What is Breech Presentation?

The period during which a foetus develops inside the womb is referred to as gestation or pregnancy. Under normal circumstances, a foetus grows for almost 38 to 40 weeks, which is considered to be a full-term gestation. However, in several cases, babies are delivered before the completion of 36 weeks of gestation for a variety of reasons. During pregnancy, there are a number of physiological changes that take place in a woman’s body. While some are related to the normal development of a baby, others may develop due to the presence of underlying conditions or complications. Here’s more about the meaning of breech in pregnancy, its types, symptoms, causes, and treatment.

According to several medical journals, that almost three to four per cent of pregnancies across the world have the foetus in breech presentation leading to an increased risk of associated breech complications at delivery time. In a normal pregnancy, a foetus is supposed to take the birthing position in the ninth month, which can be described as the baby’s head being right next to the mother’s pelvic region. This is known as vertex presentation, which leads to a normal birth without any serious breech-related complications arising. In breech presentation, the foetus is mostly lying in a longitudinal position, where its buttocks and legs enter the mother’s pelvic region first, instead of the head. It is a widely known fact that breech presentation in pregnancy is not necessarily dangerous for the baby. Children born in breech position can be completely healthy, but there are slight risks of the baby developing certain defects in some cases of breech pregnancy.

Types of Breech Presentations

Based on the breech position of the foetus, breech presentation can be categorised into the following types:

• Frank Breech

In pregnancy, this breech position is characterised by the baby’s buttocks being near the vaginal canal, its legs placed in front, and the feet being near the baby’s head. At 20 weeks, a Frank breech presentation can be easily detected in an ultrasound, helping with early management to reduce the risk of complications.

• Complete Breech

In this breech foetal position, the baby’s buttocks are positioned completely towards the pelvic region of the mother, with the legs folded underneath them. When this position is detected at the time of birth, a caesarean or C-section as the condition may increase the risk of complications. If a gynaecologist detects a breech position at 32 weeks of gestation, a C-section birth is recommended.

• Footling Breech

The footling breach position is defined as one or both legs of the baby pointing towards the vaginal canal and the head near the mother’s chest. In this presentation, normal delivery may be possible. However, the baby’s legs will come out of the vaginal canal first.

• Transverse Lie

A breech presentation of the foetus that is different from all other types is the transverse lie. In this position, the baby is horizontally lying in the mother’s womb instead of longitudinally. This breech foetal position makes it highly probable that the baby’s shoulder will come out of the vaginal canal before any other body part.

Symptoms of a Breech Presentation in Pregnancy

There are no significant or noticeable symptoms of breech presentations before 32 to 35 weeks of gestation. This is because the position of the baby keeps changing over time. So, even if the foetal position is breached at 20 weeks, it may eventually move to a head-down position in the coming weeks. Mothers, in the last few weeks of pregnancy, may feel an irregular mass in the pelvis, along with subcostal tenderness. An ultrasound can further help in examining the foetal position by allowing the gynaecologist to listen to the baby’s heartbeat. If the baby is in breech position, the heartbeat will be loudest near the umbilicus. Taking these symptoms into account, it is highly suggested that gestating mothers undergo regular ultrasounds and check-ups. 

Causes of a Breech Presentation

The most commonly observed causes of breech presentation include:

• A breech pregnancy is more likely in case of multiple pregnancies. This means that women pregnant with twins or triplets are at a higher risk of breech presentations than others. 
• An insufficient or excessive amount of amniotic fluid in the womb is another cause of breech presentation.
• A regular uterus is shaped like a pear with ample amounts of space for a growing baby. However, some irregularly shaped uteruses may not have the space needed. This can also lead to restricted movements of the baby during pregnancy.
• Placenta previa, which is a condition where the placenta covers the cervix or a part of it, can also be a cause of concern. 
• Pre-term babies that are born before completing 37 weeks of gestation, are generally unable to move into the birth position.
• Birth defects are also significant reasons behind breech presentation as in such cases, the baby may be unable to move into the head-down position. 

How to Manage Breech Presentation

Once a baby is in breech position, preparing for a C-section is highly recommended as and when required. This evaluation is done by the gynaecologist and is based on a physical exam where they feel the stomach of the mother, ultrasounds, and other relevant factors. It is possible to manage breech positions without having to take any special measures, especially when the movement of the child is still taking place.

• External Cephalic Version (EVC) - This is a non-surgical procedure in which medication is given to the mother to help relax the uterus in order to gently assist the baby’s movements into a head-down position.
• Essential Oils - This technique involves rubbing essential oils like peppermint on the stomach to help achieve the proper birthing position. As there is no scientific evidence for this, expecting mothers are recommended to consult their OB/GYNs before trying it.
• Inversion - Another home remedy for attempting to turn babies into the right position, many try inverting their own bodies. This may be done by placing pillows under their pelvis or by standing on the hands in a swimming pool.
• Bridge Position - A common exercise position, the mother lies on the floor and positions her pelvis and hips to form a “bridge” using their hands and feet. Holding this position for 10 to 15 minutes in a day is believed to help with a breech position foetus.
• Music - A modern-age technique, this involves headphones, or a speaker, being placed near the uterus to stimulate the baby’s movements.

When to See an OB/GYN?

Breech position in pregnancy may pose a challenge, especially for normal deliveries, but it does not necessarily mean that the birthing experience has been compromised in any way. It is vital to remember that only a medical practitioner can perform the right diagnosis of a breech presentation. There are special ultrasounds that can help detect a breech foetal position. Therefore, regular check-ups with a trusted gynaecologist are highly recommended. If there are any causes of concern, it is best to keep an open mind and get a second opinion if need be. Ultimately, the experience of pregnancy is precious for every mother, so, ensuring every precaution is in place is advised.