If your baby’s buttocks is down in the birth canal the baby is in a breech position. The term breech was derived from the term britches, which is what we call clothing covering the lions and thighs.
Early in most pregnancies the baby is in a breech position, however as you approach your due date, most babies turn spontaneously and the head is in the birth canal. Only about 3 to 4 percent of babies at term will remain in a breech position.
If your baby is breech, it is important to understand the type of breech. There are three types of breech configurations, frank breech, complete breech and footling breech.
With a frank breech both legs are bent over the hips and both feet are touching the head. This configuration places the baby’s buttock down into the birth canal.
A complete breech is similar to the frank breech, but one or both legs are bent at the knees. The buttock is still down in the birth canal, but the feet may not be extended to touch the head.
A footling breech is when the baby has one or both feet in the birth canal below the buttocks.
When you are near term and your physician expects that your baby is in a breech presentation, your physician will do an ultrasound to identify the part of your baby that is lying in the birth canal. Ultrasound will also help identify the type of breech.
There are many complications associated with a baby that remains in a breech position as your due date approaches:
- Umbilical cord prolapse – Is a rare emergency that occurs when the umbilical cord enters the birth canal before the baby. It is a life threatening obstetrical emergency for the baby, since the blood flow to the baby is slowed or stopped completely. Umbilical cord prolapse is most y seen in the footling breech.
- Placenta previa – refers to the presence of the after birth (placenta) overlying or proximate to the birth canal. Bleeding, which ranges from spotting to hemorrhagic, is the main complication. It is believed that the placenta gets in the way of the baby turning and the baby remains in a breech position.
- Congenital anomalies – A major birth defect is one of medical, surgical or cosmetic significance for the baby. The prevalence of these defects is 2 to 4 percent among all births. The breech infant is associated with a higher incidence of birth defects than non-breech deliveries.
- Uterine abnormalities – such as a uterine septum, intrauterine adhesions, or fibroids are associated with a baby remaining in the breech position at term. The true incidence of uterine anomalies is hard to determine because most pregnant women do not have any symptoms from the anomaly. It is believed that uterine abnormalities occur in 2 to 4 percent of women with normal pregnancies.
- Difficult delivery – Vaginal delivery of the breech baby is associated with a higher incidence of injury to the baby at the time of delivery. Several specific types of injuries are seen. Fracture of the humerus (arm) and clavicle (shoulder) cannot always be avoided, and fracture of the femur (leg) may be sustained during difficult breech extractions.
Current Thinking on Breech Birth
The American College of Obstetricians and Gynecologists recommends that all first time moms with a breech presentation at term should undergo a planned cesarean birth.
The American College of Obstetricians and Gynecologists also recommend that external cephalic version (manually rotating the baby to a head down position) should be offered when a breech presentation is recognized prior to labor and is greater than 36 weeks pregnant. External version success rate is around 58 percent.
SUMMARY AND RECOMMENDATIONS
- There are three main types of breech position frank, complete, or footling.
- Breech position is found in 3 to 4 percent of term pregnancies.
- Breech position may be associated with fetal or uterine abnormality.
- The diagnosis of breech position is usually based on your physician’s physical examination, and then confirmed with ultrasound.
- If your baby is in a breech position it can be turned by external version, undergo a vaginal breech birth, or you can have a cesarean breech delivery.
- The American College of Obstetricians and Gynecologists recommends an external cephalic version for women with breech presentation at term to reduce the rate of breech birth and cesarean delivery.
- For persistent breech position in first time moms, American College of Obstetricians and Gynecologists suggests planned cesarean delivery.