Breech Birth Statistics

by Mrs. BWF on September 6, 2011

This article by Richard Fischer, M.D. gives eye opening and reliable information about breech births.

Vaginal Breech Birth

Types of Breeches

  • Frank breech (50-70%) – Hips flexed, knees extended (pike position)
  • Complete breech (5-10%) – Hips flexed, knees flexed (cannonball position)
  • Footling or incomplete (10-30%) – One or both hips extended, foot presenting

Percent of Breech Babies

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% of births prior to 28 weeks’ gestation to 7% of births at 32 weeks’ gestation to 1-3% of births at term.[1]

96-97% of babies will turn head down prior to their birth (97-99% if born at term).

Predisposing factors for breech presentation include prematurity, uterine malformations or fibroids, polyhydramnios, placenta previa, fetal abnormalities (eg, CNS malformations, neck masses, aneuploidy), and multiple gestations. Fetal abnormalities are observed in 17% of preterm breech deliveries and in 9% of term breech deliveries.

Of the 1-3% of term breech babies, there is a 9% chance of fetal abnormalities being present. It is higher in preterm breech deliveries.

Perinatal mortality is increased 2- to 4-fold with breech presentation, regardless of the mode of delivery. Deaths are most often associated with malformations, prematurity, and intrauterine fetal demise.

The perinatal mortality rate does increase with breech presentation, but that is REGARDLESS OF THE TYPE OF BIRTH! The increased death rate is due to malformations already present, prematurity and intrauterine fetal demise!

Thoughts

Wait. Be patient and keep an eye on baby. Most breech babies will turn head down. Also, prematurity increases risk of death. Wait for that baby to fully develop so s(he) is ready to be earthside (don’t induce or have an early cesarean if there is no medical indication to do so). Most issues with breech births are because of other factors and not because of where baby is born.

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{ 25 comments… read them below or add one }

Christina September 6, 2011 at 4:34 pm

I had a c-sec at 38wks cause of breech presentation. He was my second baby. My first i had a very fast labour and then a fairly severe PPH. and i was cornered into a c-sec cause the policy at the time was no breech babies in hospitals, they also didn’t want me at that time to birth at home cause of the PPH. They alsy didn’t want me to wait till i was in labour cause of the speed of my labour. I was niave and didn’t know i could actually not show up for my c-sec appt. Who knows, he could have turned had I not shown up. but the external version didn’t work , his head was too big. being born at 38wks he was 9lbs 10oz. it makes me sad to think of what codl have been, especially when i read articles like this, and the fact that my 3rd was a surprise breech at a hospital and they allowed me to birth her, and she was 9lbs 15oz.

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My Educated Birth September 7, 2011 at 12:32 am

Mrs. BWF, can you clarify?
“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.” Just below that you write “97-99% of babies will turn head down prior to their birth.” This is conflicting, because first you state that 96-97% of deliveries are not breech, then you are stating that 97-99% of babies are not breech. Are you stating that of the 3-4% that are breech deliveries they are the 1-3% who did not turn head down?
Also, I have to respectfully disagree with breech being a “variation of normal”. There is a noted correlation with thyroid stimulating hormone levels and breech presentation – it appears that women with higher TSH concentrations are significantly more likely to have a baby in breech presentation. This would tell me that breech is actually a symptom of abnormal more than a variation of normal. Have you heard this at all?
Also, a ten year study done in Sweden, of all places, found that infant mortality was actually higher in vaginal deliveries than delivery by c-section before labor. Not a huge number – it was calculated that it would take 400 c-sections to prevent one death – but when you consider that worldwide in 2007 roughly 255 babies are born every minute, take that times 3% (7.65 babies per minute are breech), divide 400 by 7.65 (meaning that 400 babies are born every 52.3 minutes), that means that globally c-sections for breech presentations could save a baby every hour! So it’s a small and large number at the same time, know what I mean? (“Term Breech Delivery in Sweden: mortality relative to fetal presentation and planned mode of delivery”, Herbst, Andreas, 2005)

I’m not trying to be a pain, I’m just curious your thoughts. I respect you and all the work and research you do, I just may be a little more medically minded. Thanks in advance!

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Mrs. BWF September 7, 2011 at 12:49 am

Ah! Thank you for pointing that out. I made the necessary changes to the %! I have not heard about higher TSH concentrations or the study in Sweden. If you’d share the link, I’d love to take a look at it. Thanks again!

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MyEducatedBirth September 7, 2011 at 1:52 am

I found Sweden – I use a database through my University, so I wasn’t sure if I could find it elsewhere!

http://onlinelibrary.wiley.com/doi/10.1111/j.0001-6349.2005.00852.x/abstract

And regarding TSH and breech:

http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2265.2009.03729.x/full

There are more about thyroid issues and breech if you do some looking, but I have to go to bed! :-)

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Connie May 16, 2012 at 3:00 pm

I disagree with the statement made regarding higher TSH levels in women who have breech babies. Not all woman have the elevation in TSH upon breech births. There may may a correlation in some women in the Swedish population. However, I have not seen any studies indicating higher TSH levels in women done in the US or other countries. If there are studies done, perhaps I am not looking in the correct research areas. I welcome the opportunity to be enlightened.

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PluckyMo March 25, 2013 at 4:28 pm

The posting does not assert that all women who have a baby in a breech position have elevated levels of TSH, but rather that elevated levels correlate with a breech. That is, women with elevated levels of TSH are more likely to experience this delivery complication. The study does not claim causality; it observes that the 2 seem to accompany each other.

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HR June 11, 2013 at 2:17 pm

Connie is correct. Cumulative research on this topic has mixed findings. There are similar studies that have shown no correlation. See example below:

http://www.ncbi.nlm.nih.gov/pubmed/21176303

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Rhonda Tombros September 11, 2011 at 3:13 am

There are a number of studies about the risks and results for caesarean section vs vaginal birth for breech babies. The medical evidence is conflicted on this issue. A good summary of the different studies is the article by Deans and Penn in the Obsetrician and Gynaecologist (2008, 10: 139-144). There have been several studies, the most well known being the PREMODA study (Goffinet et al, American Journal of Obstet Gynecol (2006, 194: 1002-1011) showing that in carefully controlled environments, there is no significant difference in outcome between planned vaginal birth and planned caesarean section. Other studies suggest caesarean is safer for the baby. NONE take into account the long term morbidity of caesarean section on the mother including the affects on her future pregnancies and the psychological aspects sufficiently well.

One thing is clear: there is insufficient medical evidence to warrant a blanket policy of elective caesarean for breech.

I’ve never heard of the thyroid point but it relates to a different question: why the baby is breech (and the consensus is that there are a number of factors which make it more likely but nobody really knows why). The ‘variation on normal’ vs ‘abnormal’ point really is just about definitions. We should be focusing on mums and bubs.

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Nerida November 3, 2011 at 5:52 pm

I agree Rhonda, I had a natural breech birth – but only chose that route after ALOT of research. The main study on breech birth is massively flawed, and subsequent studies that involve women who WANT to have a natural birth show outcomes that are pretty much identical. I have a friend who almost died after a c-section last year – they are not the magical “safe” solution.

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Mumof2expecting3rd March 15, 2012 at 6:03 am

I agree with you both Rhonda and Nerida – I also had an unmedicated natural vaginal breech birth… it did not turn out to be the birth I wanted at the hospital with pro-cesarian and nasty staff. We had planned to birth at home but on the very day our Midwife phoned saying she was sick and couldnt see us for our regular appointment our bub decided that was the day to arrive- luckily our Midwife was still there with us and fought off the nasty hospital staff but we still had to deliver at the hospital- thats a story for another time though. Our daughter was born a Frank Breech and a perfectly healthy little girl. I too would not and WILL not have a c-section.
It would be a lot better for people to have a wider knowledge of breech births ESSPECIALLY the medical proffesionals so that more woman can manage a natural vaginal breech birth with support & without ridicule.

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Nev September 13, 2011 at 3:43 am

Just like Christina I was ‘bullied’ into a c-section with my first because she was breech. They tried turning her but it was so painful so I asked them to stop. I was 39 weeks pregnant when I had her and I believe she would’ve turned and to this day I don’t understand why I couldn’t go into labour. :(

Nev

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Cole D September 17, 2011 at 11:59 am

ooh, I am adding this post to my Breech Options post: http://wonderfullymadebelliesandbabies.blogspot.com/2011/08/breech-options.html

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Cynthia October 4, 2011 at 12:25 am

My son is 23 and was breech my whole pregnancy as per sonograms…my Doctor never suggested caesarian before going into labor. 2 days before he was born it showed he had one leg down the birth canal, but I hadn’t dropped at all and they didn’t think I was that close to delivering. Well he was born less than 48 hours later, via c-section, and was perfectly fine. He was born on his due date, :) it saddens me so many times when I see young pregnant women feeling like they are “late” and/or feeling pressure to induce or have a c-section and they haven’t even reached their due date. So many times I have seen young women told “the baby is getting too big” as a reason, and then when the baby is born they are way smaller than they ‘thought’.

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jennifer nichols November 2, 2011 at 5:05 pm

It makes me sad my ob never gave me a chance with #1. He was due 1/13. Was told on 12/11 he was breech and would have a c/s. He was born 12/18. That ob NEVER mentioned ecv or chiro or accupuncture or anything… NOTHING! I later saw a diff ob practice for complications from 2nd c/s. They would have let me deliver him frank. Which makes sense… The excuse of c/s from my ob was possible tearing.. less likely to occur with a frank. 2nd was footling. Tried ecv with a diff ob but was too far along. My presiding ob at the time tried to get #2 out with a early c/s but i said no. My niece flipped 3 days before she came.. and oddly enough my sister and i both had thyroid issues at the time.

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Marlene January 6, 2012 at 7:39 pm

That was awfully early to schedule a c/s because of breech. I’m guessing that OB would have found another reason to schedule a c/s if your baby wasn’t breech. Can you imagine how inconvenient it would be for the OB if you were to go into labor over the holidays?

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Nerida November 3, 2011 at 5:48 pm

I had a beautiful breech birth in a hospital with a fantastic Obstetrician and unreal midwives. She was my 2nd baby, and I had to go to a different hospital 4 hours from my home to have her naturally. My initial obstetrician, whilst supportive of my decision, could not deliver a breech baby naturally (due to insurance). After researching my options, and much thought, I did not want to go down the c-section route, and having delivered my first daughter, who was in a posterior position, I knew that my body could achieve a natural breech birth.

I’m so thankful that I found the doctor I did – he is a natural birth advocate, and is teaching the practise of safe breech birth. There were several pre-requisits you have to meet in order to try for a vaginal breech birth, and the baby’s heart was monitored throughout the labour. I was not allowed an epidural as you have to be active in labour, and had to birth on a birthing stool (which was fantastic). I was up and about minutes after giving birth and my daughter arrived safely and healthily.

It saddens me to hear that women think a c-section is the only option for a breech birth, when with the right medical support a vaginal birth is just as safe.

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Chana November 15, 2011 at 7:52 pm

I was fortunate to have a beautiful breech birth, a vaginal birth, a homebirth, with skilled midwives who believed in me, in my baby, in my body’s ability to birth.
I am grateful to have had this experience.

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Insight. April 10, 2012 at 6:56 pm

I was born breech and my mom never had an issue or problem with my brothers (I was born first) also I was the only girl born. I was born 6 pounds 7 ounces and I was tiny yet the doctors choose vaginal birth which after researching didn’t make a lot of sense. Maybe at first when I wasn’t in distress but after 11 hours in labor and being in distress thats when things changed.

This was what happened to me:

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.

I couldn’t breathe and almost died yet lived.
11 hours later born said to be healthy yet that doesn’t make much sense.

My whole life from as early on as kindgergarden always was a step behind my classmates. In grade school I was in special education and was not intergrated with my peers very often. I didn’t have many friends. My dad was an alcholic and verbally abusive. Almost everyone made fun of me. I didn’t have the best grade school years or highshcool years.

I have a learning disability which I think links to what happened when my mom gave birth to me. Says being born that way causes autism and downe syndrome yet I just have a mild learning disability nothing that serious. But still struggle.

Another interesting note probably based on my life experience and having a learning difference somewhere down the line I developed mental illness “Bi-Polar” and didn’t know of this untill I was dignosed at 16 years old. By that point I hit rock bottom and had to be hosbitalized.

Doing better in therapy now and have been for 7 months and trying to get my life back after constantly strugglig between both (LD and BP) and figureing out how to start over since in school I didn’t have a chance because I had exams to worry about and to understand the material which I struggled with. No time to work on myself or my inner problems.

To make matters worse I was born under Aquarius sign and said to unemotional which cleary changed after being diagnosed with Bi-Polar. Emotional 24/7 like a rollercoaster, to this day I still hate crying. I never cried as much as I did between 13-25 years old!

I am not affectionate person which I think falls under aqaurius and probably not feeling like I belong anywhere. My whole life I have been called names and not normal and experiencing normal life.

I lost a lot of friends I think lack to knowledge of Bi-Polar disorder.

Realtionships still aren’t perfect I don’t have much of one with my dad or my bother. They are improving slowley. It is almost too bad I feel like I suffered the most and for the longest time I couldn’t properly communicate what my problem was. I always had trouble with expressing how I feel (again aqaurius) trait. Just keeps getting better and better!

I feel like life is unfair a lot no one should have to suffer this much from a birth gone wrong.

Theres more to be said here but thats just the jist of it. Really I wished people would get more informed on breech birth I wouldn’t want to see another kid have a childhood I had.

I do think it’s all linked no one else in my family has mental health issue, no one esle in my family is a lesbian either. Guess I am different but isn’t ‘easy’ making this out to be a good thing. To see the good side of it. I suppose I have a lot of knowledge about a lot of things (I am constantly researching), opening others eyes to change. Not everything is so black and white.

Well thats my storey. Thanks for reading.
I was really sad about this yesterday so I thought i’d type about it.

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Melissa December 5, 2012 at 8:05 pm

Just had my first baby at home. Surprise complete breech! She was sitting cross legged on her way down. I’ll have to send you the story and some pictures, January. It was incredible. :)

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Tally March 25, 2013 at 6:05 pm

You say there’s no difference in infant mortality, yet in the article that you provided a link to, I found this under “Vaginal Delivery”:

After 37 weeks’ gestation, parents should be informed of the results of a recent multicenter randomized clinical trial that demonstrated significantly increased perinatal mortality and short-term neonatal morbidity associated with vaginal breech delivery (see Comparative Studies). For those attempting vaginal delivery, if estimated fetal weight (EFW) is more than 4000 g, some recommend cesarean delivery because of concern for entrapment of the unmolded head in the maternal pelvis, although data to support this practice are limited

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HR June 11, 2013 at 2:39 pm

As far as I understand, cumulative research shows that c-section deliveries are advantageous (safer for the baby) by a statistical percentage of 1%. This does not lead to a very powerful argument for c-section births when breech babies meet the basic criteria for safe vaginal delivery. It is also the reason that many hospitals (at least here in Canada) have changed their policies relevant to delivering breech babies–a 1% advantage makes it difficult to justify a blanket policy that forces women to deliver by c-section (and exaggerates concern about the safety to the child). When making the decision between the two options, it is important to consider that both options present risks. In the case of c-section, infant mortality may be reduced, while risk to the maternal mortality (usually from post-natal complications i.e. infections) is increased.

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Racine April 2, 2013 at 9:00 am

I found out that I was footling breech after my waters broke at 40 weeks +3 days.
I didnt have any ultrasounds during my pregnancy, my ob and midewife were sure that my son was head down though.
I was in hospital and the doctor said that the best thing to do would be a c section. i stood there for an hour asking questions and saying i want to try for a natural birth.
In the end they said it would be much to dangerouse becasue my amniotic fluid was green and this ment my baby had pooped in me, meaning he was stressed. he was also “to big”, ( 3840g and 54cm long), to give birth to him breech. also after 2 days of hard contractions i was only 2 cm dialated.
so he was not going to come out alone. I needed a c section.
it was the last thing I wanted to happen, I was very sad about it.
But when i finally got to hold my baby i was happy he was alive and healthy and decided it was the right choice to have the csection.
I just hope my next birth will go much better.

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Jodie June 11, 2013 at 5:59 pm

When my waters broke with my first I went straight into hospital. All the midwives told me my son was head down, they try to induce me when he wasn’t wanting to come out and put me on a dip, at one point this stupid midwife even try putting wires on his head and that hurt like hell. Only by the time my waters had broke for 48 hours and I only had one contraction that I didn’t even feel they did a scan and found out he was breech, by this time all my waters had gone and a dry birth would have hurt my son so was left with the only option with was an csection. I was very sad but he was a very healthy child bought in to this world and I wouldn’t have it any other way, I’m now on my second pregnancy and looking into a water birth I’m just hoping I get a normal birth this time

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Julia August 31, 2013 at 8:52 pm

My baby is complete breech. I went in for an external cephalic version at 37 weeks. She wouldn’t budge. I’m scheduled for a csection at 39 weeks 0 days. I am totally find with this outcome. I decided in the first trimester to let the birth happen however it needed to happen. I trust my doctor and medical staff. My sister had a csection. Yes. It sucks. But a hard vaginal birth can suck too. I have friends who tried vaginal with a doula/midwife at home and ended up in the hospital with a csection. Others just had the baby pop out in 8 hours.

All the research I’ve done is that there is no real significant difference in risks/benefits between vaginal and csection. The upside of csection is that it is not a surprise and you have a much lower chance of urinary incontinence (22% with vaginal delivery). But I sure would’ve liked to experience natural child birth and to have passed on my micro biome on to her through vaginal delivery. Ultimately though, I just want a healthy baby. So I’m going with csection.

It feels good to have a choice. But as I said, I trust my doctor and won’t choose vaginal delivery for breech against her recommendation.

Good luck to everyone in their birth and recovery.

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Charlotte White March 12, 2014 at 5:43 pm

Hi
My son was breech and I went into hospital to have him turned they tried twice but in the end it was so painful I couldn’t cope with anymore and the doctor wasn’t willing to put me through it, plus my son wasn’t having any of it! I was told that a C-section was the option for me. I was booked in for the following week. When my son was deleivered by C-section we found out the reason he didn’t want to move was due to his U/cord being around his neck 3 times, this wasn’t picked up on any scans but if I had given birth to him he would of died, I think myself very lucky.

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