what is presentation in breech

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StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

StatPearls [Internet].

Breech presentation.

Caron J. Gray ; Meaghan M. Shanahan .

Affiliations

Last Update: November 6, 2022 .

Continuing Education Activity

Breech presentation refers to the fetus in the longitudinal lie with the buttocks or lower extremity entering the pelvis first. The three types of breech presentation include frank breech, complete breech, and incomplete breech. In a frank breech, the fetus has flexion of both hips, and the legs are straight with the feet near the fetal face, in a pike position. This activity reviews the cause and pathophysiology of breech presentation and highlights the role of the interprofessional team in its management.

Describe the pathophysiology of breech presentation.
Review the physical exam of a patient with a breech presentation.
Summarize the treatment options for breech presentation.
Explain the importance of improving care coordination among interprofessional team members to improve outcomes for patients affected by breech presentation.
Introduction

Breech presentation refers to the fetus in the longitudinal lie with the buttocks or lower extremity entering the pelvis first. The three types of breech presentation include frank breech, complete breech, and incomplete breech. In a frank breech, the fetus has flexion of both hips, and the legs are straight with the feet near the fetal face, in a pike position. The complete breech has the fetus sitting with flexion of both hips and both legs in a tuck position. Finally, the incomplete breech can have any combination of one or both hips extended, also known as footling (one leg extended) breech, or double footling breech (both legs extended). [1] [2] [3]

Clinical conditions associated with breech presentation include those that may increase or decrease fetal motility, or affect the vertical polarity of the uterine cavity. Prematurity, multiple gestations, aneuploidies, congenital anomalies, Mullerian anomalies, uterine leiomyoma, and placental polarity as in placenta previa are most commonly associated with a breech presentation. Also, a previous history of breech presentation at term increases the risk of repeat breech presentation at term in subsequent pregnancies. [4] [5] These are discussed in more detail in the pathophysiology section.

Epidemiology

Breech presentation occurs in 3% to 4% of all term pregnancies. A higher percentage of breech presentations occurs with less advanced gestational age. At 32 weeks, 7% of fetuses are breech, and 28 weeks or less, 25% are breech.

Specifically, following one breech delivery, the recurrence rate for the second pregnancy was nearly 10%, and for a subsequent third pregnancy, it was 27%. Prior cesarean delivery has also been described by some to increase the incidence of breech presentation two-fold.

Pathophysiology

As mentioned previously, the most common clinical conditions or disease processes that result in the breech presentation are those that affect fetal motility or the vertical polarity of the uterine cavity. [6] [7]

Conditions that change the vertical polarity or the uterine cavity, or affect the ease or ability of the fetus to turn into the vertex presentation in the third trimester include:

Mullerian anomalies: Septate uterus, bicornuate uterus, and didelphys uterus
Placentation: Placenta previa as the placenta is occupying the inferior portion of the uterine cavity. Therefore, the presenting part cannot engage
Uterine leiomyoma: Mainly larger myomas located in the lower uterine segment, often intramural or submucosal, that prevent engagement of the presenting part.
Prematurity
Aneuploidies and fetal neuromuscular disorders commonly cause hypotonia of the fetus, inability to move effectively
Congenital anomalies: Fetal sacrococcygeal teratoma, fetal thyroid goiter
Polyhydramnios: Fetus is often in unstable lie, unable to engage
Oligohydramnios: Fetus is unable to turn to vertex due to lack of fluid
Laxity of the maternal abdominal wall: Uterus falls forward, the fetus is unable to engage in the pelvis.

The risk of cord prolapse varies depending on the type of breech. Incomplete or footling breech carries the highest risk of cord prolapse at 15% to 18%, while complete breech is lower at 4% to 6%, and frank breech is uncommon at 0.5%.

History and Physical

During the physical exam, using the Leopold maneuvers, palpation of a hard, round, mobile structure at the fundus and the inability to palpate a presenting part in the lower abdomen superior to the pubic bone or the engaged breech in the same area, should raise suspicion of a breech presentation.

During a cervical exam, findings may include the lack of a palpable presenting part, palpation of a lower extremity, usually a foot, or for the engaged breech, palpation of the soft tissue of the fetal buttocks may be noted. If the patient has been laboring, caution is warranted as the soft tissue of the fetal buttocks may be interpreted as caput of the fetal vertex.

Any of these findings should raise suspicion and ultrasound should be performed.

Diagnosis of a breech presentation can be accomplished through abdominal exam using the Leopold maneuvers in combination with the cervical exam. Ultrasound should confirm the diagnosis.

On ultrasound, the fetal lie and presenting part should be visualized and documented. If breech presentation is diagnosed, specific information including the specific type of breech, the degree of flexion of the fetal head, estimated fetal weight, amniotic fluid volume, placental location, and fetal anatomy review (if not already done previously) should be documented.

Treatment / Management

Expertise in the delivery of the vaginal breech baby is becoming less common due to fewer vaginal breech deliveries being offered throughout the United States and in most industrialized countries. The Term Breech Trial (TBT), a well-designed, multicenter, international, randomized controlled trial published in 2000 compared planned vaginal delivery to planned cesarean delivery for the term breech infant. The investigators reported that delivery by planned cesarean resulted in significantly lower perinatal mortality, neonatal mortality, and serious neonatal morbidity. Also, there was no significant difference in maternal morbidity or mortality between the two groups. Since that time, the rate of term breech infants delivered by planned cesarean has increased dramatically. Follow-up studies to the TBT have been published looking at maternal morbidity and outcomes of the children at two years. Although these reports did not show any significant difference in the risk of death and neurodevelopmental, these studies were felt to be underpowered. [8] [9] [10] [11]

Since the TBT, many authors since have argued that there are still some specific situations that vaginal breech delivery is a potential, safe alternative to planned cesarean. Many smaller retrospective studies have reported no difference in neonatal morbidity or mortality using these specific criteria.

The initial criteria used in these reports were similar: gestational age greater than 37 weeks, frank or complete breech presentation, no fetal anomalies on ultrasound examination, adequate maternal pelvis, and estimated fetal weight between 2500 g and 4000 g. In addition, the protocol presented by one report required documentation of fetal head flexion and adequate amniotic fluid volume, defined as a 3-cm vertical pocket. Oxytocin induction or augmentation was not offered, and strict criteria were established for normal labor progress. CT pelvimetry did determine an adequate maternal pelvis.

Despite debate on both sides, the current recommendation for the breech presentation at term includes offering external cephalic version (ECV) to those patients that meet criteria, and for those whom are not candidates or decline external cephalic version, a planned cesarean section for delivery sometime after 39 weeks.

Regarding the premature breech, gestational age will determine the mode of delivery. Before 26 weeks, there is a lack of quality clinical evidence to guide mode of delivery. One large retrospective cohort study recently concluded that from 28 to 31 6/7 weeks, there is a significant decrease in perinatal morbidity and mortality in a planned cesarean delivery versus intended vaginal delivery, while there is no difference in perinatal morbidity and mortality in gestational age 32 to 36 weeks. Of note, due to lack of recruitment, no prospective clinical trials are examining this issue.

Differential Diagnosis
Face and brow presentation
Fetal anomalies
Fetal death
Grand multiparity
Multiple pregnancies
Oligohydramnios
Pelvis Anatomy
Preterm labor
Primigravida
Uterine anomalies
Pearls and Other Issues

In light of the decrease in planned vaginal breech deliveries, thus the decrease in expertise in managing this clinical scenario, it is prudent that policies requiring simulation and instruction in the delivery technique for vaginal breech birth are established to care for the emergency breech vaginal delivery.

Enhancing Healthcare Team Outcomes

A breech delivery is usually managed by an obstetrician, labor and delivery nurse, anesthesiologist and a neonatologist. The ultimate decison rests on the obstetrician. To prevent complications, today cesarean sections are performed and experienced with vaginal deliveries of breech presentation is limited. For healthcare workers including the midwife who has no experience with a breech delivery, it is vital to communicate with an obstetrician, otherwise one risks litigation if complications arise during delivery. [12] [13] [14]

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Disclosure: Caron Gray declares no relevant financial relationships with ineligible companies.

Disclosure: Meaghan Shanahan declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

Cite this Page Gray CJ, Shanahan MM. Breech Presentation. [Updated 2022 Nov 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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Breech Births

In the last weeks of pregnancy, a baby usually moves so his or her head is positioned to come out of the vagina first during birth. This is called a vertex presentation. A breech presentation occurs when the baby’s buttocks, feet, or both are positioned to come out first during birth. This happens in 3–4% of full-term births.

What are the different types of breech birth presentations?

Complete breech: Here, the buttocks are pointing downward with the legs folded at the knees and feet near the buttocks.
Frank breech: In this position, the baby’s buttocks are aimed at the birth canal with its legs sticking straight up in front of his or her body and the feet near the head.
Footling breech: In this position, one or both of the baby’s feet point downward and will deliver before the rest of the body.

What causes a breech presentation?

The causes of breech presentations are not fully understood. However, the data show that breech birth is more common when:

You have been pregnant before
In pregnancies of multiples
When there is a history of premature delivery
When the uterus has too much or too little amniotic fluid
When there is an abnormally shaped uterus or a uterus with abnormal growths, such as fibroids
The placenta covers all or part of the opening of the uterus placenta previa

How is a breech presentation diagnosed?

A few weeks prior to the due date, the health care provider will place her hands on the mother’s lower abdomen to locate the baby’s head, back, and buttocks. If it appears that the baby might be in a breech position, they can use ultrasound or pelvic exam to confirm the position. Special x-rays can also be used to determine the baby’s position and the size of the pelvis to determine if a vaginal delivery of a breech baby can be safely attempted.

Can a breech presentation mean something is wrong?

Even though most breech babies are born healthy, there is a slightly elevated risk for certain problems. Birth defects are slightly more common in breech babies and the defect might be the reason that the baby failed to move into the right position prior to delivery.

Can a breech presentation be changed?

It is preferable to try to turn a breech baby between the 32nd and 37th weeks of pregnancy . The methods of turning a baby will vary and the success rate for each method can also vary. It is best to discuss the options with the health care provider to see which method she recommends.

Medical Techniques

External Cephalic Version (EVC) is a non-surgical technique to move the baby in the uterus. In this procedure, a medication is given to help relax the uterus. There might also be the use of an ultrasound to determine the position of the baby, the location of the placenta and the amount of amniotic fluid in the uterus.

Gentle pushing on the lower abdomen can turn the baby into the head-down position. Throughout the external version the baby’s heartbeat will be closely monitored so that if a problem develops, the health care provider will immediately stop the procedure. ECV usually is done near a delivery room so if a problem occurs, a cesarean delivery can be performed quickly. The external version has a high success rate and can be considered if you have had a previous cesarean delivery.

ECV will not be tried if:

You are carrying more than one fetus
There are concerns about the health of the fetus
You have certain abnormalities of the reproductive system
The placenta is in the wrong place
The placenta has come away from the wall of the uterus ( placental abruption )

Complications of EVC include:

Prelabor rupture of membranes
Changes in the fetus’s heart rate
Placental abruption
Preterm labor

Vaginal delivery versus cesarean for breech birth?

Most health care providers do not believe in attempting a vaginal delivery for a breech position. However, some will delay making a final decision until the woman is in labor. The following conditions are considered necessary in order to attempt a vaginal birth:

The baby is full-term and in the frank breech presentation
The baby does not show signs of distress while its heart rate is closely monitored.
The process of labor is smooth and steady with the cervix widening as the baby descends.
The health care provider estimates that the baby is not too big or the mother’s pelvis too narrow for the baby to pass safely through the birth canal.
Anesthesia is available and a cesarean delivery possible on short notice

What are the risks and complications of a vaginal delivery?

In a breech birth, the baby’s head is the last part of its body to emerge making it more difficult to ease it through the birth canal. Sometimes forceps are used to guide the baby’s head out of the birth canal. Another potential problem is cord prolapse . In this situation the umbilical cord is squeezed as the baby moves toward the birth canal, thus slowing the baby’s supply of oxygen and blood. In a vaginal breech delivery, electronic fetal monitoring will be used to monitor the baby’s heartbeat throughout the course of labor. Cesarean delivery may be an option if signs develop that the baby may be in distress.

When is a cesarean delivery used with a breech presentation?

Most health care providers recommend a cesarean delivery for all babies in a breech position, especially babies that are premature. Since premature babies are small and more fragile, and because the head of a premature baby is relatively larger in proportion to its body, the baby is unlikely to stretch the cervix as much as a full-term baby. This means that there might be less room for the head to emerge.

Want to Know More?

Creating Your Birth Plan
Labor & Birth Terms to Know
Cesarean Birth After Care

Compiled using information from the following sources:

ACOG: If Your Baby is Breech
William’s Obstetrics Twenty-Second Ed. Cunningham, F. Gary, et al, Ch. 24.
Danforth’s Obstetrics and Gynecology Ninth Ed. Scott, James R., et al, Ch. 21.

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Fetal Presentation, Position, and Lie (Including Breech Presentation)

Variations in Fetal Position and Presentation |

During pregnancy, the fetus can be positioned in many different ways inside the mother's uterus. The fetus may be head up or down or facing the mother's back or front. At first, the fetus can move around easily or shift position as the mother moves. Toward the end of the pregnancy the fetus is larger, has less room to move, and stays in one position. How the fetus is positioned has an important effect on delivery and, for certain positions, a cesarean delivery is necessary. There are medical terms that describe precisely how the fetus is positioned, and identifying the fetal position helps doctors to anticipate potential difficulties during labor and delivery.

Presentation refers to the part of the fetus’s body that leads the way out through the birth canal (called the presenting part). Usually, the head leads the way, but sometimes the buttocks (breech presentation), shoulder, or face leads the way.

Position refers to whether the fetus is facing backward (occiput anterior) or forward (occiput posterior). The occiput is a bone at the back of the baby's head. Therefore, facing backward is called occiput anterior (facing the mother’s back and facing down when the mother lies on her back). Facing forward is called occiput posterior (facing toward the mother's pubic bone and facing up when the mother lies on her back).

Lie refers to the angle of the fetus in relation to the mother and the uterus. Up-and-down (with the baby's spine parallel to mother's spine, called longitudinal) is normal, but sometimes the lie is sideways (transverse) or at an angle (oblique).

For these aspects of fetal positioning, the combination that is the most common, safest, and easiest for the mother to deliver is the following:

Head first (called vertex or cephalic presentation)

Facing backward (occiput anterior position)

Spine parallel to mother's spine (longitudinal lie)

Neck bent forward with chin tucked

Arms folded across the chest

If the fetus is in a different position, lie, or presentation, labor may be more difficult, and a normal vaginal delivery may not be possible.

Variations in fetal presentation, position, or lie may occur when

The fetus is too large for the mother's pelvis (fetopelvic disproportion).

The uterus is abnormally shaped or contains growths such as fibroids .

The fetus has a birth defect .

There is more than one fetus (multiple gestation).

Position and Presentation of the Fetus

Variations in fetal position and presentation.

Some variations in position and presentation that make delivery difficult occur frequently.

Occiput posterior position

In occiput posterior position (sometimes called sunny-side up), the fetus is head first (vertex presentation) but is facing forward (toward the mother's pubic bone—that is, facing up when the mother lies on her back). This is a very common position that is not abnormal, but it makes delivery more difficult than when the fetus is in the occiput anterior position (facing toward the mother's spine—that is facing down when the mother lies on her back).

When a fetus faces up, the neck is often straightened rather than bent,which requires more room for the head to pass through the birth canal. Delivery assisted by a vacuum device or forceps or cesarean delivery may be necessary.

Breech presentation

In breech presentation, the baby's buttocks or sometimes the feet are positioned to deliver first (before the head).

When delivered vaginally, babies that present buttocks first are more at risk of injury or even death than those that present head first.

The reason for the risks to babies in breech presentation is that the baby's hips and buttocks are not as wide as the head. Therefore, when the hips and buttocks pass through the cervix first, the passageway may not be wide enough for the head to pass through. In addition, when the head follows the buttocks, the neck may be bent slightly backwards. The neck being bent backward increases the width required for delivery as compared to when the head is angled forward with the chin tucked, which is the position that is easiest for delivery. Thus, the baby’s body may be delivered and then the head may get caught and not be able to pass through the birth canal. When the baby’s head is caught, this puts pressure on the umbilical cord in the birth canal, so that very little oxygen can reach the baby. Brain damage due to lack of oxygen is more common among breech babies than among those presenting head first.

In a first delivery, these problems may occur more frequently because a woman’s tissues have not been stretched by previous deliveries. Because of risk of injury or even death to the baby, cesarean delivery is preferred when the fetus is in breech presentation, unless the doctor is very experienced with and skilled at delivering breech babies or there is not an adequate facility or equipment to safely perform a cesarean delivery.

Breech presentation is more likely to occur in the following circumstances:

Labor starts too soon (preterm labor).

The uterus is abnormally shaped or contains abnormal growths such as fibroids .

Breech presentation

Overview  
Theory  
Diagnosis  
Management  
Follow up  
Resources  

Breech presentation refers to the baby presenting for delivery with the buttocks or feet first rather than head.

Associated with increased morbidity and mortality for the mother in terms of emergency cesarean section and placenta previa; and for the baby in terms of preterm birth, small fetal size, congenital anomalies, and perinatal mortality.

Incidence decreases as pregnancy progresses and by term occurs in 3% to 4% of singleton term pregnancies.

Treatment options include external cephalic version to increase the likelihood of vaginal birth or a planned cesarean section, the optimal gestation being 37 and 39 weeks, respectively.

Planned cesarean section is considered the safest form of delivery for infants with a persisting breech presentation at term.

Breech presentation in pregnancy occurs when a baby presents with the buttocks or feet rather than the head first (cephalic presentation) and is associated with increased morbidity and mortality for both the mother and the baby. [1] Cunningham F, Gant N, Leveno K, et al. Williams obstetrics. 21st ed. New York: McGraw-Hill; 1997. [2] Kish K, Collea JV. Malpresentation and cord prolapse. In: DeCherney AH, Nathan L, eds. Current obstetric and gynecologic diagnosis and treatment. New York: McGraw-Hill Professional; 2002. There is good current evidence regarding effective management of breech presentation in late pregnancy using external cephalic version and/or planned cesarean section.

History and exam

Key diagnostic factors.

buttocks or feet as the presenting part
fetal head under costal margin
fetal heartbeat above the maternal umbilicus

Other diagnostic factors

subcostal tenderness
pelvic or bladder pain

Risk factors

premature fetus
small for gestational age fetus
nulliparity
fetal congenital anomalies
previous breech delivery
uterine abnormalities
abnormal amniotic fluid volume
placental abnormalities
female fetus

Diagnostic investigations

1st investigations to order.

transabdominal/transvaginal ultrasound

Treatment algorithm

<37 weeks' gestation, ≥37 weeks' gestation not in labor, ≥37 weeks' gestation in labor: no imminent delivery, ≥37 weeks' gestation in labor: imminent delivery, contributors, natasha nassar, phd.

Associate Professor

Menzies Centre for Health Policy

Sydney School of Public Health

University of Sydney

Disclosures

NN has received salary support from Australian National Health and a Medical Research Council Career Development Fellowship; she is an author of a number of references cited in this topic.

Christine L. Roberts, MBBS, FAFPHM, DrPH

Research Director

Clinical and Population Health Division

Perinatal Medicine Group

Kolling Institute of Medical Research

CLR declares that she has no competing interests.

Jonathan Morris, MBChB, FRANZCOG, PhD

Professor of Obstetrics and Gynaecology and Head of Department

JM declares that he has no competing interests.

Peer reviewers

John w. bachman, md.

Consultant in Family Medicine

Department of Family Medicine

Mayo Clinic

JWB declares that he has no competing interests.

Rhona Hughes, MBChB

Lead Obstetrician

Lothian Simpson Centre for Reproductive Health

The Royal Infirmary

RH declares that she has no competing interests.

Brian Peat, MD

Director of Obstetrics

Women's and Children's Hospital

North Adelaide

South Australia

BP declares that he has no competing interests.

Lelia Duley, MBChB

Professor of Obstetric Epidemiology

University of Leeds

Bradford Institute of Health Research

Temple Bank House

Bradford Royal Infirmary

LD declares that she has no competing interests.

Justus Hofmeyr, MD

Head of the Department of Obstetrics and Gynaecology

East London Private Hospital

East London

South Africa

JH is an author of a number of references cited in this topic.

Differentials

Transverse lie
Antenatal corticosteroids to reduce neonatal morbidity and mortality
Caesarean birth

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Labor & Delivery

What Causes Breech Presentation?

Learn more about the types, causes, and risks of breech presentation, along with how breech babies are typically delivered.

What Is Breech Presentation?

Types of breech presentation, what causes a breech baby, can you turn a breech baby, how are breech babies delivered.

FatCamera/Getty Images

Toward the end of pregnancy, your baby will start to get into position for delivery, with their head pointed down toward the vagina. This is otherwise known as vertex presentation. However, some babies turn inside the womb so that their feet or buttocks are poised to be delivered first, which is commonly referred to as breech presentation, or a breech baby.

As you near the end of your pregnancy journey, an OB-GYN or health care provider will check your baby's positioning. You might find yourself wondering: What causes breech presentation? Are there risks involved? And how are breech babies delivered? We turned to experts and research to answer some of the most common questions surrounding breech presentation, along with what causes this positioning in the first place.

During your pregnancy, your baby constantly moves around the uterus. Indeed, most babies do somersaults up until the 36th week of pregnancy , when they pick their final position in the womb, says Laura Riley , MD, an OB-GYN in New York City. Approximately 3-4% of babies end up “upside-down” in breech presentation, with their feet or buttocks near the cervix.

Breech presentation is typically diagnosed during a visit to an OB-GYN, midwife, or health care provider. Your physician can feel the position of your baby's head through your abdominal wall—or they can conduct a vaginal exam if your cervix is open. A suspected breech presentation should ultimately be confirmed via an ultrasound, after which you and your provider would have a discussion about delivery options, potential issues, and risks.

There are three types of breech babies: frank, footling, and complete. Learn about the differences between these breech presentations.

Frank Breech

With frank breech presentation, your baby’s bottom faces the cervix and their legs are straight up. This is the most common type of breech presentation.

Footling Breech

Like its name suggests, a footling breech is when one (single footling) or both (double footling) of the baby's feet are in the birth canal, where they’re positioned to be delivered first .

Complete Breech

In a complete breech presentation, baby’s bottom faces the cervix. Their legs are bent at the knees, and their feet are near their bottom. A complete breech is the least common type of breech presentation.

Breech - series—Types of breech presentation

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There are three types of breech presentation: complete, incomplete, and frank.

Complete breech is when both of the baby's knees are bent and his feet and bottom are closest to the birth canal.

Incomplete breech is when one of the baby's knees is bent and his foot and bottom are closest to the birth canal.

Frank breech is when the baby's legs are folded flat up against his head and his bottom is closest to the birth canal.

There is also footling breech where one or both feet are presenting.

Review Date 11/21/2022

Updated by: LaQuita Martinez, MD, Department of Obstetrics and Gynecology, Emory Johns Creek Hospital, Alpharetta, GA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

What to know if your baby is breech

Find out what breech position means, how to turn a breech baby, and what having a breech baby means for your labor and delivery.

What does it mean when a baby is breech?

Signs of a breech baby, why are some babies breech, how to turn a breech baby: is it possible, will i need a c-section if my baby is breech, how to turn a breech baby naturally.

Breech is a term used to describe your baby's position in the womb. Breech position means your baby is bottom-down instead of head-down.

Babies are often active in early pregnancy, moving into different positions. But by around 8 months, there's not much room in the uterus. Most babies maximize their cramped quarters by settling in head down, in what's known as a cephalic or vertex presentation. But if you have a breech baby, it means they're poised to come out buttocks and/or feet first. At 28 weeks or less, about a quarter of babies are breech, and at 32 weeks, 7 percent are breech. By the end of pregnancy, only 3 to 4 percent of babies are in breech position. At term, a baby in breech position is unlikely to turn on their own.

There are several types of breech presentations:

Frank breech (bottom first with feet up near the head)
Complete breech (bottom first with legs crossed)
Incomplete or footling breech (one or both feet are poised to come out first)

(In rare cases, a baby will be sideways in the uterus with their shoulder, back, or arm presenting first – this is called a transverse lie.)

See what these breech presentations look like .

If your baby is in breech position, you may feel them kicking in your lower belly. Or you may feel pressure under your ribcage, from their head.

By the beginning of your third trimester , your practitioner may be able to tell what position your baby is in by feeling your abdomen and locating the baby's head, back, and bottom.

If your baby's position isn't clear during an abdominal exam at 36 weeks, your caregiver may do an internal exam to try to feel what part of the baby is in your pelvis. In some cases, they may use ultrasound to confirm the baby's position.

We don't usually know why some babies are breech – in most cases it seems to be chance. While sometimes a baby with certain birth defects may not turn to a head-down position, most babies in breech position are perfectly fine. Here are some things that might increase the risk of a breech presentation:

You're carrying multiples
You've been pregnant before
You've had a breech presentation before
There's too much amniotic fluid or not enough amniotic fluid
You have placenta previa (the placenta is covering all of part of the opening of the uterus)
Your baby is preterm
Your uterus is shaped abnormally or has growths, such as fibroids
The umbilical cord is short
You were a breech delivery, or your sibling or parent was a breech delivery
Advanced maternal age (especially age 45 and older)
Your baby is a low weight at delivery
You're having a girl

There is a procedure for turning a breech baby. It's called an external cephalic version (ECV). An ob/gyn turns your baby by applying pressure to your abdomen and manually manipulating the baby into a head-down position. Some women find it very uncomfortable or even painful.

An EVC has about a 58 percent success rate, and it's more likely to work if this isn't your first baby. It's not for everyone – you can't have the procedure if you're carrying multiples or if you have too little amniotic fluid or placental abruption , for example. Your provider also won't attempt to turn your breech baby if your baby has any health problems.

The procedure is done after 36 weeks and in the hospital, where your baby can be monitored and where you'll be near a delivery room should any complications arise.

It depends, and it's something you'll want to talk with your caregiver about ahead of time. Discuss your preferences, the advantages and risks of each option ( vaginal and cesarean delivery of a breech presentation), and their experience. The biggest risk of a breech delivery is when the body delivers but the head stays entrapped within the cervix.

In the United States, most breech babies are delivered via cesarean. You may wind up having a vaginal breech delivery if your labor is so rapid that you arrive at the hospital just about to deliver. Another scenario is if you have a twin pregnancy where the first baby is in the head-first position and the second baby is not. A baby who delivers head-first will make room for the breech baby.

However, the vast majority of babies who remain breech arrive by c-section. If a c-section is planned, it will usually be scheduled at 39 weeks. To make sure your baby hasn't changed position in the meantime, you'll have an ultrasound at the hospital to confirm their position just before the surgery.

If you go into labor or your water will break s before your planned c-section, be sure to call your provider right away and head for the hospital.

In rare circumstances, if you're at low risk of complications and your caregiver is experienced delivering breech babies vaginally, you may choose to have what is called a "trial of vaginal birth." This means that you can attempt to deliver vaginally but should be prepared to have a cesarean delivery if labor isn't progressing well. You and your baby will be closely monitored during labor.

In addition to ECV, there are some alternative, natural ways to try to turn your baby. There's no proof that any of them work – or that all of them are safe. Consult your practitioner before trying them.

There's no conclusive proof that the mother's position has any effect on the baby's position, but the idea is to employ gravity to help your baby somersault into a head-down position. A few tips:

Get into one of the following positions twice a day, starting at around 32 weeks.
Be sure to do these moves on an empty stomach, lest your lunch comes back up.
Make sure there's someone around to help you get up if you start feeling lightheaded.
If you find these positions uncomfortable, stop doing them.

Position 1: Lie flat on your back and raise your pelvis so that it's 9 to 12 inches off the floor. Support your hips with a pillow and stay in this position for five to 15 minutes. Position 2: Kneel down, with your forearms on the floor in front of you, so that your bottom sticks up in the air. Stay in this position for five to 15 minutes. Sleeping position

Many women wonder if there are sleeping positions to turn a breech baby. But the positions you use to try to coax your baby head down for a short time shouldn't be used while you're sleeping. (It's not safe to sleep flat on your back in late pregnancy, for example, because the weight of your baby may compress the blood vessels that provide oxygen and nutrients to them.)

The best position for sleeping during pregnancy is on your side. Placing a pillow between your legs in this position may help open your pelvis, giving your baby room to move more easily. Support your back with plenty of pillows, too. Again, there's no proof that this works, but since it's the best sleeping position for you and your baby, you may as well give it a try.

Moxibustion

This ancient Chinese technique burns herbs to stimulate key acupressure points. To help turn a breech baby, an acupuncturist or other practitioner burns mugwort near the acupressure point of your pinky toes. According to Chinese medicine, this should stimulate your baby's activity enough that they may change position on their own. Some studies show that moxibustion in combination with acupuncture and/or positioning methods may be of some benefit. Others show moxibustion to provide no help in coaxing a baby into cephalic position. If you've discussed it with your caregiver and want to give it a try, contact your state acupuncture or Chinese medicine association and ask for the names of licensed practitioners.

One small study found that women who are regularly hypnotized into a state of deep relaxation at 37 to 40 weeks are more likely to have their baby turn than other women. If you're willing to try this technique, look for a licensed hypnotherapist with experience working with pregnant women.

Chiropractic care

There's a technique – called The Webster Breech Technique – that aims to reduce stress on the pelvis by relaxing the uterus and surrounding ligaments. The idea is that a breech baby can turn more naturally in a relaxed uterus, but research is limited as to the risks and benefits of this technique. If you're interested, talk with your provider about working with a chiropractor who's experienced with the technique.

This is a safe – and again, unproven – method based on the fact that your baby can hear sounds outside the womb. Simply play music close to the lower part of your abdomen (some women use headphones) to encourage your baby to move in the direction of the sound.

Learn more:

C-section recovery
Third trimester pregnancy guide and checklist
Hospital bag checklist

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Breech, posterior, transverse lie: What position is my baby in?

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BabyCenter's editorial team is committed to providing the most helpful and trustworthy pregnancy and parenting information in the world. When creating and updating content, we rely on credible sources: respected health organizations, professional groups of doctors and other experts, and published studies in peer-reviewed journals. We believe you should always know the source of the information you're seeing. Learn more about our editorial and medical review policies .

ACOG. 2019. If your baby is breech. FAQ. The American College of Obstetricians and Gynecologists. https://www.acog.org/womens-health/faqs/if-your-baby-is-breech Opens a new window [Accessed November 2021]

ACOG. 2018. Mode of term singleton breech delivery. Committee opinion number 745. The American College of Obstetricians and Gynecologists. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/08/mode-of-term-singleton-breech-delivery Opens a new window [Accessed November 2021]

Brici P et al. 2019. Turning foetal breech presentation at 32-35 weeks of gestational age by acupuncture and moxibustion. Evidence-based Complementary and Alternative Medicine https://www.hindawi.com/journals/ecam/2019/8950924/ Opens a new window [Accessed November 2021]

Ekeus C et al. 2019. Vaginal breech delivery at term and neonatal morbidity and mortality — a population-based cohort study in Sweden. Journal of Maternal Fetal Neonatal Medicine 32(2):265. https://pubmed.ncbi.nlm.nih.gov/28889774/ Opens a new window [Accessed November 2021]

Fruscalzo A et al 2014. New and old predictive factors for breech presentation: our experience in 14433 singleton pregnancies and a literature review. Journal of Maternal Fetal Neonatal Medicine 27(2): 167-72. https://pubmed.ncbi.nlm.nih.gov/23688372/ Opens a new window [Accessed November 2021]

Garcia MM et al. 2019 Effectiveness and safety of acupuncture and moxibustion in pregnant women with noncephalic presentation: An overview of systematic reviews. Evidence Based Complementary Alternative Medicine 7036914. https://pubmed.ncbi.nlm.nih.gov/31885661/ Opens a new window [Accessed November 2021]

Gray C. 2021. Breech presentation. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK448063/ Opens a new window [Accessed November 2021]

Meaghan M et al. 2021. External cephalic version. NCBI StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK482475/ Opens a new window [Accessed November 2021]

MedlinePlus. 2020. Breech - series - Types of breech presentation. https://medlineplus.gov/ency/presentations/100193_3.htm Opens a new window [Accessed November 2020]

Noli SA et al. 2019. Preterm birth, low gestational age, low birth weight, parity, and other determinants of breech presentation: Results from a large retrospective population-based study. Biomed Research International https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6766171/ Opens a new window [Accessed November 2021]

Pistolese RA. 2002. The Webster Technique: A chiropractic technique with obstetric implications. Journal of Manipulative and Physiological Therapeutics 25(6): E1-9. https://pubmed.ncbi.nlm.nih.gov/12183701/ Opens a new window [Accessed November 2021]

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Pregnancy week by week
Fetal presentation before birth

The way a baby is positioned in the uterus just before birth can have a big effect on labor and delivery. This positioning is called fetal presentation.

Babies twist, stretch and tumble quite a bit during pregnancy. Before labor starts, however, they usually come to rest in a way that allows them to be delivered through the birth canal headfirst. This position is called cephalic presentation. But there are other ways a baby may settle just before labor begins.

Following are some of the possible ways a baby may be positioned at the end of pregnancy.

Head down, face down

When a baby is head down, face down, the medical term for it is the cephalic occiput anterior position. This the most common position for a baby to be born in. With the face down and turned slightly to the side, the smallest part of the baby's head leads the way through the birth canal. It is the easiest way for a baby to be born.

Head down, face up

When a baby is head down, face up, the medical term for it is the cephalic occiput posterior position. In this position, it might be harder for a baby's head to go under the pubic bone during delivery. That can make labor take longer.

Most babies who begin labor in this position eventually turn to be face down. If that doesn't happen, and the second stage of labor is taking a long time, a member of the health care team may reach through the vagina to help the baby turn. This is called manual rotation.

In some cases, a baby can be born in the head-down, face-up position. Use of forceps or a vacuum device to help with delivery is more common when a baby is in this position than in the head-down, face-down position. In some cases, a C-section delivery may be needed.

Illustration of the head-down, face-up position

Frank breech

When a baby's feet or buttocks are in place to come out first during birth, it's called a breech presentation. This happens in about 3% to 4% of babies close to the time of birth. The baby shown below is in a frank breech presentation. That's when the knees aren't bent, and the feet are close to the baby's head. This is the most common type of breech presentation.

If you are more than 36 weeks into your pregnancy and your baby is in a frank breech presentation, your health care professional may try to move the baby into a head-down position. This is done using a procedure called external cephalic version. It involves one or two members of the health care team putting pressure on your belly with their hands to get the baby to roll into a head-down position.

If the procedure isn't successful, or if the baby moves back into a breech position, talk with a member of your health care team about the choices you have for delivery. Most babies in a frank breech position are born by planned C-section.

Illustration of the frank breech position

Complete and incomplete breech

A complete breech presentation, as shown below, is when the baby has both knees bent and both legs pulled close to the body. In an incomplete breech, one or both of the legs are not pulled close to the body, and one or both of the feet or knees are below the baby's buttocks. If a baby is in either of these positions, you might feel kicking in the lower part of your belly.

If you are more than 36 weeks into your pregnancy and your baby is in a complete or incomplete breech presentation, your health care professional may try to move the baby into a head-down position. This is done using a procedure called external cephalic version. It involves one or two members of the health care team putting pressure on your belly with their hands to get the baby to roll into a head-down position.

If the procedure isn't successful, or if the baby moves back into a breech position, talk with a member of your health care team about the choices you have for delivery. Many babies in a complete or incomplete breech position are born by planned C-section.

Illustration of a complete breech presentation

When a baby is sideways — lying horizontal across the uterus, rather than vertical — it's called a transverse lie. In this position, the baby's back might be:

Down, with the back facing the birth canal.
Sideways, with one shoulder pointing toward the birth canal.
Up, with the hands and feet facing the birth canal.

Although many babies are sideways early in pregnancy, few stay this way when labor begins.

If your baby is in a transverse lie during week 37 of your pregnancy, your health care professional may try to move the baby into a head-down position. This is done using a procedure called external cephalic version. External cephalic version involves one or two members of your health care team putting pressure on your belly with their hands to get the baby to roll into a head-down position.

If the procedure isn't successful, or if the baby moves back into a transverse lie, talk with a member of your health care team about the choices you have for delivery. Many babies who are in a transverse lie are born by C-section.

If you're pregnant with twins and only the twin that's lower in the uterus is head down, as shown below, your health care provider may first deliver that baby vaginally.

Then, in some cases, your health care team may suggest delivering the second twin in the breech position. Or they may try to move the second twin into a head-down position. This is done using a procedure called external cephalic version. External cephalic version involves one or two members of the health care team putting pressure on your belly with their hands to get the baby to roll into a head-down position.

Your health care team may suggest delivery by C-section for the second twin if:

An attempt to deliver the baby in the breech position is not successful.
You do not want to try to have the baby delivered vaginally in the breech position.
An attempt to move the baby into a head-down position is not successful.
You do not want to try to move the baby to a head-down position.

In some cases, your health care team may advise that you have both twins delivered by C-section. That might happen if the lower twin is not head down, the second twin has low or high birth weight as compared to the first twin, or if preterm labor starts.

Landon MB, et al., eds. Normal labor and delivery. In: Gabbe's Obstetrics: Normal and Problem Pregnancies. 8th ed. Elsevier; 2021. https://www.clinicalkey.com. Accessed May 19, 2023.
Holcroft Argani C, et al. Occiput posterior position. https://www.updtodate.com/contents/search. Accessed May 19, 2023.
Frequently asked questions: If your baby is breech. American College of Obstetricians and Gynecologists https://www.acog.org/womens-health/faqs/if-your-baby-is-breech. Accessed May 22, 2023.
Hofmeyr GJ. Overview of breech presentation. https://www.updtodate.com/contents/search. Accessed May 22, 2023.
Strauss RA, et al. Transverse fetal lie. https://www.updtodate.com/contents/search. Accessed May 22, 2023.
Chasen ST, et al. Twin pregnancy: Labor and delivery. https://www.updtodate.com/contents/search. Accessed May 22, 2023.
Cohen R, et al. Is vaginal delivery of a breech second twin safe? A comparison between delivery of vertex and non-vertex second twins. The Journal of Maternal-Fetal & Neonatal Medicine. 2021; doi:10.1080/14767058.2021.2005569.
Marnach ML (expert opinion). Mayo Clinic. May 31, 2023.

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What happens if your baby is breech?

Babies often twist and turn during pregnancy, but most will have moved into the head-down (also known as head-first) position by the time labour begins. However, that does not always happen, and a baby may be:

bottom first or feet first (breech position)
lying sideways (transverse position)

Bottom first or feet first (breech baby)

If your baby is lying bottom or feet first, they are in the breech position. If they're still breech at around 36 weeks' gestation, the obstetrician and midwife will discuss your options for a safe delivery.

Turning a breech baby

If your baby is in a breech position at 36 weeks, you'll usually be offered an external cephalic version (ECV). This is when a healthcare professional, such as an obstetrician, tries to turn the baby into a head-down position by applying pressure on your abdomen. It's a safe procedure, although it can be a bit uncomfortable.

Giving birth to a breech baby

If an ECV does not work, you'll need to discuss your options for a vaginal birth or caesarean section with your midwife and obstetrician.

If you plan a caesarean and then go into labour before the operation, your obstetrician will assess whether it's safe to proceed with the caesarean delivery. If the baby is close to being born, it may be safer for you to have a vaginal breech birth.

The Royal College of Obstetricians and Gynaecologists (RCOG) website has more information on what to expect if your baby is still breech at the end of pregnancy .

The RCOG advises against a vaginal breech delivery if:

your baby's feet are below its bottom – known as a "footling breech"
your baby is larger or smaller than average – your healthcare team will discuss this with you
your baby is in a certain position – for example, their neck is very tilted back, which can make delivery of the head more difficult
you have a low-lying placenta (placenta praevia)
you have pre-eclampsia

Lying sideways (transverse baby)

If your baby is lying sideways across the womb, they are in the transverse position. Although many babies lie sideways early on in pregnancy, most turn themselves into the head-down position by the final trimester.

Giving birth to a transverse baby

Depending on how many weeks pregnant you are when your baby is in a transverse position, you may be admitted to hospital. This is because of the very small risk of the umbilical cord coming out of your womb before your baby is born (cord prolapse). If this happens, it's a medical emergency and the baby must be delivered very quickly.

Sometimes, it's possible to manually turn the baby to a head-down position, and you may be offered this.

But, if your baby is still in the transverse position when you approach your due date or by the time labour begins, you'll most likely be advised to have a caesarean section.

Video: My baby is breech. What help will I get?

In this video, a midwife describes what a breech position is and what can be done if your baby is breech.

Page last reviewed: 1 November 2023 Next review due: 1 November 2026

Breech baby at the end of pregnancy

Published: July 2017

Please note that this information will be reviewed every 3 years after publication.

This patient information page provides advice if your baby is breech towards the end of pregnancy and the options available to you.

It may also be helpful if you are a partner, relative or friend of someone who is in this situation.

The information here aims to help you better understand your health and your options for treatment and care. Your healthcare team is there to support you in making decisions that are right for you. They can help by discussing your situation with you and answering your questions.

This information is for you if your baby remains in the breech position after 36 weeks of pregnancy. Babies lying bottom first or feet first in the uterus (womb) instead of in the usual head-first position are called breech babies.

This information includes:

What breech is and why your baby may be breech
The different types of breech
The options if your baby is breech towards the end of your pregnancy
What turning a breech baby in the uterus involves (external cephalic version or ECV)
How safe ECV is for you and your baby
Options for birth if your baby remains breech
Other information and support available

Within this information, we may use the terms ‘woman’ and ‘women’. However, it is not only people who identify as women who may want to access this information. Your care should be personalised, inclusive and sensitive to your needs, whatever your gender identity.

A glossary of medical terms is available at A-Z of medical terms .

Breech is very common in early pregnancy, and by 36–37 weeks of pregnancy most babies will turn into the head-first position. If your baby remains breech, it does not usually mean that you or your baby have any problems.
Turning your baby into the head-first position so that you can have a vaginal delivery is a safe option.
The alternative to turning your baby into the head-first position is to have a planned caesarean section or a planned vaginal breech birth.

Babies lying bottom first or feet first in the uterus (womb) instead of in the usual head-first position are called breech babies. Breech is very common in early pregnancy, and by 36-37 weeks of pregnancy, most babies turn naturally into the head-first position.

Towards the end of pregnancy, only 3-4 in every 100 (3-4%) babies are in the breech position.

A breech baby may be lying in one of the following positions:

It may just be a matter of chance that your baby has not turned into the head-first position. However, there are certain factors that make it more difficult for your baby to turn during pregnancy and therefore more likely to stay in the breech position. These include:

if this is your first pregnancy
if your placenta is in a low-lying position (also known as placenta praevia); see the RCOG patient information Placenta praevia, placenta accreta and vasa praevia
if you have too much or too little fluid ( amniotic fluid ) around your baby
if you are having more than one baby.

Very rarely, breech may be a sign of a problem with the baby. If this is the case, such problems may be picked up during the scan you are offered at around 20 weeks of pregnancy.

If your baby is breech at 36 weeks of pregnancy, your healthcare professional will discuss the following options with you:

trying to turn your baby in the uterus into the head-first position by external cephalic version (ECV)
planned caesarean section
planned vaginal breech birth.

What does ECV involve?

ECV involves applying gentle but firm pressure on your abdomen to help your baby turn in the uterus to lie head-first.

Relaxing the muscle of your uterus with medication has been shown to improve the chances of turning your baby. This medication is given by injection before the ECV and is safe for both you and your baby. It may make you feel flushed and you may become aware of your heart beating faster than usual but this will only be for a short time.

Before the ECV you will have an ultrasound scan to confirm your baby is breech, and your pulse and blood pressure will be checked. After the ECV, the ultrasound scan will be repeated to see whether your baby has turned. Your baby’s heart rate will also be monitored before and after the procedure. You will be advised to contact the hospital if you have any bleeding, abdominal pain, contractions or reduced fetal movements after ECV.

ECV is usually performed after 36 or 37 weeks of pregnancy. However, it can be performed right up until the early stages of labour. You do not need to make any preparations for your ECV.

ECV can be uncomfortable and occasionally painful but your healthcare professional will stop if you are experiencing pain and the procedure will only last for a few minutes. If your healthcare professional is unsuccessful at their first attempt in turning your baby then, with your consent, they may try again on another day.

If your blood type is rhesus D negative, you will be advised to have an anti-D injection after the ECV and to have a blood test. See the NICE patient information Routine antenatal anti-D prophylaxis for women who are rhesus D negative , which is available at: www.nice.org.uk/guidance/ta156/informationforpublic .

Why turn my baby head-first?

If your ECV is successful and your baby is turned into the head-first position you are more likely to have a vaginal birth. Successful ECV lowers your chances of requiring a caesarean section and its associated risks.

Is ECV safe for me and my baby?

ECV is generally safe with a very low complication rate. Overall, there does not appear to be an increased risk to your baby from having ECV. After ECV has been performed, you will normally be able to go home on the same day.

When you do go into labour, your chances of needing an emergency caesarean section, forceps or vacuum (suction cup) birth is slightly higher than if your baby had always been in a head-down position.

Immediately after ECV, there is a 1 in 200 chance of you needing an emergency caesarean section because of bleeding from the placenta and/or changes in your baby’s heartbeat.

ECV should be carried out by a doctor or a midwife trained in ECV. It should be carried out in a hospital where you can have an emergency caesarean section if needed.

ECV can be carried out on most women, even if they have had one caesarean section before.

ECV should not be carried out if:

you need a caesarean section for other reasons, such as placenta praevia; see the RCOG patient information Placenta praevia, placenta accreta and vasa praevia
you have had recent vaginal bleeding
your baby’s heart rate tracing (also known as CTG) is abnormal
your waters have broken
you are pregnant with more than one baby; see the RCOG patient information Multiple pregnancy: having more than one baby .

Is ECV always successful?

ECV is successful for about 50% of women. It is more likely to work if you have had a vaginal birth before. Your healthcare team should give you information about the chances of your baby turning based on their assessment of your pregnancy.

If your baby does not turn then your healthcare professional will discuss your options for birth (see below). It is possible to have another attempt at ECV on a different day.

If ECV is successful, there is still a small chance that your baby will turn back to the breech position. However, this happens to less than 5 in 100 (5%) women who have had a successful ECV.

There is no scientific evidence that lying down or sitting in a particular position can help your baby to turn. There is some evidence that the use of moxibustion (burning a Chinese herb called mugwort) at 33–35 weeks of pregnancy may help your baby to turn into the head-first position, possibly by encouraging your baby’s movements. This should be performed under the direction of a registered healthcare practitioner.

Depending on your situation, your choices are:

There are benefits and risks associated with both caesarean section and vaginal breech birth, and these should be discussed with you so that you can choose what is best for you and your baby.

Caesarean section

If your baby remains breech towards the end of pregnancy, you should be given the option of a caesarean section. Research has shown that planned caesarean section is safer for your baby than a vaginal breech birth. Caesarean section carries slightly more risk for you than a vaginal birth.

Caesarean section can increase your chances of problems in future pregnancies. These may include placental problems, difficulty with repeat caesarean section surgery and a small increase in stillbirth in subsequent pregnancies. See the RCOG patient information Choosing to have a caesarean section .

If you choose to have a caesarean section but then go into labour before your planned operation, your healthcare professional will examine you to assess whether it is safe to go ahead. If the baby is close to being born, it may be safer for you to have a vaginal breech birth.

Vaginal breech birth

After discussion with your healthcare professional about you and your baby’s suitability for a breech delivery, you may choose to have a vaginal breech birth. If you choose this option, you will need to be cared for by a team trained in helping women to have breech babies vaginally. You should plan a hospital birth where you can have an emergency caesarean section if needed, as 4 in 10 (40%) women planning a vaginal breech birth do need a caesarean section. Induction of labour is not usually recommended.

While a successful vaginal birth carries the least risks for you, it carries a small increased risk of your baby dying around the time of delivery. A vaginal breech birth may also cause serious short-term complications for your baby. However, these complications do not seem to have any long-term effects on your baby. Your individual risks should be discussed with you by your healthcare team.

Before choosing a vaginal breech birth, it is advised that you and your baby are assessed by your healthcare professional. They may advise against a vaginal birth if:

your baby is a footling breech (one or both of the baby’s feet are below its bottom)
your baby is larger or smaller than average (your healthcare team will discuss this with you)
your baby is in a certain position, for example, if its neck is very tilted back (hyper extended)
you have a low-lying placenta (placenta praevia); see the RCOG patient information Placenta Praevia, placenta accreta and vasa praevia
you have pre-eclampsia or any other pregnancy problems; see the RCOG patient information Pre-eclampsia .

With a breech baby you have the same choices for pain relief as with a baby who is in the head-first position. If you choose to have an epidural, there is an increased chance of a caesarean section. However, whatever you choose, a calm atmosphere with continuous support should be provided.

If you have a vaginal breech birth, your baby’s heart rate will usually be monitored continuously as this has been shown to improve your baby’s chance of a good outcome.

In some circumstances, for example, if there are concerns about your baby’s heart rate or if your labour is not progressing, you may need an emergency caesarean section during labour. A paediatrician (a doctor who specialises in the care of babies, children and teenagers) will attend the birth to check your baby is doing well.

If you go into labour before 37 weeks of pregnancy, the balance of the benefits and risks of having a caesarean section or vaginal birth changes and will be discussed with you.

If you are having twins and the first baby is breech, your healthcare professional will usually recommend a planned caesarean section.

If, however, the first baby is head-first, the position of the second baby is less important. This is because, after the birth of the first baby, the second baby has lots more room to move. It may turn naturally into a head-first position or a doctor may be able to help the baby to turn. See the RCOG patient information Multiple pregnancy: having more than one baby .

If you would like further information on breech babies and breech birth, you should speak with your healthcare professional.

Further information

NHS information on breech babies
NCT information on breech babies

If you are asked to make a choice, you may have lots of questions that you want to ask. You may also want to talk over your options with your family or friends. It can help to write a list of the questions you want answered and take it to your appointment.

Ask 3 Questions

To begin with, try to make sure you get the answers to 3 key questions , if you are asked to make a choice about your healthcare:

What are my options?
What are the pros and cons of each option for me?
How do I get support to help me make a decision that is right for me?

*Ask 3 Questions is based on Shepherd et al. Three questions that patients can ask to improve the quality of information physicians give about treatment options: A cross-over trial. Patient Education and Counselling, 2011;84:379-85

https://aqua.nhs.uk/resources/shared-decision-making-case-studies/

Sources and acknowledgements

This information has been developed by the RCOG Patient Information Committee. It is based on the RCOG Green-top Clinical Guidelines No. 20a External Cephalic Version and Reducing Incidence of Term Breech Presentation and No. 20b Management of Breech Presentation . The guidelines contain a full list of the sources of evidence we have used.

This information was reviewed before publication by women attending clinics in Nottingham, Essex, Inverness, Manchester, London, Sussex, Bristol, Basildon and Oxford, by the RCOG Women’s Network and by the RCOG Women’s Voices Involvement Panel.

Please give us feedback by completing our feedback survey:

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Management of Breech Presentation Green-top Guideline

The influence of epidural anesthesia in pregnancies with scheduled vaginal breech delivery at term: a hospital-based retrospective analysis

Maternal-Fetal Medicine
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Published: 20 November 2023

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Roman Allert ORCID: orcid.org/0000-0003-0051-4792 1 ,
Dörthe Brüggmann 1 ,
Florian J. Raimann 2 ,
Nadja Zander 3 ,
Frank Louwen 1 &
Lukas Jennewein 1

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Introduction

Epidural anesthesia is a well-established procedure in obstetrics for pain relief in labor and has been well researched as it comes to cephalic presentation. However, in vaginal intended breech delivery less research has addressed the influence of epidural anesthesia. The Greentop guideline on breech delivery states that there’s little evidence and recommends further evaluation.

The aim of this study was to compare maternal and neonatal outcomes in vaginally intended breech deliveries at term with and without an epidural anesthesia.

This study was a retrospective cohort study.

This study included 2122 women at term with a singleton breech pregnancy from 37 + 0 weeks of pregnancy on and a birth weight of at least 2500 g at the obstetric department of University hospital Frankfurt from January 2007 to December 2018.

Neonatal and maternal outcome was analyzed and compared between women receiving “walking” epidural anesthesia and women without an epidural anesthesia.

Fetal morbidity, measured with a modified PREMODA score, showed no significant difference between deliveries with (2.96%) or without (1.79%; p = 0.168) an epidural anesthesia. Cesarean delivery rates were significantly higher in deliveries with an epidural (35 vs. 26.2%, p = 0.0003), but after exclusion of multiparous women, cesarean delivery rates were not significantly different (40.2% cesarean deliveries with an epidural vs. 41.5%, p = 0.717). As compared to no epidurals, epidural anesthesia in vaginal delivery was associated with a significantly higher rate of manual assistance (33.8 versus 52.1%) and a longer duration of birth (223.7 ± 194 versus 516.2 ± 310 min) (both p < 0.0001)".

Epidural anesthesia can be offered as a safe option for pain relief without increasing neonatal or maternal morbidity and mortality. Nevertheless, it is associated with a longer birth duration and manually assisted delivery.

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Regional anesthesia is a well-established procedure in obstetrics for pain relief in labor and is broadly recommended in guidelines [ 1 ]. A Cochrane review including data of 40 trials and over 11.000 women shows a higher chance of instrumental assisted delivery in trials before 2005, an effect that did not occur when trials before 2005 were excluded from the analysis. No difference was shown concerning neonatal outcome or the rate of cesarean delivery [ 2 ].

In deliveries with breech presentation evidence is scarce regarding the safety and effect of epidural anesthesia and recommendations are vague: the British Greentop guideline states that the effect of an epidural anesthesia on the success of vaginal breech birth is unclear and might increase the risk of intervention and recommends further research [ 3 ]. The French clinical practice guideline emphasizes the high level of evidence for epidural anesthesia in cephalic version, with no higher risk of cesarean or risk of vaginally assisted delivery and therefore encourages the use of epidural anesthesia in breech presentation [ 4 ]. The SOGC (Society of Obstetricians and Gynecologists of Canada) clinical practice guideline on breech delivery recommends avoiding dense epidural to maximize expulsive efforts, while neither ACOG (American College of Obstetricians and Gynecologists) nor RANZCOG (Royal Australian and New Zealand College of Obstetricians and Gynaecologists) addresses the issue of epidural anesthesia [ 5 , 6 , 7 ].

In the term Breech trial epidural anesthesia was not associated with adverse perinatal outcome [ 8 , 9 , 10 ]. The PREMODA (PREsentation et MODe d'Accouchement) trial does not report an impact of epidural anesthesia [ 11 ]. Even though safety of epidural anesthesia is established, there still are reports of associated increased adverse neonatal outcome, prolonged labor, or cesarean delivery rate [ 12 , 13 , 14 ].

In the FRABAT (FRAnkfurt Breech At Term Study Group) cohort, the demand for epidural analgesia was high, especially in primiparous women [ 15 ]. Thus, it can be assumed that the patients’ need for an epidural anesthesia during an intended vaginal breech birth is high and clinicians will be confronted with this topic frequently during clinical counseling.

Since every medical intervention with its possible complications should be discussed with patients before administration, it is mandatory to gain evidence in order to be able to give reliable information. The effect of epidural analgesia on vaginally intended birth out of breech presentation has not been elucidated properly because the respective recommendations are adopted from vertex presentations. We present a cohort study on the neonatal and maternal outcome in vaginally intended breech deliveries in light of the use of an epidural anesthesia. We hypothesize that an epidural anesthesia does not influence perinatal morbidity in vaginally intended breech deliveries provided the epidural keeps the motor function and patients are not immobilized.

Study design

We conducted a single center cohort study in all pregnant women at term (≥ 37 weeks of gestation) presenting with a breech presentation at the Goethe University Hospital Frankfurt, Germany, from January 2004 to December 2018. The analysis was performed in a retrospective manner through generating subgroups (deliveries with or without an epidural) within our study cohort.

The university hospital’s ethics committee gave consent (420/11). All data were assessed through the in-house patient data system as well as the Hessen Perinatalerhebung and were acquired after patient’s dismissal from the hospital. All patients received the standard clinical care. Because of the retrospective nature of data acquisition, the ethics committee waived an informed patient’s consent.

Exclusion criteria were fetal birth defect, uterine malformation, multiple pregnancies, contraindication for an epidural anesthesia, estimated birth weight less than 2500 g, and contraindications for vaginal approach.

Other studies with intersection cohorts have been published by different authors of the FRABAT group within previous publications. [ 15 , 16 , 17 , 18 , 19 ].

Clinical procedure and counseling

All pregnant women with a breech presentation are counseled between 34 and 36 weeks of gestation. External cephalic version, vaginal attempted birth, as well as cesarean delivery are discussed with each patient, depending on the individual patient history and examination. During vaginal delivery, which is performed predominantly in an upright maternal position, manual assistance to deliver the arms or the fetal head is performed by a trained physician if necessary. A maternal upright position applies when the mother stands or is on all fours (hands and knees). An epidural is offered to every woman by their own choice if no contraindications (e.g., thrombocytopenia) are present. Counseling specifics and details on manual assistance in the upright maternal position have been published [ 17 , 20 ]

Outcome parameters

Primary outcome was perinatal fetal morbidity, which was assessed using the modified PREMODA Score, potentially associated with the delivery mode. The PREMODA Score is adapted from the PREMODA study [ 11 ] implies NICU stay > 4 days, trauma at birth, neurological deficits, intubation > 24 h, or an APGAR score of less than 4 at 5 min [ 9 ]. Secondary outcome measures were duration of labor, rate of cesarean delivery, and rate of assisted vaginal delivery.

Method of epidural anesthesia

Epidural anesthesia was administered by an in-house anesthesiologist. It was initiated with a dose of Ropivacaine and Sufentanil. After the loading dose, a patient controlled pump with Ropivacaine / Sufentanil was connected to maintain persistent pain reduction. Patients were not immobilized and the rate could be reduced if necessary. If analgesia was not sufficient patients could receive up to three additional boli per hour.

Statistical analysis

Groups of variables were tested for normal distribution with Kolmogorov–Smirnov test [ 21 ]. Group differences were analyzed using Pearson’s χ2 testing. Student’s T-test was utilized to compare continuous variables [ 22 , 23 ]. A nominal logistic regression analysis with Wald testing was performed.[ 24 ] We used JMP 14.0 software (SAS Institute, Cary, NC, USA) for our analyses. A p-value of below 0.05 was considered as statistically significant.

Of the 2122 women presenting for counseling with breech presentation at our center, 1413 attempted vaginal delivery.

744/1413 (52.7%) women received an epidural anesthesia (EPI group), 669/1413 (47.3%) did not (NEPI group, Table 1 ). Patients in the NEPI group were significantly older than patients in the EPI group (NEPI 32.7 (± 4.5), EPI 31.9 (± 4.3) p = 0.0009). BMI was equally distributed between both groups (Table 1 ). There were significantly more primiparous women in the EPI group (EPI 523, 70.3%; NEPI 316, 47.2%; p < 0.0001; Table 1 ). Mean birth weight was significantly higher in the EPI group (3388 g; NEPI: 3323 g; p = 0.002; Table 1 ). Duration of pregnancy was significantly longer in the EPI group (280 days) as compared to the NEPI group (278 days, p > 0.0001; Table 1 ).

There were significantly more manually assisted vaginal deliveries when women received an epidural anesthesia: In the NEPI group 327/669 (48.9%) women delivered vaginally, while 167/669 (25.0%) delivered with manual assistance. In the EPI group 232/744 (31.2%) women delivered spontaneous and 252/744 (33.9%) with assistance ( p < 0.0001). Cesarean delivery after onset of labor was performed in 175/669 (26.2%) in the NEPI group which is significantly less often than in the EPI group (260/744 (35.0%), p = 0.0003, Table 1 and Fig. 1 ).

Flow chart of the study cohort

We investigated all vaginal deliveries in a sub-cohort analysis. There were significantly more primiparous women in the group of patients giving vaginal birth with an epidural anesthesia (vEPI group, n = 313, 64.7%) as compared to primiparous women without an epidural anesthesia (vNEPI group, n = 185, 37.5%; p < 0.0001, Table 2 ). Birth weight was not significantly different between vNEPI group (3307 ± 340 g) and vEPI group (3325 ± 391 g; p = 0.361; Table 2 ). Duration of labor was significantly longer in vaginal deliveries with an epidural anesthesia as compared to vaginal deliveries without epidural anesthesia (vEPI 516 ± 310 min; vNEPI 224 ± 194 min; p < 0.0001, Table 2 ). Manual assistance was significantly more often necessary in vaginal deliveries with an epidural anesthesia (vEPI: n = 252, 52.1%; vNEPI: n = 167 33.8%; p < 0.0001, Table 3 ). Fetal morbidity measured with the modified PREMODA score was not significantly different between both groups (vNEPI: 2.02%, vEPI: 3.31%; p = 0.2373; Table 2 ). There was no significant difference in high grade perineal tears between groups (vNEPI: n = 8; 1.6%, vEPI: n = 10; 3.3%, p = 0.642; Table 2 ), but perineal tears of all degrees were significantly more often in vaginal deliveries with an epidural anesthesia (vNEPI: n = 224; 45.3%, vEPI: n = 249; 51.4%, p = 0.0056; Table 2 ).

We investigated a subgroup of primiparous women ( n = 839). In the group of primiparous women with an epidural anesthesia (pEPI) birth weight was significantly higher as compared to deliveries of primiparous women without an epidural anesthesia (pNEPI: 3253 ± 411 g, pEPI: 3379 ± 416 g; p < 0.0001, Table 3 ). Cesarean delivery rate was not significantly different between groups in this sub-analysis (pNEPI: n = 131; 41.5%, pEPI: n = 210; 40.2%; p = 0.7174, Table 3 ). In primiparous women, there was no significant difference in the modified PREMODA score whether patients received an epidural or not (pNEPI: n = 5; 1.58%, pEPI: n = 20 3.82%; p = 0.0917, Table 3 ).

Within a multiple nominal logistic regression analysis, maternal age, birth weight, neonatal morbidity, and cesarean delivery were not significantly associated with an epidural anesthesia (Table 4 ). In contrast, primiparity (OR 2.295; 95% CI: 1.781–2.956; p < 0.0001) and pregnancy duration (OR 1.316; 95% CI: 1.182–1.465; p < 0.0001) were significantly associated with an epidural anesthesia (Table 4 ).

In the subgroup of vaginal deliveries, only duration of birth (OR 1.0055; 95% CI: 1.0044–1.0066; p < 0.0001) and manually assisted delivery (OR 2.23; 95% CI: 1.57–3.52; p < 0.0001) were significantly increased, whereas perineal injuries were not affected (Table 4 ).

Evidence is scarce on the impact of an epidural anesthesia in vaginally intended breech deliveries since all recommendations are based on studies investigating epidural analgesia in cephalic deliveries. We have performed a cohort study on vaginally intended breech deliveries analyzing the effect of epidural anesthesia on perinatal outcome.

Perinatal morbidity was not significantly different between deliveries with and without epidural anesthesia (see Tables 1 , 2 , 3 , 4 ). Furthermore, Goffinet et al. [ 11 ] showed that increased short-term morbidity in breech deliveries did not translate into long-term morbidity. Primiparous women were analyzed separately because parity has an impact on delivery outcome measures. In our sub-cohort analyses of primiparous women (Table 3 ) and a nominal logistic regression model (Table 4 ), we were able to confirm the data seen in our whole cohort analyses concerning fetal morbidity. Here, PREMODA scores were consistently not different between deliveries with and without epidural anesthesia.

Patients receiving an epidural anesthesia had a higher probability for cesarean delivery after onset of labor in our main cohort (Table 1 ). But when only primiparous women were analyzed, cesarean delivery rates were not significantly different (Table 3 ). Also, a nominal logistic regression analysis found no association of cesarean delivery rate and epidural anesthesia (Table 4 ). The effect on cesarean delivery rates thus derives from the influence of parity. Primiparous women received an epidural anesthesia in 70.3% of cases, multiparous women only in 29.7% (Table 1 ). This finding contrasts the RCOG guideline; here authors stated that an epidural “might increase the risk of caesarean section” [ 3 ]. In vertex deliveries, a Cochrane analysis reports no effect on cesarean delivery rates linked to the use of epidurals [ 2 ].

New data suggest that not the epidural anesthesia but a prolonged labor and higher need for pain relief itself pose risk factors for an increased cesarean delivery likelihood; underlying problems are the actual cause rather than the analgesia itself [ 25 ].

In vaginal deliveries, the duration of the labor was significantly longer in deliveries with an epidural anesthesia. This effect has also been reported in vertex deliveries [ 26 , 27 ]. In these studies the immobilization though the application of an epidural is supposedly causative for a longer birth duration. In our center, patients are not immobilized after they receive pain relief by an epidural. This is important because women give birth predominantly in an upright position in order to reduce interventions and newborn morbidity [ 20 ]. This is both arguable in vertex and breech presentations. We believe that a “walking” epidural—keeping maternal motor function—is of important benefit for the course of labor: walking and an upright position reduce the duration of labor and the risk of cesarean [ 28 ].

Among the patients who delivered vaginally epidural anesthesia was associated with a higher chance of assisted vaginal delivery (see Tables 1 , 4 ). From vertex deliveries we have learned that operative vaginal deliveries are more often performed in deliveries with an epidural anesthesia [ 26 ].

When a vaginal operative delivery is indicated because of arrest of birth in active labor, women without an epidural anesthesia might prefer a cesarean section, while women with an epidural anesthesia might feel more equipped for a vaginal operative procedure.

In the cohort of women who experienced a successful vaginal breech delivery, maternal morbidity was not significantly increased in patients with an epidural anesthesia; in particular, we did not find a higher rate of third- and fourth-degree perineal tears or tear of all degrees (Tables 2 and 4 ). Our data imply that the use of an epidural for patients with a breech presentation undergoing labor is safe and not associated with a higher morbidity – neither for the fetus nor for the mother.

A strength of our study is a large cohort of patients, treated with a standardized protocol. This leads to homogeneity and comparability within our results.

A major limitation of our study is selection bias as all data derive from a single center. This is a retrospective analysis of an existing study cohort. Thus, only associations and not causative relationships can be concluded from our data. A prospective randomized controlled trial would be the gold standard to investigate a clinical intervention. Nevertheless, randomized controlled trials are hardly possible in women with breech delivery and an intention to deliver vaginally since only a few women would accept to stay without pain relief and to withhold an epidural due to a study design would be unethical.

In our data, only the application of an epidural analgesia was documented. The degree of actual pain relief and the time point of administration during labor were not recorded. Duration of pain relief of an epidural analgesia and patient satisfaction are important issues possibly influencing our outcome measures. In future studies, these items should be assessed in order to improve the quality of our results.

However, while the retrospective analysis has limitations, the absence of an influence on perinatal morbidity in our study adds value to the body of knowledge: our data show that mothers will not impact perinatal morbidity by requesting an epidural during labor, contrasting studies by Macharey or Toijonen. In these studies an epidural has been associated with adverse perinatal outcome in breech deliveries [ 12 , 14 ].

As in vertex presentations, an epidural anesthesia may be offered to ensure pain relief and is a safe gold standard for analgesia during labor. If manual assistance during birth is necessary, a sufficient pain relief might also be beneficial.

Further research in prospective settings would provide a more robust foundation for clinical decision-making and improve the understanding of the impact of epidural anesthesia on breech deliveries.

Data availability

The data that support the findings of this study are available from the corresponding author, [RA], upon reasonable request.

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Acknowledgements

The authors are in great gratitude toward all participants and the whole team staff of the obstetrics department at Frankfurt Goethe University hospital.

Open Access funding enabled and organized by Projekt DEAL.

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Department of Obstetrics and Gynecology, University Hospital Frankfurt, Goethe University, 60590, Frankfurt, Germany

Roman Allert, Dörthe Brüggmann, Frank Louwen & Lukas Jennewein

Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, 60590, Frankfurt, Germany

Florian J. Raimann

Department of Midwifery Frankfurt, Goethe University, 60590, Frankfurt, Germany

Nadja Zander

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RA, DB, and FJR contributed to manuscript writing and editing, and data collection. NZ collected data. FL was responsible for protocol/project development. LJ performed protocol/project development, data analysis, and manuscript writing and editing.

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Allert, R., Brüggmann, D., Raimann, F.J. et al. The influence of epidural anesthesia in pregnancies with scheduled vaginal breech delivery at term: a hospital-based retrospective analysis. Arch Gynecol Obstet (2023). https://doi.org/10.1007/s00404-023-07244-w

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DOI : https://doi.org/10.1007/s00404-023-07244-w

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Baltimore Ravens

There was only one man Harbs trusted for the job… @stavvybaby @SeatGeek | 📺: @nflnetwork pic.twitter.com/3a9OfunYK0 — Baltimore Ravens (@Ravens) May 16, 2024

What started out as a bit on social media by comedian Stavros Halkias has turned into a legitimate role for Ronnie the Raven, who has now been tasked with revealing the team's schedule. It's a little chaotic, but that's what you expect when Ronnie is running around with the company card.

Buffalo Bills

It’s a simple life for @JoshAllenQB across the street. @Ticketmaster | #BillsMafia pic.twitter.com/PEgQEzzOL3 — Buffalo Bills (@BuffaloBills) May 16, 2024

Josh Allen has a rocket arm, but did you also know that he had some decent acting chops? In a video reminiscent of Andy Dwyer taking up residence in The Pit in "Parks and Recreation," Allen is already making the Bills' new stadium his home. Get Allen a role in the next great sitcom.

Carolina Panthers

We like it, Picasso 👨‍🎨 @Ticketmaster | #KeepPounding pic.twitter.com/0s3aVcQMEf — Carolina Panthers (@Panthers) May 16, 2024

The Panthers tried their hand at painting for this one, and I feel quite confident that none of them should hang up the cleats in favor of picking up a brush. Credit to Shy Tuttle for making no attempt to paint Derrick Brown and trying to roast him instead.

Chicago Bears

The season moves pretty fast. If you don't stop and look around once in a while, you could miss it. pic.twitter.com/MpXMPEcTD6 — Chicago Bears (@ChicagoBears) May 16, 2024

D.J. Moore channels his inner Ferris Bueller and gives folks a tour of the school -- and the Bears' 2024 schedule -- which includes a cameo from Yung Gravy. As is mandatory for comic book movies nowadays, it includes a mid-credits scene to tease the next great heroes.

Cincinnati Bengals

Tell mom to throw the pizza rolls in... THE SCHEDULE IS HERE!!! pic.twitter.com/3iFn3BCpbC — Cincinnati Bengals (@Bengals) May 16, 2024

Halftime entertainment doesn't get much funnier than mascots schooling young children in football, and the Bengals capture that in their schedule release. That said, I can't say I've ever seen a child take a guitar to the face from a mascot before.

Cleveland Browns

hate us or love us, you'll watch 🎳 2024 schedule release. pic.twitter.com/TN3mCo5LGr — Cleveland Browns (@Browns) May 16, 2024

The Browns' schedule release video only gets stronger as it goes on. Not only is it worth sticking around for the Lamar Jackson gag, but there is also a cameo from a viral bowling legend.

Dallas Cowboys

🎶 The Cowboys called, seen you on Facetime 🎶 We prank called our opponents' fans for our 2024 schedule release 📲 Get @SeatGeek 🎟️s now: https://t.co/BAuSp2okCF pic.twitter.com/ZhSvFVXp39 — Dallas Cowboys (@dallascowboys) May 16, 2024

Post Malone. Eli Manning. Michael Vick. Calvin Johnson. Shane Gillis. Sam Morril. This is perhaps the most star-studded schedule release video ever filmed. The Cowboys do know how to put on a show, even in May.

Denver Broncos

. @LewisHamilton ATE and left no crumbs. 🍽️ pic.twitter.com/VKMfBAtYIt — Denver Broncos (@Broncos) May 16, 2024

"There's no way that they're eating carrots down there." Lewis Hamilton insults the cuisine of Indiana and the entire southeastern United States while revealing the Broncos' 2024 schedule. That should be all the encouragement you need to watch.

Detroit Lions

We hired a couple Detroiters to help us unveil this year’s schedule @ticketmaster pic.twitter.com/5DpHhcqp7X — Detroit Lions (@Lions) May 16, 2024

Detroit essentially outsourced its schedule release video to the "I Think You Should Leave" duo of Tim Robinson and Sam Richardson, and it was a stroke of genius. This is one of the funnier reveals with Robinson and Richardson doing riffing back and forth the entire time.

Green Bay Packers

Who signed off on this? @bookseatscom pic.twitter.com/LE9xwwlykw — Green Bay Packers (@packers) May 16, 2024

From WWE stars to Bachelor contestants, the Packers had an eclectic group of guest stars assisting them with their schedule release. Green Bay also leaned heavily on former players and got media that covers the team involved too.

Houston Texans

Our schedule release ASMR 🤘 pic.twitter.com/4vSwVBsnXU — Houston Texans (@HoustonTexans) May 16, 2024

If you've ever spent an embarrassing amount of time watching hydraulic press videos on social media, then this is the schedule reveal for you. This one does get some points off for a lack of originality, and you'll see why later.

Indianapolis Colts

Schedule (sche-du-le) SKE-j'l – SKE-juw-w'l /skEjOOUHl/ pic.twitter.com/wGA5DyumwC — Indianapolis Colts (@Colts) May 16, 2024

Had to do a little social media sleuthing to get the joke behind this one, but the Colts are spoofing a very funny graduation ceremony that recently went viral. Fair warning: It will come with an uncomfortable amount of cringe.

Jacksonville Jaguars

To Me, My Jaguars! 💥 @Dream_Finders | #DUUUVAL — Jacksonville Jaguars (@Jaguars) May 16, 2024

In the sake of full disclosure, I just watched the season finale of X-Men '97 this morning, so it probably goes without saying that I love this one. Saturday morning cartoon nostalgia will get me every time, and the production value on this one is top notch.

Kansas City Chiefs

In honor of crushing it last season, we’re revealing our 2024 schedule by… well, you know. pic.twitter.com/hVpI4GQNlN — Kansas City Chiefs (@Chiefs) May 16, 2024

We have another hydraulic press video here, so it's not exactly unique, but I'm going to watch these every time. I will say, Kansas City's video does have some very satisfying explosions going for it.

Las Vegas Raiders

No gimmicks. #RaiderNation pic.twitter.com/douAkUnZwH — Las Vegas Raiders (@Raiders) May 16, 2024

The Raiders went with more of a hype video, zigging when everyone else is zagging. Raiders fans will love it, especially the appearance from new head coach Antonio Pierce, but this won't move the needle for other fan bases.

Los Angeles Chargers

should we REALLY make our schedule release video in the sims? yes yes yesyes yesyes yes yes yes yes yes yes yes yes yes yesyes yes yes yes yesye yes yes yes yes yesyes pic.twitter.com/MXzfAPyhe8 — Los Angeles Chargers (@chargers) May 16, 2024

The Chargers are quite good at this, and they have knocked it out of the park again this year. This Sims-themed release video features some hilarious shots at their rivals, including the aforementioned Butker gag. It's probably no coincidence that his Sims character just happened to be in the kitchen.

Los Angeles Rams

5 o'clock on the dot, we're in our (schedule) drop top pic.twitter.com/oWuELM27wR — Los Angeles Rams (@RamsNFL) May 16, 2024

The Rams chose to go with a Grand Theft Auto theme for their video, and now all I can think about is how much longer I have to wait for GTA VI to release. Thanks a lot, Rams social media team.

Miami Dolphins

The NFL’s fastest schedule release, brought to you by the NFL’s fastest team. 😎 pic.twitter.com/5jHcUUwLAc — Miami Dolphins (@MiamiDolphins) May 16, 2024

The Dolphins are known for their team speed, and they applied that to their schedule release video. Considering most of these videos now go beyond three minutes, I can appreciate the restraint and brevity shown by Miami.

Minnesota Vikings

The next generation of #Vikings schedules is here! https://t.co/UeiFxRs60a pic.twitter.com/RTpkaEmlLF — Minnesota Vikings (@Vikings) May 16, 2024

T.J. Hockenson does his best Tim Cook impression for this video, as the Vikings spoof an Apple presentation of the iPhone (insert number here). I know it's a bit, but the schedule does look pretty sleek. I might even pay $1,400 for that.

New England Patriots

Do you like schedules? pic.twitter.com/xxNTeCxFvv — New England Patriots (@Patriots) May 16, 2024

The Pats leaned into their New England branding with a "Good Will Hunting" parody. While Julian Edelman and Rob Gronkowski get the leading roles in this trailer, Ernie Adams really steals the show.

New Orleans Saints

🚨 NOW HIRING: Social Media Intern for the New Orleans Saints 🚨 Please DM for qualifications. #Saints | @SeatGeek pic.twitter.com/nhSSw9bchg — New Orleans Saints (@Saints) May 16, 2024

I, for one, would love for the Saints to turn control of their social media accounts over to Shannon Sharpe. Let him and Katt Williams cook up some ideas for the upcoming season.

New York Giants

“Do you know what a schedule release video is?” pic.twitter.com/DqfeOBSFHT — New York Giants (@Giants) May 15, 2024

The people of New York have spoken, and they do not care about schedule release videos. The Giants, at the risk of bringing their fans joy, listened and put out a simple graphic when the time came to unveil the 2024 schedule.

New York Jets

This guy almost dumped it on @AreYouKiddingTV for our 2024 Schedule Release Challenge #ad pic.twitter.com/qDaOItgt8h — New York Jets (@nyjets) May 16, 2024

The Jets went with a promotion for their schedule release, which was a choice. Can you blame a Jets fan for dumping a bucket of Gatorade on his head to get as far away from the team as possible?

Philadelphia Eagles

Eagles fans: slightly unhinged @Ticketmaster | #FlyEaglesFly pic.twitter.com/RxEDJ8xlQX — Philadelphia Eagles (@Eagles) May 16, 2024

Asking Eagles fans for their honest thoughts on the team's opponents was a risky move, but the team rolled the dice anyway. The editing team may have had their work cut out for them on this one, so shoutout to the employees who had to cut this one together.

Pittsburgh Steelers

No joke. Our 2024 schedule is here. @laurelhighlands | @jharrison9292 | 📺: Schedule release coverage on NFLN pic.twitter.com/okiDg2L4XR — Pittsburgh Steelers (@steelers) May 16, 2024

Watching terrified Steelers recite dad jokes to an unamused James Harrison was quite amusing to me personally. I'm not sure seeing the schedule a little early was worth the risk of getting snapped in half, though.

San Francisco 49ers

And now a message from Nick Bosa 😂 @Steph49K | @Ticketmaster https://t.co/c0NW44RI7D pic.twitter.com/Db4RTewe4K — San Francisco 49ers (@49ers) May 16, 2024

Nick Bosa was supposed to unveil the 49ers' 2024 schedule, but he chose to take the day off instead. That's why the duties fell to Steph Sanchez, who did her best to fill Bosa's shoes, and his spot in the gym.

Seattle Seahawks

Every power has an origin story. pic.twitter.com/XXreXbdDvA — Seattle Seahawks (@Seahawks) May 15, 2024

As if Chris Pratt didn't have enough roles on his plate, he now plays the role of talking sunglasses in the Seahawks' schedule release video. This guy really is everywhere these days.

Tampa Bay Buccaneers

Not the Ottawa Pancakes… @Chaad_1 & @lukethelifter attempt to draw our opponents 🎨🖌️ pic.twitter.com/jCOw0uaTPb — Tampa Bay Buccaneers (@Buccaneers) May 16, 2024

Rachaad White and Luke Goedeke may not be artists, but they gave valiant efforts for this one. Did White's version of the Superdome look like a snow globe with the snow on the outside? Sure, but he gets an A for effort and an A+ for attitude.

Tennessee Titans

Back on Broadway with some help from a friend 🤣 2024 Titans Schedule Release presented by @shift4 📺: 2024 NFL Schedule release on @nflnetwork & ESPN2 pic.twitter.com/n4EN6DmC6t — Tennessee Titans (@Titans) May 16, 2024

If it ain't broke, don't fix it. That is good advice, and the Titans followed it by running back their 2023 schedule release video for 2024. The team got one of the stars from last year's video to ask well-lubricated folks on Broadway to identify the team's 2024 opponents, and it went as you might expect.

Washington Commanders

Whipped up something sweet for schedule release 🎂 🎟️ https://t.co/1MtIrnqvuP | @SeatGeek | 📺 @nflnetwork pic.twitter.com/KaDZZkSeBz — Washington Commanders (@Commanders) May 16, 2024

The Commanders played a little game of "Is It Cake?" with their 2024 opponents, and all I could think about was how much of that leftover cake Major Tuddy ate once filming was complete.

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IMAGES

Breech
Breech Baby
Breech presentation: diagnosis and management
types of breech presentation ultrasound
Breech Presentation
What is Breech Presentation?

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COMMENTS

Breech Presentation
Breech presentation refers to the fetus in the longitudinal lie with the buttocks or lower extremity entering the pelvis first. The three types of breech presentation include frank breech, complete breech, and incomplete breech. In a frank breech, the fetus has flexion of both hips, and the legs are straight with the feet near the fetal face, in a pike position. The complete breech has the ...
Breech Baby: Causes, Complications, Turning & Delivery
A breech baby (breech birth or breech presentation) is when a baby's feet or buttocks are positioned to come out of your vagina first. This means its head is up toward your chest and its lower body is closest to your vagina. Ideally, your baby is in a head down, or vertex presentation, at delivery. While most babies do eventually turn into this ...
Fetal Presentation, Position, and Lie (Including Breech Presentation
In breech presentation, the presenting part is a poor dilating wedge, which can cause the head to be trapped during delivery, often compressing the umbilical cord. For breech presentation, usually do cesarean delivery at 39 weeks or during labor, but external cephalic version is sometimes successful before labor, usually at 37 or 38 weeks. ...
Overview of breech presentation
Breech presentation, which occurs in approximately 3 percent of fetuses at term, describes the fetus whose presenting part is the buttocks and/or feet. Although most breech fetuses have normal anatomy, this presentation is associated with an increased risk for congenital malformations and mild deformations, torticollis, and developmental ...
Breech Presentation
Breech Births. In the last weeks of pregnancy, a baby usually moves so his or her head is positioned to come out of the vagina first during birth. This is called a vertex presentation. A breech presentation occurs when the baby's buttocks, feet, or both are positioned to come out first during birth. This happens in 3-4% of full-term births.
Breech: Types, Risk Factors, Treatment, Complications
At full term, around 3%-4% of births are breech. The different types of breech presentations include: Complete: The fetus's knees are bent, and the buttocks are presenting first. Frank: The fetus's legs are stretched upward toward the head, and the buttocks are presenting first. Footling: The fetus's foot is showing first.
Fetal Presentation, Position, and Lie (Including Breech Presentation
Breech presentation is more likely to occur in the following circumstances: Labor starts too soon (preterm labor). There is more than one fetus (multiple gestation). The uterus is abnormally shaped or contains abnormal growths such as fibroids. The fetus has a birth defect.
Breech presentation
Breech presentation refers to the baby presenting for delivery with the buttocks or feet first rather than head. Associated with increased morbidity and mortality for the mother in terms of emergency cesarean section and placenta previa; and for the baby in terms of preterm birth, small fetal size, congenital anomalies, and perinatal mortality.
Breech presentation management: A critical review of leading clinical
This pamphlet explains what a breech presentation is, the different types of breech presentation, discusses ECV and provides balanced information related to birth mode options along with visual representations of statistics comparing the perinatal mortality rate between cephalic vaginal birth, VBB and C/S. This pamphlet was also developed in ...
If Your Baby Is Breech
In a breech presentation, the body comes out first, leaving the baby's head to be delivered last. The baby's body may not stretch the cervix enough to allow room for the baby's head to come out easily. There is a risk that the baby's head or shoulders may become wedged against the bones of the mother's pelvis.
Breech Presentation: Types, Causes, Risks
A complete breech is the least common type of breech presentation. Other Types of Mal Presentations The baby can also be in a transverse position, meaning that they're sideways in the uterus.
Breech Presentation: Overview, Vaginal Breech Delivery ...
Breech presentation is defined as a fetus in a longitudinal lie with the buttocks or feet closest to the cervix. This occurs in 3-4% of all deliveries. The percentage of breech deliveries decreases with advancing gestational age from 22-25% of births prior to 28 weeks' gestation to 7-15% of births at 32 weeks' gestation to 3-4% of births at term.
What Is a Breech Birth? Types, Causes, and Giving Birth
Breech birth happens when a baby doesn't move into a head-first position before birth and instead stays in a bottom-down position. The cause of a breech presentation isn't fully understood, but various situations ma. A breech birth is rare, occurring in about 1 out of 25 full-term pregnancies. It happens when a baby does not move into a ...
Management of Breech Presentation (Green-top Guideline No. 20b)
Breech presentation occurs in 3-4% of term deliveries and is more common in preterm deliveries and nulliparous women. Breech presentation is associated with uterine and congenital abnormalities, and has a significant recurrence risk. Term babies presenting by the breech have worse outcomes than cephalic presenting babies, irrespective of the ...
Fetal presentation: Breech, posterior, transverse lie, and more
In the frank breech presentation, both the baby's legs are extended so that the feet are up near the face. This is the most common type of breech presentation. Breech babies are difficult to deliver vaginally, so most arrive by c-section.
Breech
Overview. There are three types of breech presentation: complete, incomplete, and frank. Complete breech is when both of the baby's knees are bent and his feet and bottom are closest to the birth canal. Incomplete breech is when one of the baby's knees is bent and his foot and bottom are closest to the birth canal.
Breech position baby: How to turn a breech baby
Discuss your preferences, the advantages and risks of each option (vaginal and cesarean delivery of a breech presentation), and their experience. The biggest risk of a breech delivery is when the body delivers but the head stays entrapped within the cervix. In the United States, most breech babies are delivered via cesarean.
Fetal presentation before birth
Frank breech. When a baby's feet or buttocks are in place to come out first during birth, it's called a breech presentation. This happens in about 3% to 4% of babies close to the time of birth. The baby shown below is in a frank breech presentation. That's when the knees aren't bent, and the feet are close to the baby's head.
Breech birth
Complete breech presentation is the next most favorable position, but these babies sometimes shift and become footling breeches during labour. Footling and kneeling breeches have a higher risk of cord prolapse and head entrapment. Parity - Parity refers to the number of times a woman has given birth before. If a woman has given birth ...
What happens if your baby is breech?
Turning a breech baby. If your baby is in a breech position at 36 weeks, you'll usually be offered an external cephalic version (ECV). This is when a healthcare professional, such as an obstetrician, tries to turn the baby into a head-down position by applying pressure on your abdomen. It's a safe procedure, although it can be a bit uncomfortable.
Breech baby at the end of pregnancy
Babies lying bottom first or feet first in the uterus (womb) instead of in the usual head-first position are called breech babies. Breech is very common in early pregnancy, and by 36-37 weeks of pregnancy, most babies turn naturally into the head-first position. Towards the end of pregnancy, only 3-4 in every 100 (3-4%) babies are in the breech ...
The influence of epidural anesthesia in pregnancies with ...
Introduction Epidural anesthesia is a well-established procedure in obstetrics for pain relief in labor and has been well researched as it comes to cephalic presentation. However, in vaginal intended breech delivery less research has addressed the influence of epidural anesthesia. The Greentop guideline on breech delivery states that there's little evidence and recommends further evaluation ...
What is Breech? Dr. Jyoti Sharma explain
Breech birth is when a baby is positioned bottom or feet first in the womb, rather than the typical head-first position. Understanding breech presentation is crucial for expectant parents and ...
WATCH: 2024 NFL schedule release videos for all 32 teams include
The Cardinals went outside the box and got local artists to paint a mural revealing their 2024 schedule. It may not go as viral as some of the other videos, but it was a really cool idea.

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Breech Births

What are the different types of breech birth presentations?

What causes a breech presentation?

How is a breech presentation diagnosed?

Can a breech presentation mean something is wrong?

Can a breech presentation be changed?

Medical Techniques

ECV will not be tried if:

Complications of EVC include:

Vaginal delivery versus cesarean for breech birth?

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When is a cesarean delivery used with a breech presentation?

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Episiotomy: Advantages & Complications

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Fetal Presentation, Position, and Lie (Including Breech Presentation)

Position and Presentation of the Fetus

Occiput posterior position

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Other presentations

Breech presentation

History and exam

Other diagnostic factors

Risk factors

Diagnostic investigations

Treatment algorithm

Disclosures

Christine L. Roberts, MBBS, FAFPHM, DrPH

Jonathan Morris, MBChB, FRANZCOG, PhD

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Brian Peat, MD

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Justus Hofmeyr, MD

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What Causes Breech Presentation?

What Is Breech Presentation?

Frank Breech

Footling Breech

Complete Breech

Other Types of Mal Presentations

Related Articles

Breech - series—Types of breech presentation

Review Date 11/21/2022

Related MedlinePlus Health Topics

What to know if your baby is breech

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What happens if your baby is breech?

Bottom first or feet first (breech baby)

Turning a breech baby

Giving birth to a breech baby

Lying sideways (transverse baby)