As the due date approaches, most babies naturally move into a head-down orientation, known as the vertex presentation. When a baby remains positioned with their bottom or feet closer to the pelvis, this is termed a breech presentation. While a parent can develop a strong suspicion about their baby’s orientation through observation and touch, only a trained healthcare professional, using diagnostic tools, can confirm the exact fetal position.
Understanding Fetal Position and Breech Types
Fetal presentation describes the part of the baby closest to the birth canal. The ideal position is vertex, where the baby’s head is directed downward toward the cervix. A breech presentation occurs in about three to four percent of full-term pregnancies, with the baby’s lower half positioned to present first.
There are three primary types of breech positions, categorized by the baby’s leg posture. The most common is a frank breech, where the baby’s bottom is down, but their legs are extended straight upward with their feet near their head. In a complete breech, the baby is essentially sitting in a “criss-cross applesauce” position, with both hips and knees flexed. A footling breech is the least common type, occurring when one or both of the baby’s feet are positioned to enter the pelvis first.
Subjective Signs Interpreting Fetal Movement
One of the most noticeable indicators of a breech position is the location and quality of fetal movements. When a baby is head-down, the strongest, most coordinated kicks are typically felt high up under the ribs or diaphragm. If the baby is breech, the strongest movements often register in the lower abdomen, near the pelvic floor or bladder, as the baby’s feet are positioned low. These lower movements can sometimes be described as sharp, intense jabs.
Another sensation unique to a breech presentation is feeling a hard, distinct mass lodged high up under the rib cage. This is likely the baby’s head, which is round and firm, occupying the top of the uterus. This upward pressure can cause maternal discomfort, heartburn, or a feeling of breathlessness and fullness after eating. Conversely, in a head-down position, the softer, less regular shape of the baby’s bottom would be felt at the top of the uterus.
Using Touch Simplified Palpation Methods
A simplified form of abdominal palpation can help determine the baby’s position. To attempt this technique, the mother should lie down with knees slightly bent and abdominal muscles relaxed. The first step is gently feeling the upper part of the uterus, known as the fundus, which is the area just below the ribcage.
The goal is to differentiate the head from the buttocks based on their physical characteristics. The head feels like a hard, round, distinct mass, often compared to a small bowling ball. If the mass felt at the top can be gently wiggled or moved separately from the rest of the body, it is highly likely to be the head. In contrast, the buttocks feel softer, are broader, and move the entire trunk of the baby rather than moving independently.
Next, gently press just above the pubic bone to feel what part is resting in the pelvis. If the baby is breech, the part felt here—the buttocks or feet—will feel softer and more irregular than a head. A hard, round object felt low in the pelvis suggests a head-down position. Finally, feeling the sides of the abdomen can help locate the baby’s back, which feels smooth and firm, as opposed to the bumpy, irregular feel of the limbs.
Next Steps After Suspecting Breech
If subjective signs and palpation methods suggest a breech position, especially after 36 weeks of pregnancy, the next action is to contact a healthcare provider immediately. Self-assessment is an estimation, not a diagnosis, and professional confirmation is necessary for safety. The provider will typically perform a detailed physical examination and order an ultrasound, which is considered the gold standard for confirming the baby’s presentation, position, and type of breech.
The ultrasound also provides information on the placenta location and amniotic fluid volume, which are factors influencing the available options. If a breech position is confirmed, one common option offered is an External Cephalic Version (ECV). This procedure involves a trained obstetrician using manual pressure on the abdomen to try to turn the baby into a head-down position. ECV has an average success rate of approximately 58 percent and is usually performed around 37 weeks of gestation. If the baby remains breech, the medical team will discuss the safest options for delivery, which typically involve planning a cesarean delivery or, in select circumstances, a planned vaginal breech birth.