An Overview of the Frank Breech Baby

Doctor examining pregnant woman
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When it’s time for labor and delivery, the part of the baby that is near the birth canal is called the presenting part. It’s the part of the baby’s body that is born first, and is usually the head (vertex presentation). In a small number of deliveries, a baby’s bottom or feet are in a position to be born first. This is called a breech presentation, and frank breech (bottom first, with feet up near the head) is the most common type.

Breech presentations are more common in premature births than in full-term births. As a pregnancy continues, it’s more likely the baby will turn, and the head will be down when it's time for delivery. So, as a pregnancy gets closer to term, the chances of a breech birth go down.

  • Before the 28th week of pregnancy, about 20% to 25% of babies are breech.
  • By the 34th week of pregnancy, most babies will turn, and approximately 5% to 7% will be breech.
  • By full term, only 3% to 4% of babies (3 or 4 out of every 100 births) are breech.

Types of Breech Babies

A frank breech is the most common breech presentation, especially when a baby is born at full term. Of the 3% to 4% of term breech births, babies are in the frank breech position 50% to 70% of the time. A frank breech is when the baby’s bottom is down, but his legs are straight up with his feet near his head. The presenting part is the buttocks. There are also other breech presentations.

Complete Breech

In this position, the bottom is down, but the baby's knees are also bent, so the feet are also down near the buttocks. The presenting part is not only the bottom but both feet as well. At delivery, about 10% of breech babies are in a complete breech position.

Incomplete or Footling Breech

A footling breech is when the baby’s legs are extended and facing straight down. Instead of the bottom, the presenting part is one foot (a single footling) or both feet (a double footling). Approximately 25% of breech deliveries are incomplete.

How to Tell If Your Baby Is Breech

As your pregnancy progresses, your doctor will examine you and keep track of your baby’s position. You might even be able to figure where your baby is in your womb on your own. Here are some of the techniques you and your doctor can use to tell which way your baby is facing.

  • Kicks: You can feel where your baby is kicking you and judge their general position. If you feel kicks in your lower pelvis, then the baby hasn’t turned head down yet. But if the kicks are up toward your ribs and the top of your uterus, then the baby’s head is most likely facing down.
  • Palpation: At your prenatal visits, your doctor or midwife will check your baby's position by palpating or feeling your belly to find the baby’s head, back, and bottom.
  • Heartbeat: Listening to the baby’s heartbeat is another way to tell where your baby is in your womb. By finding the heartbeat's location, the doctor or midwife can get a better idea of the baby’s position.
  • Ultrasound: An ultrasound provides the best information. It shows you and your healthcare team a picture of the baby and their exact position in your uterus. If your baby is breech, the ultrasound can determine the type of breech position your baby is in, such as frank breech or complete breech.
  • Pelvic exam: During labor, your healthcare provider can perform a pelvic examination. They will be able to feel whether the baby’s head or their bottom and feet are in the birth canal.

Causes of Breech Presentations

The size of the baby, how much amniotic fluid is in the uterus, and the amount of space inside the womb are all factors that can contribute to a baby’s ability to move around. A premature baby is smaller and has more room inside the uterus to move around, for example. Twins or other multiples have less room in the uterus to move around and get into the head-down position for delivery.

Uterine issues, such as fibroids or a heart-shaped uterus, can get in the way of the baby’s ability to turn. Similarly, if the umbilical cord is very short, the baby may not be able to move and turn.

Too much amniotic fluid gives the baby the ability to move around freely in the womb. As they grow, they may still be able to flip and turn. Too little amniotic fluid may prevent a baby from moving into the head-down position as they get closer to full-term.

When the placenta is low and covers all or part of the cervix, it’s called placenta previa. Since the placenta takes up the room at the bottom of the uterus, it makes it difficult for the baby to turn.

Some congenital abnormalities can affect the baby’s ability to move into the head-down position. These conditions are usually not a surprise at delivery since they are typically seen on ultrasound examinations during pregnancy.

The most common reason for a breech presentation is prematurity.

Treatment for Breech Presentations

From yoga and chiropractic adjustments to music and exercises, there are plenty of things you can do to try to get your baby to move head down for delivery. Your doctor might help is by performing a procedure called external cephalic version (ECV).

If there are no complications in your pregnancy and the baby has not yet turned on their own by the 36th or 37th week, your doctor may attempt to turn the baby using this procedure. This works approximately 60% of the time. If it is successful, your chances of having a cesarean are much lower.

Complications

Most babies who are born breech are healthy. But when a baby is in the frank breech position, or any breech position, there is more of a chance that labor and delivery can be difficult. Some of the complications of a vaginal breech birth are:

Umbilical Cord Prolapse

During a vaginal breech delivery, there is a chance that the umbilical cord will come down through the cervix before the baby is born. As the baby comes through the birth canal, his body and head can press on the cord and cut off the supply of blood and oxygen that the cord is carrying.

This can affect the baby’s heart rate and the flow of oxygen and blood to the baby’s brain. The danger of a prolapsed cord is greater with a footling breech and a complete breech. The risk is less when the baby is in the frank breech position.

Head Entrapment

The baby’s head can get stuck during the delivery if the baby’s body is born before the cervix fully dilates. This situation is dangerous since the head can press against the umbilical cord and cause asphyxia or a lack of oxygen. Head entrapment is more common in premature deliveries because the baby’s head is typically bigger than the body.

Physical Injuries to the Baby

The risk of injury to the baby is higher when the baby is breech compared to when the baby is not breech. Preemies are more likely to injure their head and skull. Bruising, broken bones and dislocated joints can also occur depending on the baby's position during birth.

Physical Injuries to the Mother

The vaginal delivery of a breech baby can include an episiotomy and the use of forceps, which can cause injury to the genital area. Breech presentation is one of the reasons for a cesarean section. A cesarean is surgery with anesthesia. Besides the surgical incision, a mom may experience pain, infection, bleeding, or other complications.

Delivery of a Frank Breech Baby

Many babies will turn to the head-down position before labor begins. However, if your child is still breech when it’s time to deliver, you and your doctor will have to decide on the type of birth. When there are no other complications, a baby in the frank breech position may be delivered vaginally if:

  • The baby is at least 36 weeks gestation.
  • The baby is not too big or too small.
  • You have delivered vaginally before.
  • The size of your pelvis is large enough.
  • The baby’s head is in the right position (flexed).
  • The healthcare team has experience with breech deliveries.
  • There is continuous monitoring of the baby.
  • Emergency resources are available.

If any complications arise during the delivery, you may still need an emergency c-section. Whenever possible, the standard choice is to deliver any breech baby who is premature or in distress via cesarean section. Since vaginal deliveries, even when all the above criteria are met, come with a higher risk of a difficult birth and birth injuries, most doctors prefer to deliver all breech presentations by c-section.

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