Breech Baby: Symptoms, Types, Causes and Treatment

Bringing a baby into the world is a journey filled with anticipation and questions. One topic that often raises both concern and confusion is breech presentation. While most babies settle head-down before birth, some remain bottom-first or feet-first. This article unpacks everything you need to know about breech babies—including symptoms, types, causes, and the latest evidence-based treatments—to support parents and caregivers with clear, compassionate information.

Symptoms of Breech Baby

When expecting a baby, knowing your child’s position in the womb can impact delivery planning. Most breech babies do not cause obvious symptoms, but there are subtle clues and clinical findings that may suggest a breech position. Recognizing these signs is the first step to ensuring the best possible care.

Symptom	Description	Detection Method	Source(s)
Palpable Hard Lump	Hard, round head felt in upper abdomen	Abdominal palpation	5
Kicking Sensation	Movements felt lower in the abdomen	Maternal perception	5
Unusual Heart Tones	Fetal heartbeat heard highest in the abdomen	Doppler/auscultation	5
Confirmed by Imaging	Breech detected on ultrasound	Ultrasound	5

Table 1: Key Symptoms

Understanding Breech Baby Symptoms

Breech presentation often does not produce dramatic symptoms. Most women find out during a routine prenatal checkup or ultrasound.

Subtle Clues

• Abdominal Palpation: During a clinical exam, a healthcare provider might feel the hard, rounded head of the baby higher up in the abdomen, rather than in the pelvis where it’s usually expected close to term. This is a classic sign suggesting breech position 5.
• Baby Kicks Lower Down: Some mothers notice pronounced movements or kicking sensations low in the pelvis, which can indicate the baby’s legs or feet are down 5.
• Fetal Heart Sounds: When using a Doppler, the baby's heartbeat may be heard higher up on the mother's abdomen, as the chest (not the head) is positioned closer to the upper uterus 5.

Imaging and Confirmation

• Ultrasound: The gold standard for confirming fetal position is an ultrasound. This imaging provides a clear view of the baby’s orientation and is routinely performed in late pregnancy 5.
• Routine Check-ups: Sometimes, breech is discovered incidentally during scheduled checks or upon investigating other concerns such as slow fetal growth or preterm labor.

Emotional and Psychological Symptoms

While not physical symptoms of breech position itself, some women may experience anxiety or stress upon learning their baby is breech. However, studies show that the level of psychological distress is not significantly higher in women with breech pregnancies compared to those with head-down babies. Younger and multiparous women may be at slightly higher risk for anxiety and depression, highlighting the importance of emotional support 1.

Types of Breech Baby

Breech presentation isn’t a one-size-fits-all scenario. Understanding the different types is key for both parents and healthcare providers when making decisions about delivery options.

Type	Description	Frequency	Source(s)
Frank Breech	Buttocks down, legs up towards head	Most common (60-65%)	3 5
Complete Breech	Buttocks down, knees bent, feet near buttocks	30-35%	3 5
Footling Breech	One or both feet present first	Least common	5

Table 2: Types of Breech Presentation

Frank Breech

Frank breech is the most common type, accounting for about 60–65% of breech presentations. In this position, the baby's buttocks are aimed toward the birth canal, and the legs are extended straight up in front of the body, with the feet near the head 3 5. This position can sometimes be managed safely with a vaginal delivery under certain conditions.

Complete Breech

In a complete breech, both the baby’s hips and knees are flexed, so the baby appears to be sitting cross-legged, with the buttocks pointing down and the feet near the buttocks 3 5. This type is less common than frank breech.

Footling Breech

Footling breech occurs when one or both of the baby's feet are positioned to come out first. This is the least common type and can increase the risk of complications during delivery, such as cord prolapse, where the umbilical cord slips down into the birth canal ahead of the baby 5 3.

Clinical Implications

Although there are differences in delivery risks—like the higher chance of cord prolapse in complete and footling breech—the overall maternal and neonatal outcomes do not differ significantly between frank and complete breech types, especially when vaginal delivery is considered in eligible women 3. However, certain types may necessitate specific interventions or increase the likelihood of needing forceps assistance 3.

Causes of Breech Baby

Why do some babies end up breech? While the exact cause isn’t always clear, researchers have identified several factors that increase the likelihood of breech presentation. These causes are often multifactorial and may involve both maternal and fetal factors.

Cause	Description	Relative Risk/Association	Source(s)
Preterm Birth	Breech more common before 37 weeks	Higher risk	4 5 6
Low Birth Weight	Smaller babies less likely to turn head-down	Increased risk	4 6
Uterine Abnormalities	Fibroids, septate or bicornuate uterus	Increased risk	5 7
Fetal Malformations	Neural tube defects, hydrocephalus, etc.	Increased risk	4 5 6 7
Placental Location	Placenta previa, fundal/cornual location	Associated	5 7
Oligohydramnios/Polyhydramnios	Too little or too much amniotic fluid	Associated	5
Maternal Age	Older mothers at higher risk	Higher risk	4 6
Parity	First-time mothers at higher risk	Higher risk	4 6
Prior Cesarean	Scarred uterus increases risk	Associated	6
Smoking	Associated with increased risk	Increased risk	4

Table 3: Risk Factors for Breech Presentation

Preterm Birth and Low Birth Weight

Babies born before 37 weeks are much more likely to be in a breech position. This is partly because they haven’t had as much time to turn head-down. Similarly, smaller babies may not move as easily or may not have the strength to turn 4 5 6.

Uterine and Placental Factors

• Uterine Shape: Abnormal uterine shapes (like bicornuate or septate uterus), fibroids, or pelvic tumors can physically limit the space available for the baby to turn 5 7.
• Placental Position: Placenta previa or fundal/cornual placental attachment may restrict fetal movement, increasing the chance of a breech position 5 7.

Fetal Conditions

Certain fetal malformations are strongly associated with breech presentation, including neural tube defects and hydrocephalus 4 5 6 7. These conditions can affect the baby's ability to move or change position.

Amniotic Fluid Levels

Both too little (oligohydramnios) and too much (polyhydramnios) amniotic fluid can impact a baby's ability to turn 5. Too little fluid reduces movement, while too much may prevent the baby from settling into a head-down position.

Maternal Factors

• Maternal Age: Older mothers have a higher risk of breech presentation at delivery 4 6.
• First-time Mothers: Primiparous women (those having their first baby) are at greater risk 4 6.
• Previous Cesarean Section: A scarred uterus can increase the chances of breech presentation 6.
• Smoking During Pregnancy: Smoking has been linked to a higher risk of having a breech baby 4.

Unexplained Cases

Despite these known risk factors, the majority of breech presentations occur without any identifiable cause. Up to 85% of cases have no obvious explanation, highlighting the role of chance and fetal movement patterns 5 7.

Treatment of Breech Baby

Once a breech baby is identified, the focus shifts to management and safe delivery. There are several strategies—ranging from attempts to turn the baby to planning the safest mode of birth.

Treatment	Description	Effectiveness/Evidence	Source(s)
External Cephalic Version (ECV)	Manual turning of baby to head-down position	Reduces breech at birth, lowers C-section rates	11 12
Tocolytics	Medications to relax uterus for ECV	Improve ECV success	11 12
Moxibustion	Traditional Chinese medicine, burning herb over toe	Some evidence for higher turning rates, but insufficient for routine use	8 10
Planned Cesarean	Surgical delivery of breech baby	Reduces neonatal mortality/morbidity	9 12
Vaginal Breech Delivery	Vaginal birth with breech baby	Increased risks, requires expertise	2 9
Supportive Care	Emotional, psychological, and clinical monitoring	Important for maternal wellbeing	1

Table 4: Treatment Options for Breech Presentation

External Cephalic Version (ECV)

• What It Is: ECV is a manual procedure performed by a trained healthcare provider to turn the baby from breech to head-down by applying pressure on the abdomen.
• Effectiveness: ECV significantly increases the likelihood of a head-first delivery and lowers the rate of caesarean sections 11 12.
• How It’s Done: The procedure is typically performed around 36–37 weeks. Tocolytic drugs (such as beta-stimulants) can be used to relax the uterus and improve success rates 11 12.
• Risks: Complications are rare but can include temporary changes in the baby’s heart rate or, very rarely, the need for emergency delivery.

Tocolytics and Other Interventions

• Tocolytics: Medications like beta-stimulants are beneficial in relaxing the uterus for ECV, increasing the likelihood of success and reducing caesarean rates 11 12.
• Other Methods: Trials have investigated fetal acoustic stimulation, epidural/spinal analgesia, and amnioinfusion, but evidence is limited or mixed regarding their effectiveness 11 12.

Moxibustion and Complementary Therapies

• Moxibustion: This traditional Chinese practice involves burning a herb (commonly mugwort) near the acupuncture point BL67 on the little toe. Some studies show higher turning rates compared to controls, but evidence is not strong enough to recommend routine use, and safety data are limited 8 10.
• Acupuncture: Sometimes combined with moxibustion, but more robust research is needed.

Mode of Delivery: Cesarean vs. Vaginal

• Planned Cesarean Section: Cesarean delivery for breech babies, especially at term, significantly reduces the risk of birth trauma and perinatal mortality compared to planned vaginal breech delivery 9 12.
• Vaginal Breech Delivery: Can be considered in select cases with experienced caregivers, appropriate maternal pelvic measurements, and when the estimated fetal weight is not excessive. However, there are increased risks of trauma, especially to muscles and soft tissues, and higher neonatal morbidity 2 9.
• Decision Factors: The type of breech presentation (frank, complete, footling) does not significantly affect overall maternal or neonatal morbidity, but footling breech increases the risk of cord prolapse 3.

Monitoring and Support

• Continuous Monitoring: During labor, fetal heart monitoring is essential to quickly detect complications 9.
• Psychological Support: Women with breech pregnancies may experience stress or anxiety and can benefit from reassurance and emotional support, especially younger or multiparous women 1.

Conclusion

Breech presentation is a complex and relatively common finding that requires thoughtful evaluation and management. Understanding its subtle symptoms, types, and causes empowers parents and clinicians to make informed choices for a safe and healthy delivery.

Key Takeaways:

• Most breech babies are identified by clinical exam or ultrasound rather than dramatic symptoms.
• There are three primary types of breech: frank, complete, and footling.
• Causes are multifactorial—preterm birth, low birth weight, uterine/fetal abnormalities, and maternal factors all play a role, but most cases remain unexplained.
• Treatment options center on ECV (often with tocolytics), with cesarean delivery preferred in most term breech cases. Vaginal breech delivery is possible with careful selection and experienced clinicians.
• Psychological support and clear communication are essential for maternal wellbeing.

By staying informed and working closely with healthcare providers, families can navigate breech presentation with confidence and care.