breech presentation 28 weeks pregnant

An official website of the United States government

The .gov means it's official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Publications
Account settings
Browse Titles

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

StatPearls [Internet].

Breech presentation.

Caron J. Gray ; Meaghan M. Shanahan .

Affiliations

Last Update: November 6, 2022 .

Continuing Education Activity

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 are frank, complete, and incomplete. 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. This activity reviews the cause and pathophysiology of breech presentation and highlights the role of the interprofessional team in its management.

Determine the pathophysiology of breech presentation.
Apply the physical exam of a patient with a breech presentation.
Differentiate the treatment options for breech presentation.
Communicate the importance of improving care coordination among interprofessional team members to improve outcomes for patients affected by breech presentation.
Introduction

Breech presentation refers to the fetus in the longitudinal lie with the buttocks or lower extremity entering the pelvis first. The 3 types of breech presentation are frank, complete, and incomplete. 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 fetus sitting with flexion of both hips and both legs in a tuck position. Finally, the incomplete breech can have any combination of 1 or both hips extended, also known as footling (one leg extended) or double footling breech (both legs extended). [1] [2] [3]

Clinical conditions associated with breech presentation may increase or decrease fetal motility or affect the vertical polarity of the uterine cavity. Prematurity, multiple gestations, aneuploidies, congenital anomalies, Mullerian anomalies, uterine leiomyoma, and placental polarity as in placenta previa are most commonly associated with a breech presentation. Also, a previous history of breech presentation at term increases the risk of repeat breech presentation in subsequent pregnancies. [4] [5] These are discussed in more detail in the pathophysiology section.

Epidemiology

Breech presentation occurs in 3% to 4% of all term pregnancies. A higher percentage of breech presentations occurs with less advanced gestational age. At 32 weeks, 7% of fetuses are breech, and 25% are breech at 28 weeks or less.

Specifically, following 1 breech delivery, the recurrence rate for the second pregnancy was nearly 10%, and for a subsequent third pregnancy, it was 27%. Some have also described prior cesarean delivery as increasing the incidence of breech presentation twofold.

Pathophysiology

As mentioned previously, the most common clinical conditions or disease processes that result in breech presentation affect fetal motility or the vertical polarity of the uterine cavity. [6] [7] Conditions that change the vertical polarity or the uterine cavity or affect the ease or ability of the fetus to turn into the vertex presentation in the third trimester include:

Mullerian anomalies: Septate uterus, bicornuate uterus, and didelphys uterus
Placentation: Placenta previa as the placenta occupies the inferior portion of the uterine cavity. Therefore, the presenting part cannot engage
Uterine leiomyoma: Larger myomas are mainly located in the lower uterine segment, often intramural or submucosal, and prevent engagement of the presenting part.
Prematurity
Aneuploidies and fetal neuromuscular disorders commonly cause hypotonia of the fetus, inability to move effectively
Congenital anomalies: Fetal sacrococcygeal teratoma, fetal thyroid goiter
Polyhydramnios: The fetus is often in an unstable lie, unable to engage
Oligohydramnios: Fetus is unable to turn to the vertex due to lack of fluid
Laxity of the maternal abdominal wall: The Uterus falls forward, and the fetus cannot engage in the pelvis.

The risk of cord prolapse varies depending on the type of breech. Incomplete or footling breech carries the highest risk of cord prolapse at 15% to 18%, complete breech is lower at 4% to 6%, and frank breech is uncommon at 0.5%.

History and Physical

During the physical exam, using the Leopold maneuvers, palpation of a hard, round, mobile structure at the fundus and the inability to palpate a presenting part in the lower abdomen superior to the pubic bone or the engaged breech in the same area, should raise suspicion of a breech presentation.

During a cervical exam, findings may include the lack of a palpable presenting part, palpation of a lower extremity, usually a foot, or for the engaged breech, palpation of the soft tissue of the fetal buttocks may be noted. If the patient has been laboring, caution is warranted as the soft tissue of the fetal buttocks may be interpreted as caput of the fetal vertex. Any of these findings should raise suspicion, and an ultrasound should be performed.

An abdominal exam using the Leopold maneuvers in combination with the cervical exam can diagnose a breech presentation. Ultrasound should confirm the diagnosis. The fetal lie and presenting part should be visualized and documented on ultrasound. If a breech presentation is diagnosed, specific information, including the specific type of breech, the degree of flexion of the fetal head, estimated fetal weight, amniotic fluid volume, placental location, and fetal anatomy review (if not already done previously), should be documented.

Treatment / Management

Expertise in the delivery of the vaginal breech baby is becoming less common due to fewer vaginal breech deliveries being offered throughout the United States and in most industrialized countries. The Term Breech Trial (TBT), a well-designed, multicenter, international, randomized controlled trial published in 2000, compared planned vaginal delivery to planned cesarean delivery for the term breech infant. The investigators reported that delivery by planned cesarean resulted in significantly lower perinatal mortality, neonatal mortality, and serious neonatal morbidity. Also, the 2 groups had no significant difference in maternal morbidity or mortality. Since that time, the rate of term breech infants delivered by planned cesarean has increased dramatically. Follow-up studies to the TBT have been published looking at maternal morbidity and outcomes of the children at 2 years. Although these reports did not show any significant difference in the risk of death and neurodevelopmental, these studies were felt to be underpowered. [8] [9] [10] [11]

Since the TBT, many authors have argued that there are still some specific situations in that vaginal breech delivery is a potential, safe alternative to a planned cesarean. Many smaller retrospective studies have reported no difference in neonatal morbidity or mortality using these criteria.

The initial criteria used in these reports were similar: gestational age greater than 37 weeks, frank or complete breech presentation, no fetal anomalies on ultrasound examination, adequate maternal pelvis, and estimated fetal weight between 2500 g and 4000 g. In addition, the protocol presented by 1 report required documentation of fetal head flexion and adequate amniotic fluid volume, defined as a 3-cm vertical pocket. Oxytocin induction or augmentation was not offered, and strict criteria were established for normal labor progress. CT pelvimetry did determine an adequate maternal pelvis.

Despite debate on both sides, the current recommendation for the breech presentation at term includes offering an external cephalic version (ECV) to those patients who meet the criteria, and for those who are not candidates or decline external cephalic version, a planned cesarean section for delivery sometime after 39 weeks.

Regarding the premature breech, gestational age determines the mode of delivery. Before 26 weeks, there is a lack of quality clinical evidence to guide the mode of delivery. One large retrospective cohort study recently concluded that from 28 to 31 6/7 weeks, there is a significant decrease in perinatal morbidity and mortality in a planned cesarean delivery versus intended vaginal delivery, while there is no difference in perinatal morbidity and mortality in gestational age 32 to 36 weeks. Of note is that no prospective clinical trials examine this issue due to a lack of recruitment.

Differential Diagnosis

The differential diagnoses for the breech presentation include the following:

Face and brow presentation
Fetal anomalies
Fetal death
Grand multiparity
Multiple pregnancies
Oligohydramnios
Pelvis Anatomy
Preterm labor
Primigravida
Uterine anomalies
Pearls and Other Issues

In light of the decrease in planned vaginal breech deliveries, thus the decrease in expertise in managing this clinical scenario, it is prudent that policies requiring simulation and instruction in the delivery technique for vaginal breech birth are established to care for the emergency breech vaginal delivery.

Enhancing Healthcare Team Outcomes

A breech delivery is usually managed by an obstetrician, labor, delivery nurse, anesthesiologist, and neonatologist. The ultimate decision rests on the obstetrician. To prevent complications, today, cesarean sections are performed, and experience with vaginal deliveries of breech presentation is limited. For healthcare workers including the midwife who has no experience with a breech delivery, it is vital to communicate with an obstetrician, otherwise one risks litigation if complications arise during delivery. [12] [13] [14]

Review Questions
Access free multiple choice questions on this topic.
Click here for a simplified version.
Comment on this article.

Disclosure: Caron Gray declares no relevant financial relationships with ineligible companies.

Disclosure: Meaghan Shanahan declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

Cite this Page Gray CJ, Shanahan MM. Breech Presentation. [Updated 2022 Nov 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

In this Page

Bulk download.

Bulk download StatPearls data from FTP

Related information

PMC PubMed Central citations
PubMed Links to PubMed

Recent Activity

Breech Presentation - StatPearls Breech Presentation - StatPearls

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

Connect with NLM

National Library of Medicine 8600 Rockville Pike Bethesda, MD 20894

Web Policies FOIA HHS Vulnerability Disclosure

Help Accessibility Careers

Third Trimester
Labor & Delivery

What Does It Mean to Have a Breech Baby?

You’re almost full term and the finish line is approaching, when suddenly your OB or midwife informs you that baby is breech—plot twist! If baby is in a breech position, it means their feet or bottom is pointed toward your cervix rather than their head. You’ve just encountered an early example of a universal truth in parenting: Few things ever go as perfectly as you planned.

A breech birth often means a c-section delivery is in store for you, and that can feel disappointing and worrisome, especially if you’ve been hoping to deliver vaginally. Deep breath— you may still have options; your doctor will talk you through everything well before the big day comes. In the meantime, it’s helpful to get a better grasp on all things breech baby. Want to know how to tell if baby is breech, what the position means for your pregnancy, how it affects delivery and ways your doctor (and you!) can try to turn baby? Read on for the full lowdown.

What Is a Breech Baby?

In the last few weeks of pregnancy, most babies move in the womb so that their heads are facing down, positioned to come out of the vagina first during delivery. But if baby is breech, their head is not approaching the birth canal; rather, it’s their feet or bottom that’s poised to come out first.

Types of breech positions

There are three different types of breech positions, according to the American Pregnancy Association :

Complete. Baby’s buttocks are pointing down and legs are crossed beneath it
Frank. Baby’s bottom is positioned down and legs are pointed up toward the head
Footling. Baby has one leg pointed toward the cervix, poised to deliver before the rest of their body. “There’s also a double footling breech, where the baby’s feet and legs are facing down toward the cervix,” says Elizabeth Deckers , MD, director of the maternal quality and safety program at Hartford HealthCare.

Baby could also be in a transverse lie position (occasionally referred to as a transverse breech position). This means that they’re horizontal across the uterus instead of vertical.

What percentage of babies are breech?

According to the American Pregnancy Association, approximately 1 out of every 25 full-term births involves a baby in a breech position. That means roughly 4 percent of babies have their bottom and/or feet pointed down toward the birth canal.

Why a Breech Position Can Be a Concern

Your doctor won’t be too concerned if baby is in a breech position throughout most of your pregnancy. In fact, it’s likely that at some point in your second or early third trimester, baby will be breech. At this early stage, though, baby is smaller and has more room to move around and turn, notes Deckers.

As baby grows and your due date nears, a breech position becomes slightly more concerning. For starters, there’s some evidence linking a breech presentation—and its tendency to reduce the amount of space in the womb—with hip dysplasia , a condition where the ball and socket joint of baby’s hip doesn’t properly form.

Your doctor or midwife may raise a red flag if baby is in breech position at 36 weeks or later. At this point, they’ll probably start talking about the potential need for a c-section. “Vaginal breech delivery is no longer commonly done in the US because about 20 years ago there was a large, well-designed trial that showed there was more risk to the fetus of going through a vaginal breech delivery versus being born by a c-section,” says Deckers. The trial showed that breech babies born vaginally were more likely to have fetal fractures and a harder time getting out of the birth canal, says Amber Samuel , MD, medical director of Obstetrix Maternal-Fetal Medicine Specialists of Houston. Deckers reiterates this, noting that most babies in the US identified as breech will be born via c-section, as doctors “believe it’s safer in the short run for baby.”

What Causes a Breech Pregnancy?

Don’t beat yourself up or worry that you did something wrong in pregnancy to put baby into a breech position. The truth is there’s usually no rhyme or reason to explain baby’s breech presentation, says Samuel. That said, if you have a uterine anomaly, where your uterus is wider at the top or generally more narrow, it may play a role, she says. “If the shape is abnormal, some babies get stuck,” she says. Having too much amniotic fluid around baby might also be a potential factor.

The American College of Obstetricians and Gynecologists (ACOG) lists other factors that might contribute to baby being breech: you’ve been pregnant before, you’re expecting twins or multiples, you have placenta previa (where your placenta is covering part of your uterine opening) or baby is preterm . Suffice it to say, though, that these potential breech baby causes are out of your control.

How to Tell If Baby Is Breech

You might be able to detect that baby is breech if you feel them kick low near your cervix or feel their head under your ribs, says Deckers. Samuel notes that some moms who’ve had babies before are really good at determining how and where they’re positioned.

Doctors gauge baby’s position by placing their hands on different parts of your belly to feel where fetal parts are, a technique known as Leopold’s maneuvers, explains Samuel. They may also perform a cervical exam to see if they can feel any presenting parts. Sometime around 36 or 37 weeks, they’ll confirm baby’s position with an ultrasound.

What to Expect from a Breech Pregnancy

You may not know if or when baby is in a breech position. Earlier on in your pregnancy, when they’re smaller and have more room in the womb, they may flip all around; roughly 20 percent of babies are breech at 28 weeks, says Samuel. If you discover that your little acrobat is breech at this stage, don’t panic; there’s still more than enough time for them to flip into the preferred position (and then possibly do a few more rotations).

Are breech babies more painful to carry?

The good news: Breech presentation doesn’t typically cause discomfort or pain during pregnancy, Samuel says. Pain is more likely related to “prior scar tissue, the size of your baby and your pregnancy history,” she adds.

What to Expect from a Breech Delivery

There is a possibility for a vaginal breech birth under the right circumstances. Deckers notes that you may be a candidate if baby is in a frank or complete breech presentation and your pelvic structure is adequate for vaginal birth—and if your hospital has guidelines in place for a planned vaginal breech delivery. Unfortunately, the risk of the umbilical cord falling through the cervix is too high with a double footling breech; there’s also a higher risk that baby will get stuck during delivery, which can cause birth asphyxia. Of course, you’ll also want to ensure that your doctor has a lot of experience with vaginal breech delivery and that your hospital will allow it.

If baby is in a breech position beyond 36 weeks and your doctor feels that a vaginal birth is too risky, they’ll likely recommend that you allow them to try turning baby— more on that soon . If that’s not successful, you’ll be scheduled for a c-section, says Samuel.

Having twins where one is breech changes the game a little too. If the baby that’s poised to come out first is breech, you’ll have to deliver via c-section, says Deckers. But if the first baby is head down and second is not, you and your OB have three options: deliver both via c-section; deliver the first baby vaginally and then attempt to turn the second one to deliver vaginally (if it’s unsuccessful, you’ll proceed with a c-section) or deliver the first vaginally and then do a breech extraction of the second baby (your OB will reach inside to grasp baby’s feet and pull them down.)

“The ability to do a safe breech extraction depends on the gestational age of the babies, how well the mother and babies are tolerating labor, the size of the babies and a provider with experience in performing this procedure,” says Deckers.

How to Turn a Breech Baby

Many parents want to have a vaginal birth; what’s more, they know that a c-section is a major surgery with inherent risks. To that end, before scheduling a c-section, most doctors will suggest trying an external cephalic version (ECV), which is an attempt to turn baby from the outside.

First you’ll be given medication to relax your uterus; don’t worry, your doctor will continually monitor baby. “One hand elevates the fetal breech out of the pelvis and you push up and away from the pelvis,” says Samuel. “The other hand is on the back of baby’s head to induce them to turn over—it looks like an aggressive belly massage.”

Your doctor will push baby forward before attempting a backward roll. “You can tell pretty early into it whether it’s going to work or not—some babies are ready to flip, some aren’t,” says Samuel. “We try not to struggle too much with it.”

External cephalic versions are successful roughly 58 percent of the time, says Deckers, although there’s always the chance that baby will flip back to breech on their own. If the turning is successful and you’re at 39 weeks, you can choose to be induced. If it didn’t work, you’ll be scheduled for a c-section. ECVs should only be performed in hospitals equipped to perform emergency c-sections ; risks of the procedure, which are rare, include bleeding from the placenta, rupture of membranes and going into labor, says Samuel.

It’s also worth noting that not every mom is a candidate for an EVC. If you’re having multiples or there’s a problem with placental position, an EVC is too risky, according to the ACOG.

Safe ways to try to turn a breech baby at home

If you prefer to try to make things happen on your own, there are a few things you can do to help turn a breech baby from the comfort of your home. Deckers notes, though, that research on DIY techniques hasn’t provided strong enough evidence to prove that they really work.

A little bit of gentle prenatal yoga may help. One pose to practice? Deckers says some moms try “a head down/knee-to-chest position.” You can also assume a few different sleeping positions to turn a breech baby: “Mothers can try positional things like elevating your pelvis,” she says. Finally, Deckers mentions two Eastern medicine techniques that many moms actively seek out: acupuncture and moxibustion, a therapy that involves waving burning dried plant bundles over specific parts of the body to encourage baby to turn on their own. These methods have been long used, but she points out that the efficacy of these methods haven’t been proven in trials, so “the data isn’t compelling enough to say this is something you should do.”

What to Expect for a Breech Baby After Birth

If baby is presenting breech and you and your doctor decide to move forward with a vaginal delivery, there are some potential complications to be aware of that could ultimately affect baby’s health and well being.

It’s possible for baby’s head or shoulders to get wedged against your pelvic bones; a prolapsed umbilical cord could also decrease blood flow and cut off baby’s oxygen supply, explains the ACOG. That said, even a planned c-section comes with its own set of risks.

Welcoming a healthy baby into the world is the ultimate goal, regardless of how they’re delivered. Interestingly, babies who’ve been in breech presentation and are delivered via c-section tend to have nicely shaped heads because there’s none of the swelling and other head-shifting changes that occur in babies delivered through the birth canal, notes Deckers.

Do breech babies have problems later in life?

Sometimes babies who were breech have issues with their hips, as having one or both legs extended in a partially straight position rather than crossed can prevent a baby’s hip socket from developing properly. If your child was breech, Deckers recommends following up with your pediatrician.

Having a breech baby was probably not in your original birth plan. Your stubborn little one may turn before their grand debut, or they may—quite literally—put their foot down and refuse to budge. Either way, talk to your doctor about any concerns. And remember, the good news is that baby is coming soon, either way!

Please note: The Bump and the materials and information it contains are not intended to, and do not constitute, medical or other health advice or diagnosis and should not be used as such. You should always consult with a qualified physician or health professional about your specific circumstances.

Plus, more from The Bump:

What to Expect During Your C-Section Recovery

The Best Prenatal Poses for Better Sleep

How to Care for Your C-Section Scar

Elizabeth Deckers , MD, is the director of the maternal quality and safety program at Hartford HealthCare. She received her medical degree from the University of Connecticut School of Medicine in Farmington.

Amber Samuel , MD, is the medical director of Obstetrix Maternal-Fetal Medicine Specialists of Houston. She earned her medical degree at Baylor College of Medicine in Houston, Texas.

American Pregnancy Association, Breech Presentation

Lancet, Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Term Breech Trial Collaborative Group , October 2000

American College of Obstetricians and Gynecologists (ACOG), If Your Baby Is Breech

Learn how we ensure the accuracy of our content through our editorial and medical review process .

Navigate forward to interact with the calendar and select a date. Press the question mark key to get the keyboard shortcuts for changing dates.

Next on Your Reading List

pregnant woman deep breathing on couch at home

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 vertex 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.

Cookie Preferences

This icon serves as a link to download the eSSENTIAL Accessibility assistive technology app for individuals with physical disabilities. It is featured as part of our commitment to diversity and inclusion. M

Type 2 Diabetes
Heart Disease
Digestive Health
Multiple Sclerosis
Diet & Nutrition
Health Insurance
Public Health
Patient Rights
Caregivers & Loved Ones
End of Life Concerns
Health News
Thyroid Test Analyzer
Doctor Discussion Guides
Hemoglobin A1c Test Analyzer
Lipid Test Analyzer
Complete Blood Count (CBC) Analyzer
What to Buy
Editorial Process
Meet Our Medical Expert Board

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.

Search Please fill out this field.
Newsletters
Sweepstakes
Labor & Delivery

What Causes Breech Presentation?

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.

FatCamera/Getty Images

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.