Baby’s position in the uterus is usually referred to in medical terms as the “presentation of the foetus”. Usually, during the last month of pregnancy, the baby’s position in the uterus is carefully monitored to ensure that it is in the correct position for birth.

What is a Breech Position?

Most babies usually settle into a head-down position (also called the vertex or cephalic position) in the mother’s pelvis, around the eighth month of pregnancy. When labour begins, about 96% of babies are usually head-down. But a few (around 3%) may settle into a bottom-first position, which is known as breech position.

Different types of Breech Positions

Complete Breech
Baby is positioned with the buttocks first; both the hips and the knees are flexed. Like other breech presentations, this position increases the risk of forming an umbilical cord loop that could precede the head through the cervix and cause injury to the baby if delivered vaginally.

Frank Breech
In a frank breech, the baby’s buttocks lead the way into the birth canal, with the hips flexed and the knees extended. This position increases the chance of forming an umbilical cord loop that could precede the head through the cervix and cause injury to the baby if delivered vaginally.

Footling Breech
When one or both of the baby’s feet are pointed down towards the birth canal, this increases the chances of the umbilical cord slithering down into the mouth of the womb, cutting off blood supply to the baby.

Transverse Lie
When baby lies crosswise in the uterus, it is most likely that the shoulder will enter the pelvis first. Babies in this position are usually delivered by cesarean.

Causes for Breech Positions

Some of the possible reasons for breach positions are:

Multiple babies: If you’re expecting twins or more, all the babies may not be able to settle in the head-down position due to lack of space.

Amount of Amniotic Fluid: Too little or too much of amniotic fluid results in a breech position as both conditions affect the mobility of the baby. Less fluid means baby can’t swim freely, while the opposite means baby has all the fluid and space to do acrobatics before deciding to settle down in the breech and head-down position.

Premature birth: Babies who are born before term do not have enough time to settle in the right postions, and hence are breech babies

Read: Caring for a premature baby

Position of placenta: A low lying placenta covers the cervix. Similarly, if the placenta is located at the top of the uterus it blocks the space near the baby’s head. In both cases, the baby does not have enough room to settle in the head- down position.

Weird shaped uterus: Usually the uterus is shaped like an upside down pear. But in some women, it is shaped differently. This is detected during an ultra sound or through a pelvic examination.

Short or tangled umbilical cord: Some practitioners believe the umbilical abnormalities could restrict the movement of the foetus, thus forcing it to settle in the normal birth position.

Baby’s hips are immature: if the baby’s hip joints are still in the formative stages, it will not have enough flexibility to kick and move around.

Previous history of breech birth: If the previous baby was delivered in the breech position, there is a high chance the next one too will turn out be a breech baby.

A family history: Research shows that if breech birth runs in the family, there is a good chance that your baby will be breech.

Can the baby be turned around?

When a breech presentation seems most likely, doctors sometimes try to have your baby turned manually into a head down position. This process is called External Cephalic Version (ECV). If performed after 38 weeks, it’s successful in about two thirds of cases. This procedure may be uncomfortable but not painful.

The doctor performs this procedure after administering an injection to relax the uterine muscles. Then he will use his hands to flip the baby into the head-down position. Sometimes, however, the baby may rotate back into the breech position after being turned head-down. Though your practitioner can give another try to flip it back, it could get tougher as your due date approaches as there is little room for the baby to move around.

Read: Due date calculator

What happens after the baby is turned around?

The doctor will recommend a non-stress test. If the results are satisfactory, you will be sent home. Else, the doctor may try a CV once again. Depending on the situation, he may take you in for an emergency C-section.

Are there any risks involved in ECV?

The risks are normally low. However, there could be incidences like premature rupture of membranes, minor loss of blood in the baby and mom, pre-term labour, an emergency caesarean delivery due to foetal distress and the baby going back to the breech position again.

When is ECV not possible?

An ECV cannot be performed, if you have any one of the following:

• A low lying placenta that blocks or close to the opening of the uterus
• Vaginal bleeding
• Low levels of amniotic fluid
• Premature rupture of the membranes
• An abnormal fetal heart rate
• You are expecting twins /multiples

Can the baby be turned around naturally ?

While there is no 100% guarantee that your baby will reposition itself, you could try a few things to encourage the baby to flip and settle in the head-down postion.

• Keep your hips higher than your knees when you sit down
• Play music and hold it against the bottom of your belly. You baby may follow the music
• If your job involves sitting for long hours, unseat yourself at regular intervals and walk around a bit
• Rest your palms and knees on the floor and rock gently. You buttocks should be at a higher level than the head.
• Sitting on an exercise ball could open up the pelvic region and make room for baby to move around.

Read: Vaginal delivery after a c-section - is it possible?

Can Breech Babies be delivered normally?

In breech positions, a cesarean delivery is considered the safest option for both mother and baby – though breech babies have also been successfully delivered vaginally. However, there may be a risk of injury to the baby or chances of baby being born with birth defects.

Read: Do's and don'ts  after a c-section

A vaginal delivery is possible if:

• You’ve had a healthy pregnancy without any complications ( like preeclampsia/gestational diabetes)
• If you’ve given birth vaginally previously
• Your baby is full-term in the frank breech position and not too big
• Your pelvis is big enough for your baby to pass through safely
• Your baby doesn’t show any signs of distress

If the baby stays in the breech position until the day of your delivery:
The doctor will try a version provided your membranes are still intact/your water hasn’t broken or contractions haven’t started.

You will be advised caesarian, if:

• Your baby is in the footling breech position
• Placenta is low-lying.
• Your pervious delivery was caesarean
• You’re expecting twins and the first twin is breech.
• You have pre-eclampsia or another any other complications that are potentially risky for both you and your baby
• Your baby’s estimated to be overweight (more than 4kg) or underweight (less than 2kg)
• You’ve been diagnosed with a narrow pelvis.