Uncertain Causes, But Several Factors Can Contribute to a Breech Baby

One of the most anticipated moments of pregnancy is feeling your baby settle into the ideal position for birth—head down, ready to enter the world. However, in about 3–4% of full-term pregnancies, the baby remains in a breech position, meaning the baby's bottom or feet are positioned to come out first instead of the head.

While the exact reason why a baby ends up in a breech position is often unclear, several factors may increase the likelihood. Understanding these factors can help parents and healthcare providers prepare for the best possible delivery plan.

What Is a Breech Position?

A breech position occurs when the baby is positioned feet-first, bottom-first, or with the knees bent in the womb. There are different types of breech presentations:

• Frank breech: The baby's bottom is down, with legs extended up toward the head.
• Complete breech: The baby is sitting cross-legged, with both hips and knees bent.
• Footling breech: One or both feet are pointing downward and will deliver first.

Most babies naturally turn head-down by the 36th week of pregnancy. When this doesn’t happen, it’s considered a persistent breech presentation.

Factors That May Contribute to a Breech Baby

Though many breech babies are perfectly healthy and the positioning is simply a matter of chance, certain conditions can increase the odds. These include:

1. Multiple Pregnancies

In pregnancies with twins, triplets, or more, there’s less space in the uterus. This crowding can prevent one or more babies from turning head-down.

2. Abnormal Uterine Shape or Fibroids

Structural abnormalities of the uterus—such as a septate uterus—or the presence of uterine fibroids can limit the baby’s ability to move and rotate into the correct position.

3. Unusual Levels of Amniotic Fluid

Too much (polyhydramnios) or too little (oligohydramnios) amniotic fluid can affect how freely the baby moves. Excessive fluid allows too much movement, which may prevent settling into position, while too little restricts movement entirely.

4. Placenta Position

If the placenta is located low in the uterus (placenta previa), it can block the baby’s path and prevent it from turning head-down.

5. Premature Delivery

Babies born before full term are more likely to be breech simply because they haven’t had enough time to rotate into the head-down position.

6. Previous Breech Births

Women who’ve had a breech baby in a previous pregnancy are slightly more likely to have another breech presentation.

7. Fetal Abnormalities

In rare cases, breech positioning may be linked to developmental issues such as neuromuscular disorders that affect the baby’s ability to move normally.

8. Maternal Factors

Conditions like pelvic narrowing or a history of certain uterine surgeries might also play a role, though these are less common contributors.

What Can Be Done?

If your baby is breech late in pregnancy, your doctor may suggest an external cephalic version (ECV)—a procedure where gentle pressure is applied to the abdomen to try to turn the baby manually. This is usually attempted after 37 weeks and has a success rate of about 50–70%.

In cases where the baby remains breech, a cesarean section is often recommended for a safer delivery. However, some low-risk breech pregnancies may still be eligible for a vaginal birth, depending on the situation and the expertise of the medical team.

Final Thoughts

While a breech baby can be concerning, it’s important to remember that it doesn’t necessarily indicate a problem. Many breech babies are born healthy through planned C-sections or, in select cases, carefully monitored vaginal deliveries.

If you're expecting and concerned about your baby’s position, speak with your healthcare provider. They can monitor your pregnancy closely and help you make informed decisions for a safe and healthy birth.

Always consult your doctor or midwife for personalized medical advice during pregnancy.