.

Even if you can't tell how your baby is positioned, your practitioner may be able to figure it out by examining your abdomen. A baby's head seems hard and round and feels like it moves separately from the baby's back. A baby's butt can also feel pretty hard, though, so sometimes the practitioner still won't know its position for sure.

Vaginal examination late in the pregnancy can also suggest breech. Even if the cervix is closed, the lower part of the uterus may be thin enough to feel the bones of a baby's skull (or the chubbiness of the buttocks) through it.

Sometimes the practitioner just can�t be sure of the baby�s position. In this case, the definitive test is usually ultrasound. And sometimes, despite all these checks, a baby can still surprise a practitioner at the last minute, during labor.

Why are some babies breech?
While practitioners may not be able to tell in every case, there are some factors that can play a role in babies being breech.

The baby is not yet full term. If the mother goes into labor early, a baby may not have had the chance to settle into the cephalic presentation. More preterm babies than full-term babies are born breech.

The mother has had a lot of babies. A relaxed, stretched-out abdominal wall allows a fetus to change position more freely, so once the baby aligns itself headfirst, it may not "stick" there like it would if it were held in place by a tighter abdomen.

Also, in most first pregnancies, the baby is engaged into the pelvis by full term. But in women who have already had children, the baby may not engage until partway through labor (again, allowing the baby to change position more freely).

Multiple fetuses. In twins, triplets, and larger sets of multiples, one of the babies will frequently be breech or transverse, because there often isn't enough room for all of them to line up headfirst. While the first baby's head may fit nicely into the mother's pelvis, keeping it headfirst, the subsequent ones don't have the bowl of the pelvis to fit into.

Too much or too little amniotic fluid. When there is excess amniotic fluid, the baby's position may be unstable, allowing easier rotation from cephalic to breech and back. Conversely, very little amniotic fluid may hinder the baby's ability to rotate to headfirst.

Obstruction to the baby assuming the headfirst position. If the placenta is down across the cervix, as in placenta previa, or if fibroid tumors are present down there, there may not be room for the baby's head to settle into the pelvis. Usually these conditions are readily diagnosed on ultrasound.

Sometimes the uterus has an unusual shape or a dividing wall up the middle (septum) so that the baby may not be able to move into a cephalic presentation. This type of obstruction might not be recognized unless a C-section is done.

The baby has a neurological problem. In a few cases of breech presentation, the baby doesn't move well enough to get into a headfirst position because of a neurological problem. One of the controversies about allowing breech vaginal delivery is that if the baby shows neurological problems after birth, it may be unclear if they were caused by a difficult vaginal breech delivery or if they predated the birth. For more on this subject, see Delivering a Breech Baby.

Unknown factors. Much of the time, practitioners never find out why a baby was breech at full term. A percentage of healthy babies who showed no risk factors for breech are nonetheless in a feet- or butt-first position when it is time to be born.


RELATED INFORMATION

			Cesarean Birth
			The Developing Fetus, Weeks 25-40
			Multiple Pregnancy
			Breech Babies

Created March 20, 2001
Reviewed and revised August 05, 2004

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