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Written by

Roxanne Albert, BSN, RNC-OB

Breech Positions and Birth Options

  • Birth Options

Breech Positions is where baby’s head is up towards to top of the uterus and the baby’s feet or butt is down towards the cervix.

This is a variation of normal, and around 3% of babies are in this position at birth. There are different variations of breech, and our birth options are different than with a cephalic (head down) positioned baby.

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Why is Breech a big deal?

Breech is a variation of normal that receives a lot of attention during pregnancy. When baby is breech it leads to increased stress and anxiety for many due to our limited options in the US. 

This is due to one study published in 2000, Term Breech Trial, stating that breech vaginal birth is dangerous and c-section is the safer options. The study has since been questioned by professionals and some have shown that their conclusion is flawed. When this study came out though, they stopped offering vaginal breech delivery as an option in many places. Now 23 years later, the skill of delivering babies in the breech position has almost completely disappeared.

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One of the faults of the study is that they compared Breech Vaginal Delivery to Breech C-section Delivery, but in reality they should be comparing Breech Vaginal Delivery to Cephalic Vaginal Delivery. There is an increased risk to having a breech vaginal delivery versus cephalic, but its not as statistically significant compared to breech vaginal versus breech c-section. 

C-section delivery risk-wise is the safer option for baby in both presentations, but no one is recommending C-section for all cephalic babies! 

Even when multiple people have since published the flaws of the Term Breech Trial, Routine practice in OB for Breech babies has not changed. C-section is still the recommended route of delivery when baby is breech at term and it is HARD to find a provider that will support a vaginal breech delivery in today’s times.  

Breech Positions

Just like with cephalic babies, there are different variations of breech. They have to do mostly with the position of the legs and feet and what is the presenting part to the cervix. 

All of the Breech positions, except for footling breech, as candidates for a breech vaginal delivery because the size of a baby’s buttocks when the hips are flexed is enough to dilate the cervix to 10cm. 

Frank Breech

Baby’s buttocks is the presenting part and the legs are fully extended with the feet up by the head. 

Complete Breech

Most common variation, This is when the buttocks is at the bottom with the knees flexed with both feet down away from the face. May be down by the buttocks or near the abdomen.

Incomplete Breech

A combo of frank and complete breech almost. This is the buttocks is down, one knee is flexed and the other leg is extended with one foot down and the other foot upward by either the belly or the head. 

Footling Breech

This is when the feet are the presenting part to the cervix, and the buttocks is not applying pressure on the cervix. 

This is not commonly seen when a baby is Term due to the amount of space available in the uterus. It is nearly impossible for a baby at term to fully extend their legs out. This is more commonly seen in pre-term babies when there is more space in the uterus. 

If baby is truly footling, this can present an issue for vaginal delivery because the leg can go through the cervix before it is fully dilated versus the options above. 

What to do if baby is Breech?

If you learn at your anatomy scan that baby is breech, this is when advocacy of your own prenatal care becomes important. Most babies who are breech at 20 weeks will flip by term, but for that 3% that do not flip knowing your options can be helpful to start taking action at 20 weeks versus 36weeks. 

Some Questions to Ask you Provider: 

  • What your options are if baby does not flip?
  • Do they only do C-sections, offer ECVs, or do they perform breech vaginal deliveries? 
  • If they do not do breech vaginal deliveries, do they know of a provider in the area who does offer this service? 
  • What are the risks and benefits of each option?
  • If you plan to have future children, how will this affect those births?
 

Ask the questions and seek out answers on your own if needed! Especially if the answer your provider gives you is not the right one for you. 

Birth Options

What are your options if baby is breech??

C-section

This is an abdominal surgery where they will pull baby out through a lower abdominal and uterine incision. Based on studies it has been shown to have less risks for babies, but it is NOT risk free for the mother or birthing person! 

Usually offered/scheduled around 39 weeks. If you go into labor or your water breaks, they recommend coming in then to have your c-section earlier.

ECV (External Cephalic Version)

This is when they try to flip baby head down from the outside manually. It is a procedure done in the OR or in a labor room with or without pain management. 

Each hospital and provider has a different protocol on how it is done, so good question to ask on what to expect the day of!

Usually offered around 37 weeks just in case baby goes into distress from the procedure and an emergency c-section is indicated, BUT asking if it can be done earlier and more than once may be an option you can advocate for in some hospitals. 

Breech Vaginal Birth

This is when baby is born and moves through the birthing canal in the breech position. The cardinal movements of breech delivery is different than head down, and the manuevers to assist are different. Which is why it is safest to have a SKILLED provider. Which can be hard to find. 

Some great resources for breech vaginal delivery information:

@birthinginstincts

@breechwithoutborders

Ways to Maybe Flip Baby

If vaginal breech birth is not an option for you in your area, or you choose to not explore that options. What other ways can you maybe flip baby so they are head down??

  • Chiropractic Adjustments from a Webster Certified Chiropractor
  • Forward Leaning Inversion held for 3 breaths, 7-14 times a day
  • Breech Tilt Holds
  • Moxibustion
  • Acupuncture
 

Conclusion

Breech Position is not a bad thing! It is a variation of normal that sometimes babies stay in till term. There is nothing wrong with you or anything you did wrong that caused baby to be breech!

What is hard about having a breech baby is your limited options for childbirth. If your baby is breech, and not flipping, it may be time to start exploring all your options to see which option fits your needs!