Risks of Breech Baby position & Breech birth defects myth or reality?
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Author:
Khushboo Kirale
- >> Post Created: April 14, 2022
- >> Last Updated: April 19, 2024
Medically Reviewed by: Dr. Veena Shinde (M.D, D.G.O, PG – Assisted Reproductive Technology (ART) from Warick, UK) Mumbai, India
Table of Contents - Types of Breech Presentation
An unborn baby keeps moving inside the mother’s womb until about the 36th week of pregnancy, by which it grows big enough and is left with little space to move; so, it finally settles in a position, just before the due date.
The most common fetal position – in 95% pregnancies – is the head-down position (Cephalic position or the Vertex presentation), where the baby’s head is towards the mother’s pelvic inlet and on delivery, the baby’s head is presented first.
On the other hand, you must have heard – ‘breech baby position/ breech presentation,’ the ‘Sacrum baby position,’ the ‘Franks Breech,’ transverse lie etc. fetal positions. These are mal positions and are rare fetal position.
In this article will cover all these rare mal positions – starting with breech definition, types of breech presentations, risk factors for breech presentation, and if there is really a correlation between breech baby and birth defects – Breech Birth defects?
Breech Definition - Understanding breech position
As per Collins – Breech definition is:
- the lower dorsal part of the human trunk; buttocks; rump
- the lower part or bottom of something
Breech definition with respect to baby position in womb & birth/delivery is as follows:
Breech baby means that the baby is in a head up position wherein the unborn baby’s head is up, near the mother’s chest, and feet or buttocks are pointed towards the birth canal.
Here, in case there is a vaginal delivery, which is rare, then there can be different types of breech presentations on birth; i.e. the baby’s feet or bottom will present itself first.
By the 36th week of pregnancy, breech babies settle in the womb in a position where their feet or buttocks are at the inlet of the mother’s pelvic region, resulting in different types of breech presentations at birth.
Though this fetal position is seen in only 3-4% of full-term pregnancies, there are different types of breech baby presentations like – Frank breech baby/ Sacrum Position, complete breech baby position, etc. Breech baby position comes with its own set of challenges for the mother and the baby.
Types of breech presentation
There are mainly 4 types of breech presentations –
1) Extended Breech - Frank Breech Position/ Sacrum Position
In the Frank Breech baby position, the baby’s buttocks are right above the birth canal, with their legs up close to their body, and feet near the head.
2) Complete Breech Presentation/ Complete Breech Position
In the complete breech position/ complete breech presentation, the baby’s buttocks are positioned at the birth canal opening, but the hips and knees are folded under themselves.
3) Flexed Breech Baby Position
In the Flexed Breech baby position, one of the baby’s knees is bent and the buttocks and feet are at the birth canal opening.
4) Footling Breech baby / Footling breech presentation/ Incomplete Breech position
In the Incomplete breech position of if you are having a footling breech baby, then one or both of your baby’s foot/feet are aiming at the birth canal opening, to make it/them the presentation on birth.
The Transverse baby position is also considered as one of the mal positions.
In the Transverse Lie, the baby lies in a horizontal position across the uterus, and the baby’s shoulder becomes the presentation (first part to come out on delivery).
The types of breech presentations also play an important role in deciding how easy or difficult a possible vaginal breech delivery can be or will it conclusively be breech C-section.
Frank Breech Baby – Types of breech presentation
Further, there are a few types Frank breech position/ Sacrum positions which are more common in breech babies. They are defined in detail below with the help of a diagram.
These Frank breech baby position / sacrum positions are differentiated on the basis of the direction the baby faces. This is similar to the various occiput positions:
Sacrum Anterior position (SA position):
Here, the fetal sacrum is positioned closest to the symphysis of the mother. Simply put Sacrum Anterior position is when your baby is facing your spine and the baby’s spine is adjacent to the mother’s stomach.
So, basically in the Sacrum Anterior position your baby has head Up – Feet Up – Buttocks presenting in the pelvis – Baby facing Spine – and Back adjacent to your stomach.
Left Sacrum Anterior position (LSA position)
The left sacrum anterior position is similar to the Sacrum anterior position, except for a minor change where in addition to the fetal sacrum being closest to the symphysis, it is also slightly rotated to the mother’s left. Basically, in the left sacrum anterior position the baby’s head is not directly looking at the mother’s spine, but is a bit angled towards the left of the spine.
So, in Left Sacrum Anterior position your baby has head Up – Feet Up – Buttocks presenting in the pelvis – Baby facing left of mother’s spine – and Back adjacent to your stomach – as shown in the image Types of Frank Breech Baby positions.
Right Sacrum Anterior (RSA) position
The Right Sacrum Anterior position too is similar to the sacrum anterior position, with a minor change – where the baby’s head is slightly tilted to right of the mother’s spine.
So, in Right Sacrum Anterior position your baby has head Up – Feet Up – Buttocks presenting in the pelvis – Baby facing right of mother’s spine – and Back adjacent to your stomach, as shown in the image Types of Frank Breech Baby positions.
Right Sacrum Transverse (RST) position
In Right Sacrum Transverse position, your baby has head Up – Feet Up – Buttocks presenting in the pelvis – Baby facing exactly right of mother’s spine – and Back adjacent to mothers left side of stomach as shown in the image Types of Frank Breech position chart.
Left Sacrum Transverse (LST) position
In Left Sacrum Transverse position, your baby has head Up – Feet Up – Buttocks presenting in the pelvis – Baby facing exactly Left of mother’s spine – and Back adjacent to mothers’ right side of stomach as shown in the image Types of Frank Breech position chart.
Right Sacrum Posterior (RSP) position
In Right Sacrum Posterior position, your baby has head Up, facing the stomach – Feet Up – Buttocks presenting in the pelvis – Baby facing mother’s stomach tilted a little to the right – and Back adjacent to mother’s spine as shown in the image Types of Frank Breech position chart.
Left Sacrum Posterior (LSP) position
In Left Sacrum Posterior position, your baby has head Up, facing the stomach – Feet Up – Buttocks presenting in the pelvis – Baby facing mother’s stomach tilted a little to the left – and Back adjacent to mother’s spine as shown in the image Types of Frank Breech position chart.
Sacrum Posterior (SP) position
In the Sacrum Posterior position, your baby has head Up, facing the stomach – Feet Up – Buttocks presenting in the pelvis – Baby facing towards the mother’s stomach – and back exactly adjacent to mother’s spine as shown in the image Types of Frank Breech position chart.
Types of Frank Breech position Chart / Sacrum baby positions chart
Why do babies take the breech position?
The exact reasons for having a breech baby are still not known, but the following factors may have a role to play:
- The mother’s uterus is shaped abnormally or she has abnormal growth like fibroids. The uterus is normally shaped like an upside-down pear. However, if the uterus has a different shape, then it might restrict the space a baby needs to settle into the optimal position.
Same with fibroids growth in the womb. The Baby does not get enough space to move and settles into a vertex presentation because of them.
- The presence of too much, or too little, amniotic fluid inside the uterus. Too little fluid may not allow the baby to move freely within the uterus, whereas too much of it may not allow it to settle in one position.
- If the cervix is covered by the placenta, partially or completely. This condition is called placenta previa.
- If you are expecting twins or multiples, then it might be difficult for each baby to get into the right position within a limited space.
- If the baby is pre-term, meaning it has had less than 37 weeks’ of gestation, then it obviously never got the time to turn in the optimal position.
- There is also a possibility that the baby might have a birth defect that prohibits it to move in the head-down position.
It is necessary for you to know that there is nothing you can do to prevent your baby from settling into the breech position. And it isn’t your fault that your baby decided to be breech.
In my case with my elder daughter, she remained in the Footling Breech position due to very little amniotic fluid. It’s something I suffered with throughout my pregnancy. She was born pre-term at 36 weeks and was delivered via C-section.
So basically, there are different reasons why a baby could be in breech position. Let me assure you there is nothing to worry about. Just discuss details about your breech baby position in detail with your doctor and discuss the various options you may need to look at while delivery. Do not panic. Your doctor knows what’s best for you.
Breech Birth Defects in Babies
A breech baby does not affect your pregnancy, but this fetal position does increase the risk of certain breech birth defects.
Sometimes, it is also vice-versa – certain birth defects prevent the baby from turning into the head-down position, which results in a breech baby.
Nevertheless, if the baby is breech without any birth defects or health issues, then a skilled doctor can deliver a healthy baby through a vaginal delivery.
Common Breech Birth Defects
As mentioned in the beginning, breech babies are rare – less than 5% – but there is statistical data to point to a higher possibility of such babies having congenital conditions at birth, i.e. birth defects, as compared to vertex or other babies. Even though the chances of breech birth defects in babies are low, they still exist.
A study found that the breech fetal position during delivery can indicate congenital abnormalities – Breech Birth Defects. A congenital defect can be one of the reasons why the baby did not take the cephalic (head-down) position before labor. However, it may not necessarily occur in all breech babies.
The reasons behind breech birth defects in babies may differ, but if for some reason the umbilical cord is damaged or the oxygen supply to the baby is disrupted or completely cut off during delivery, then it can cause severe damage to the baby’s brain or body and sometimes even prove to be fatal.
Sometimes unborn babies develop malformations, which is the reason why they are unable to turn to the optimal head-down position and become breech babies instead.
Here is a list of some common breech birth defects – Here the breech birth defects may be because of the baby’s fetal position or the baby’s breech position can be because of the birth defect.
- Autism: Fetal distress is an emergency situation, wherein the baby is deprived of oxygen. This increases the chances of autism in babies.
- Down’s Syndrome: There is no definitive study to prove that a breech birth can result in Down’s Syndrome, but 1 in every 10 breech babies have mild to moderate neurological issues. Developing an extra chromosome from the usual 46 may give rise to Down’s Syndrome. However, if the chromosomal structure is not perfect, then it can give rise to more issues in the child.
- Heart Disease: A higher risk of heart disease can also cause the baby to stay in breech position before labor.
- Structural deformities: Sometimes a structural deformity is what prevents the baby from coming in the cephalic position. Or at times, as the lower part of the body is the first to be delivered in a breech presentation, there is a lot of pressure on the spine, which may give rise to deformities in the spinal cord, and the baby could have muscle coordination problems.
The unborn baby may also suffer from deformities of the ears, face, eyes, and neck.
- Congenital hip deformity (Hip dysplasia): Breech babies can suffer from this because their movements in the womb are limited. This is most common in frank breech babies, where knees are extended.
- Nervous system and musculoskeletal system malformations: Once again, limited movements in the uterus can be the reason behind these disorders. In fact, this can be the reason behind the baby’s inability to turn into the head-down position before labor.
- Cleft lip or cleft palate, respiratory and circulatory system issues: These conditions may give rise to the chances of a breech presentation due to polyhydramnios or excessive amniotic fluid.
- Genital or urinary malformations: These conditions may cause breech position due to polyhydramnios (excessive amniotic fluid) or oligohydramnios (too little amniotic fluid).
Research says that many malformations are linked to breech birth, except digestive system problems.
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FAQs
Q1) How is pregnancy affected by a breech baby?
Your pregnancy is usually not affected, but delivery might be. However, you will feel your baby’s movements differently.
If you were planning on having a vaginal delivery, then a breech baby can change those plans significantly. Going for a vaginal delivery when your baby is breech can lead to complications and can be potentially dangerous for you and the baby. Your healthcare provider may be experienced enough to feel comfortable to go for a vaginal breech delivery, but predominantly, they will recommend you go for a Cesarean birth (C section).
Most breech babies are born healthy, although there is a slight elevated risk of certain breech birth defects.
Q2) How to know if your baby is breech?
If you have a breech baby, then during the 3rd trimester, your baby’s movements may feel a little different. In fact, after 36 weeks, a mother who has delivered a vertex baby previously will be able to identify a breech baby.
Depending on where you feel the baby’s movements, you and your doctor will get a fair idea of a breech position even at 32-week pregnancy stage.
Here are a few techniques to identify breech position of baby:
- Kicks: A breech baby’s kicks will be felt on the lower side of the belly, while a vertex baby’s kicks will be felt towards the ribs.
- Palpation: During your prenatal visits, your doctor will check for the baby’s position by palpating or trying to feel the head, back, and bottom of the baby. In a breech baby, a hard lump (the baby’s head) can be felt close to the mother’s ribs.
- Heartbeat: Identifying the location of the baby’s heartbeat gives a more precise understanding of the baby’s position.
- Ultrasound scan: A scan gives the most precise picture of the baby’s position in the uterus.
- Pelvic Exam: This is done during labor; the doctor examines the pelvic region by hands, to feel if the baby’s bottom, legs, or shoulder is engaged in to the birth canal first in case of vaginal breech delivery.
You can use belly mapping technique to chart out the exact position of your Sacrum baby.
Q3) Do birth defects cause breech position?
Birth defects are a tad higher in breech babies. And the two can be related, because in many cases a baby is in breech position (unable to turn in the optimal head-down position) because of a birth defect.
However, most breech birth babies are born without any health issues or birth defects altogether.
My daughter was a breech baby and she had no birth defects. So keep your mind at rest.
Later, even my triplets were delivered through planned C section at around 40 weeks for obvious reasons. Thankfully, all three were healthy as a horse, with only one of them needing to spend a few days in the NICU.
Q4) What are the various Frank Breech baby abnormalities / Frank breech Birth defects?
While we have discussed the breech birth defects earlier in the article, we have tried to list a few frank breech baby abnormalities / frank breech birth defects which can result due to the frank breech position of the baby.
If you are having a frank breech baby or if your child is in a frank breech position, then here are a few frank breech baby abnormalities / Frank breech Birth defects you should discuss with your doctor so that you all are in a better position to tackle any situation and avoid these issues from happening as much as possible.
Q5) What is Fetal Distress caused due to Cord Prolapset
When your baby is in frank breech position / frank breech baby – then during vaginal breech delivery, there are chances (absolutely rare though) of the umbilical cord emerging through the cervix before delivery.
Furthermore, there are chances that when the child comes down into the birth canal, their head and body press hard against the umbilical cord, which can cut off the blood and oxygen supply to the baby.
This can lead to autism, due to restrictive supply of blood and oxygen for heart and brain. It can also lead to long term heart related disorders.
a. Congenital hip deformity or hip dysplasia
There are higher chances of a Frank Breech baby/ baby in frank breech position to have congenital hip problems, like hip dysplasia. This is because a frank breech baby has restrictive movements in the womb due to the irregular position the baby is in.
b. Structural Deformities
There is a specific reason why head down position and vertex presentation are ideal for baby delivery. The child’s skull is strong and can withstand the initial pressure, whereas the other parts of the child’s body are still developing.
When we talk about the spinal cord – it’s kind of the most important body part and needs to be handled with care especially during birth and for a next couple of months after birth.
When baby is in frank breech position, the spinal cord ends up bearing the most pressure during delivery. This can result in the baby being born with spinal cord deformities, complications in child growth, and also muscle coordination problems.
c. Musculoskeletal system and nervous system malformations
When your baby is in a frank breech position/ when you have a frank breech baby then the movements of your child get very restricted within the womb towards the end of pregnancy.
The frank breech baby has the feet in front of their head and legs are completely flexed, and some times the hands are between the legs and the body, providing very little space for baby movement within the womb. Even kicks are difficult.
This can lead to disorders related to nervous system development, as well as musculoskeletal system development.
Q6) What does breech presentation ICD 10 stand for?
There are different guidelines provided by the World Health Organization (WHO) for treatment and care of various diseases and medical procedures and issues.
WHO authorized the publication of the International Classification of Diseases (ICD) External 10th Revision (ICD-10).
Breech presentation are listed under ICD 10 codes – hence referred to as a reference – ‘breech presentation icd 10’, which are dedicated to pregnancy, delivery, and 6 weeks post-partum procedures and issues.
Under the ICD-10-CM codes – maternal care procedures, if the baby is in breech presentation, are listed at O32.1.
Q7) How to turn a breech baby?
Your doctor can attempt to turn your breech baby in the optimal position before labor sets in. They may recommend certain positions, postures, and poses (pelvic tilts, rocking back n forth etc.) that can encourage the baby to flip naturally before delivery. A medical procedure called the External Cephalic Version (ECV) can also be performed. Talk to your doctor about the possibilities to turn a breech baby.
In a nutshell
A breech baby might make the whole labor and pregnancy experience a little more difficult than a vertex baby. Therefore, you will not only have to prepare yourself physically, but also mentally.
We started with the very basic in this article – ‘Breech Definition’ and went on to explain about types of breech presentations, related risks, and breech birth defects. We have also discussed some Frank breech Birth defects/ Frank breech baby abnormalities which you need to understand and discuss with your doctors.
Honestly, these breech birth defects are very rare, so you need not worry about it if everything is going great in terms of baby growth and milestones as per your doctor.
Hope our article has given you a better understanding about breech position in womb and everything else related to it.
We suggest you discuss and even ask a lot of questions to your doctor and the medical team to understand what you are headed for and the best way to tackle it.
There are certainly a lot more concerns with a breech birth, but the right attitude, support (family, friends, and medical team), and a whole lot of positivity can help you have a smoother experience during childbirth.
Never lose the sight of the ultimate goal – having your happy & healthy baby in your arms.
Happy Pregnancy!
Khushboo Kirale
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