Breech Baby: Causes, Complications, and Treatment Options

Safely giving birth to a breech baby can be tricky. There are ways to help one get into the right position in time for labor and delivery, but if they don’t work, you might need a C-section.

Read on to learn everything you need to know about the breech position, including its variations, causes, treatments, and more.

The breech position is when your baby’s bottom, feet, or both are facing down in the uterus. It happens in about 3% of full-term pregnancies and may cause complications during birth. 1

Most babies get into the vertex or cephalic presentation (head down in the uterus) in the last few weeks of pregnancy. It’s the ideal birthing position, as it allows your baby to come out head-first during birth, which is safer.

Why is the breech position risky?

You might already know that it’s risky for babies to be born when they’re still in the breech position because it can lead to various complications during birth. For instance, your baby’s umbilical cord might slip down into your vagina before him, which is known as umbilical cord prolapse. This can cut off his blood and oxygen supply as the baby comes down the canal and puts pressure on the cord.

Delivering your breech baby vaginally also puts him at risk of fetal entrapment, where his head gets trapped in your birth canal since his body didn’t stretch your cervix wide enough. This puts both you and your baby at a higher risk of injury and can even be fatal for him. 2 3

Fortunately, doctors have ways of delivering breech babies safely, something we’ll talk about in more detail further down.

What are the different types of breech positions?

There are three types of breech position your baby could be in:

• Frank breech: This means your baby’s buttocks are facing down (close to your birth canal), and his legs are stretched straight up with his feet close to his head. 3
• Complete breech: Your baby’s buttocks are also facing down, but his knees are bent, with his feet near his bottom.
• Footling breach: One or both of your baby’s feet are pointing down, lowered over your cervix. This position has a higher risk of complications.

In rare cases (about 1% of pregnancies), your baby may be lying horizontally in your uterus (referred to as a transverse lie), with his shoulder, arm, or trunk facing your birth canal. This is more likely to occur if your baby comes out before your due date or if you have a multiple pregnancy. 1

Experts still don’t fully understand what causes babies to be breech. However, several factors may make your baby more likely to be in the breech position.

For starters, if you have an abnormally shaped uterus, it might make it difficult for your baby to get into position or prevent him from doing so entirely. The shape of your uterus could be the result of congenital abnormalities or conditions like fibroids or scar tissue from previous surgeries (e.g., a C-section scar).

Other factors include: 2 3

• Placenta position: Placenta previa, where the placenta grows at the lowest part of the womb and covers all or part of the cervix, can block your baby’s head from engaging in your pelvis.
• Amniotic fluid levels: Too much amniotic fluid, known as hydramnios or polyhydramnios, can make it harder for your baby to settle with his head down. 4
• Multiple pregnancy: Space is limited when you’re carrying more than one baby in your womb. This makes it more difficult for all of your babies to turn their heads down.
• Previous birth: There’s a slightly higher chance of having a breech baby if this isn’t your first pregnancy.
• Prematurity: Premature babies are more likely to be breech simply because they don’t have as much time to turn into the preferred position.
• Fetal abnormalities: In some cases, certain birth defects can cause a baby to be breech. That said, most breech babies come out healthy as long as they’re delivered safely.

As you can see, there’s nothing you can do to avoid or prevent having a breech baby; the factors that affect your chances are beyond your control. Whether your baby’s in the head-first or feet-first position at birth largely comes down to chance. Don’t stress out or blame yourself if your baby is breech.

Your doctor may check your baby’s position during your regular prenatal appointments using a technique called “Leopold’s maneuvers.” With this method, your doctor places their hands on your abdomen to locate your baby’s head, back, and bottom. 5

If they can’t figure out your baby’s position, especially in the later stages of your pregnancy, they may give you an ultrasound or pelvic exam to be sure. 2

Some moms can tell their baby is breech by feeling kicks in their lower pelvis or their baby’s head pressing against their ribs.

If your baby is in the breech position after week 36 of your pregnancy, your doctor might perform a procedure called “external cephalic version” (ECV) to turn your baby into a head-down position. This procedure involves manually turning your baby’s position in your womb.

Your doctor will give you medication to help relax your uterus and create more space for your baby to turn. Then, your doctor will use their hands to firmly guide your baby’s head towards your pelvis. They’ll monitor your baby’s heart rate throughout the process. 3

In rare cases, ECV might require an emergency C-section. This usually happens if there’s a rupture between your placenta and the lining of your womb, or if your baby’s heartbeat is irregular (which can happen if his umbilical cord wraps around him too tightly). 3

The majority of ECV attempts are successful. However, it’s possible that your baby will move back into the breech position after the doctor turns his head down. In that case, your doctor may try ECV again, but the closer you are to giving birth, the harder it will be to succeed. 2

How your doctor will tell if external cephalic version is right for you

Not all women can have the external cephalic version procedure. For example, you can’t have it if you’re pregnant with multiples or your developing baby has certain health concerns.

Moreover, ECV also won’t be suitable if: 2 3

• Your placenta isn’t in the right place (e.g., you have placenta previa)
• Your placenta has torn away from the wall of your uterus

Aside from these physical factors, you won’t be able to have an ECV if you’ve already entered labor.

Are there other ways to turn a breech baby?

Some moms-to-be explore alternative methods to help their babies turn naturally. However, as with most alternative therapies, there’s little scientific evidence that they work.

One option is moxibustion, a traditional Chinese medicine technique where you burn ground mugwort near specific acupressure points on your body. The idea is that the warmth may stimulate your baby and encourage him to turn. 7

Some women also claim the following techniques can get babies into the right position:

• The Webster technique: This is a chiropractic technique that focuses on balancing the pelvic muscles and ligaments. Supposedly, it creates a better space for your baby to turn. 8
• Positional techniques: Some people believe that doing pelvic tilts or holding certain positions, such as the knee-chest position (i.e., kneeling with your head and arms on the floor and bottom in the air), may also do the trick.
• Playing music: You may have heard that playing music near your lower abdomen helps. The idea is that your baby will move toward the sound and get himself into the correct position.

Again, these methods don’t have solid scientific backing. Before you give any of them a try, run them past your doctor, and if you use them, do so alongside whatever evidence-based methods your doctor recommends.

Yes, in most cases, your doctor will perform a C-section if your baby remains in the breech position before birth. It’s generally the safest delivery method for breech babies. 3

Some moms want to avoid having a C-section at all costs. After all, it’s a major surgery that can cause complications like infection and bleeding. However, there are many risks to vaginal breech birth, and doctors generally caution against it, making a C-section the safer option.

When is a vaginal breech birth an option?

If your baby is full-term and in the frank breech position, you might be able to deliver him naturally. The following conditions also need to be met: 2 9

• Your baby isn’t in any distress
• Your baby isn’t too large for your pelvis’s width
• Your labor is going smoothly
• Your doctor is skilled in vaginal breech delivery
• Your doctor can switch to a C-section delivery if necessary

Again, C-section deliveries are typically much safer than vaginal deliveries if you have a breech baby. If you really want to have a vaginal breech birth, talk to your doctor about the potential risks and benefits.

Yes, most breech babies who were born in the breech position go on to live healthily and happily without any complications. 6

That being said, they do have a slightly higher risk of developmental dysplasia of the hip (DDH), regardless of the delivery method. 10 DDH is when a baby’s hip joints don’t form properly and are dislocated.

Doctors usually screen all babies for this condition during their checkups. If your baby is diagnosed with DDH before he’s 6 months old, your doctor may use a harness or similar device to hold his legs in a frog-leg position. Doing so will keep his hip joints in place. 10

Nobody plans to have a breech baby, and it can feel scary if it happens to you. Try not to stress out about it. Just because your baby’s position isn’t ideal doesn’t mean you can’t have a smooth delivery.

Talk to your doctor about your concerns and discuss your delivery options. They’ll help you create a plan that works for you and your little one.