Breech Presentation at the End of Your Pregnancy

ust before babies are born, most of them turn into a headfirst position to get ready for birth. A headfirst position makes it much easier for them to pass through the birth canal. Yet some babies, many for reasons we just don’t know, lie in what doctors call a ‘breech presentation’, even in the last four to five weeks of pregnancy.

About three percent of all babies remain in a breech or transverse (sideways) position during the time just before birth.

What is a breech presentation?

A breech presentation occurs when the baby lies inside your womb near the end of your pregnancy in an unusual position, usually with his or her bottom or feet nearest the birth canal. There are three main types of breech presentation:

  • Extended (also called ‘frank’) breech: This means that your baby lies with his bottom first, her thighs against her chest and her feet up by her ears. This is the most common among the breech positions.
  • Flexed breech: Again, your baby lies bottom first with his thighs against his chest, but his knees are bent instead of extended toward his ears.
  • Footling breech: Your baby’s feet lie below her bottom in a feet-first position.

Another type of presentation—very rare--is the transverse lie. This position means that the baby is lying sideways in your womb.

What causes a breech or transverse presentation?

Risks for breech or transverse presentation at the end of your pregnancy include:

  • A placenta that lies low in the uterus,
  • Lax uterine muscles (usually from having many babies)
  • Too little or too much amniotic fluid around the baby
  • An abnormally-shaped womb
  • Fibroid (benign) tumours
  • Placenta praevia
  • Multiple births (twins, triplets, or more)

We usually administer an ultrasound to women whose babies lie in a breech or transverse position during the last few weeks of gestation. More than likely, though, we will not find a specific reason. The foetus may simply prefer that position.

What are the risks involved in a breech presentation or transverse lie at birth?

Because a breech position makes it difficult for the baby to pass through the birth canal, your chances of having a complicated vaginal birth go up. 

There are a few situations in which it can be safe for you to attempt a vaginal birth. There may, however, be more risks to your baby.

As for a transverse lie, these babies are near-impossible to deliver vaginally. Usually, the physician or midwife will recommend a caesarean section for babies in the transverse lie position.

In some situations, it can be safe to attempt a vaginal birth when the baby is in a transverse lie. However, there may be increased risks to the baby.

The important thing is to remember is to discuss all your options with your healthcare provider. Weigh the risks against the benefits for each option.

Can my baby turn into a headfirst position before birth?

That depends on how close to your due date you are. The closer you get to your due date, the less likely he or she will turn to assume a head-down position before birth.

With a transverse lie, there is one intervention we may try, external cephalic version, a method in which we attempt to turn your baby into a headfirst position by hand from the outside. Though successes are rare, we can attempt it if you like.

There are, however, some alternative therapies you may consider for breech presentations, including chiropractic manipulation, postural exercises, acupuncture, and moxibustion, an Eastern practice in which practitioners burn certain dried plants near an acupuncture point to increase the flow of ‘qi’, the life force.

Be aware, though--none of these therapies are evidence-based (they have not been tested in a proper clinical trial). Therefore, you need to consider the risks associated with these methods. Ask yourself:

  • Will this treatment work?
  • What are the risks involved in this treatment?
  • Will this treatment cause more risk to my baby or myself?

Make sure you have a plan B. For most mothers, they choose a caesarean section since that usually carries less risk to both mother and child.

The main thing to remember is that whatever your options, with modern medicine, most births—even breech presentations—go smoothly when you follow your obstetrician’s or midwife’s advice. Ask questions and inform yourself about all your options.

Above all—relax. You’re about to deliver a beautiful baby.