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Breech babies are in a small minority, but they can cause a lot of worries. What is so dangerous about a breech presentation, and is vaginally giving birth to a breech baby ever safe?

Only three percent of unborn babies are not in a head-down position when they reach term. For these breech babies, cesarean section has become the preferred mode of delivery in most countries. Parents who are expecting a breech baby may face a dilemma — is a cesarean inevitable or may a vaginal delivery be attempted?

Here, we explore the risks of breech birth and look at the most favorable circumstances for a vaginal breech birth.

What is breech presentation?

The normal position for delivery is called vertex presentation. In this position, the baby's head faces the cervix so that the head will be the first part to be born. A fetus with its head in the upper part of the uterus and its buttocks in the lower part — closer to the cervix — is in a breech position.

Breech positions are quite common during the earlier stages of pregnancy:

  • at 32 weeks of pregnancy, 25% of babies will be in a breech position.
  • by term (38-42 weeks), this will have dropped to 3%.

There are four different variations of the breech position:

  • Frank breech. The baby's buttocks face the mother's cervix, while the legs are folded upward, with the feet next to the baby's head.

  • Footling breech. The baby's feet face the mother's cervix.

  • Complete breech. The baby's legs are bent and close to the buttocks, in a position that looks like sitting. Both buttocks and legs face the cervix.

  • Kneeling breech. This is so rare that most people will not have heard about it. One leg is stretched upward as with the frank breech position, while the other leg appears next to the buttocks as with the complete breech position.

What causes breech presentation?

It is impossible to make blanket statements about this, but there are risk factors that should be considered. During the earlier stages of pregnancy, most babies assume a breech position only to move into the head-down position before birth. It is highly likely to prematurity is the sole cause of breech presentation in most cases, yet the fact remains that a small minority of term babies are still breech. 

Breech presentation is also more common during twin pregnancies, subsequent pregnancies (in other words, where the mother has already given birth before), and where the mother suffers from uterine fibroids or uterine malformations. In addition, the placental complication placenta previa where the placenta covers the cervix is associated with a higher chance of breech presentation. Too little or too much amniotic fluid are other risk factors. Finally, babies with birth defects are more likely to be breech.

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