Four Types of Breech Births
The type of breech position your baby is in will affect the choices for a vaginal breech or caesarean birth and the safety and success of possible interventions used to turn the baby, such as an ECV. There are three main types of breech positions, with variations possible for each one. They include:
The Frank breech is the most common type, especially for women having their first baby. It is also referred to as an extended breech. The baby’s bottom sits over the woman’s cervix, their hips are flexed (or bent) and their legs are extended (or straight). This means the baby’s feet are usually placed on either side of their head, near their ears.
This type of breech is regarded as the most favourable type of breech for a vaginal birth, because the baby’s bottom sits closely on the woman’s cervix and is about the same width and consistency as their head. This makes the baby’s bottom an efficient dilator of the woman’s cervix during labour. Babies in this position are also considered more feasible for being turned by the caregiver into a head down position, called an external cephalic version.
Frank breech babies also have less chance of their cord slipping down into their mother’s vagina, in front of the baby if the waters break before or during labour known as a cord prolapse. The incidence is about 0.5%, similar to babies in a head down position.
Baby in a Frank breech position Image 6-34shows a baby in a frank breech position.
A complete breech
The second most common type of breech position is a complete breech, also referred to as a flexed breech. Women having their second or subsequent baby will more likely have a breech baby in this position. Both the baby’s hips and the knees are flexed (or bent), meaning that they sit with their legs crossed, therefore both their feet and buttocks sit close to the woman’s cervix. A complete breech position is considered acceptable for a vaginal birth, if the woman chooses this option. Babies in a complete breech position have the most favourable chance of being turned into a head down position with an ECV. There is a slightly higher chance of cord prolapse with this type of breech (about 5 to 10% incidence, compared to 0.5% with a frank breech).
Baby in a Complete breech position Image 6-35 image of a baby in a complete breech position.
Footling breech or kneeling breech (incomplete breech)
These two breech positions are the least common types of breech positions. The baby’s foot (or feet) sit over the woman’s cervix, leading the way or the baby is in a kneeling position (very rare) with their knees coming first. These types of breech positions are considered the most precarious, because of the higher chance of cord prolapse if the waters break (an incidence of about 8 to 20%). Babies in these positions are generally always recommended to be born by caesarean.
Baby in a Footling breech position Image 6-36 shows a baby in a footling breech position.
This term is used to describe when the baby is in one of the above breech positions but their neck is fully extended, so they are ‘looking up to the stars’. This happens for about 5% of breech babies and is sometimes caused by the baby’s cord being around their neck. Stargazers are always delivered by caesarean, as it is very difficult for them to be born vaginally with a high risk of spinal cord injury if they do.