Footling Breech Presentation: Causes, Diagnosis, and Management

Footling Breech Presentation – Causes, Diagnosis, Risks and Management:

Updated: 1 March 2026

Author: Dr. Humaira Latif, MBBS (KMU Peshawar)

Gynaecology / Obstetrics Specialist; Ultrasound Specialist and 14 years clinical experience.

⚠️ Disclaimer: This article is only written for Education and Information purposes. It cannot replace individualized medicine (consultation, diagnosis or treatment) with a doctor/health care provider. It is essential that any pregnant woman consults their registered obstetrician or healthcare provider prior to making individualized care decisions.

Background:

Most babies will turn to a head down (cephalic) position by the end of a full-term pregnancy in preparation for birth; if they present with their buttocks or feet towards the opening of the birth canal, this is called being in a breech position.

Footling breech presentations occur when one or both of the baby's feet are pointing down and moving toward the opening of the birth canal before the baby presents by their buttock or head. Footling breech presentation is much less common than some of the other characteristics of a breech presentation; careful attention should be given to monitoring this type of breech position due to the uniqueness of the delivery process as described below.

Table Of Content:

This article has been defined and consists of:

1. Definition and types.
2. Causes and risk factors.
3. Methods of diagnosis.
4. Maternal and fetal considerations.
5. Management options using evidence-based practice.

This article  to provide a balanced and accurate perspective while providing medically accurate information that meets antenatal care standards.

1. Understanding Breech Presentation:

Delivery planning for footling breech is affected as footling breech means that the presenting part (baby's bottom) is more unstable than for frank breech.

2. Are There Different Types Of Footling Breeches?

Footling Breeches Can Be Classified Into Two Categories:

A. Footling Breeches:

 Can Have One Foot Presenting Below The Bottom (Otherwise Known As Single Footling), Or.

B. Footling Breeches: 

Can Have Two Feet Presenting Toward The Cervix (Bilateral Footling)

Footling breeches tend to occur more frequently in preterm pregnancies because the fetus has additional room to move around prior to finding a more stable head down position.

3. Are There Causes And Risk Factors Related To Footling Breech?

Footling breech does not have one simple cause; however, it can be related to many maternal and fetal factors.

A. Maternal Factors: 

That May Result In Footling Breech Include:

1. Structural Abnormalities Of The Uterus

2. The Presence Of Fibroids

3. Past Surgical Procedures On The Uterus

4. Placenta Previa

5. Have Had Two Or More Full-Term Pregnancies (Multiparity)

B. Fetal Factors:

 That May Result In Footling Breech Include:

C. Fetal Factors:

 That May Result In Footling Breech Include:

1. Premature Birth

2. Multiple Births (Twins or more)

3. Congenital Defects That Affect Movement

4. The Presence Of Abnormal Amounts Of Amniotic Fluid

D. Conditions Of The Placenta:

 And Fetal Degeneration May Prevent The Fetus From Maintaining A Head-Down Orientation.

1. Polyhydramnios (excess fluid)

2. Oligohydramnios (reduced fluid)

Footling breech could affect fetal position where the fetus will have problems getting their head down.

4. Incidence of Footling Breech:

The occurrence (frequency) of breech presentation can be about: 

• Approximately 20% -25% of pregnancies before 28 weeks 
• Approximately 7%-10% of pregnancies at 32 weeks 
• Approximately 3%-4% of pregnancies at term 

Footling breech represents a smaller percentage of overall breech presentations. 

5. Diagnosing Footling Breech:

To plan the most appropriate course of action in caring for someone with footling breech diagnosis proper determination of the type of breech presentation has to be done. 

There are two main ways to establish proper determination: 

1. Clinical Examination:

• Abdominal palpation (feel of the baby by the physician) 
• Fetal Heart Sounds 
• Possibly Vaginal Examination if in Labor 

2. Ultrasound Examination:

Tv

Ultrasound is the "gold standard" for confirming the:

• Fetal Lie 
• Position of the Presenting Part 
• Placenta Location
• Amount of Amniotic Fluid
• Gestational Age 

Ultrasound can rule out any associated conditions as well. 

6. Clinical Considerations with Footling Breech Presentation:

When evaluating someone with a diagnosis of footling breech some additional variables will be taken into account to ensure that safe delivery will take place. The following considerations may be an issue: 

• Higher risk of umbilical cord prolapse
• Variable amount of descent of the presenting part
• Presence of maternal position can affect delivery of baby 

Although prognosis depends on gestational age, clinical setting, and access to providers who specialize in obstetrics, timely diagnosis and preparation of proper delivery plan for the mother and baby will generally result in positive outcomes for both.

7. Treatment Options:

The option taken for management is based on gestational age and clinical assessment.

1. Waiting and Watching:

• If diagnosed before the patient goes into labor,
• Regular visits to the obstetrician's office
• Follow up with ultrasound(s)

Monitoring the health of the baby; However, many babies will turn head down prior to 37 weeks.

2. Turning The Baby (ECV):

The baby can be turned externally by a doctor when the baby is approximately 36 - 37 weeks old. The doctor will attempt to turn the baby at an external position.

• Not all patients are candidates for external cephalic version. Contraindications include:
• Having previa of the placenta.
• Having anatomical abnormalities to uterus.
• Some fetal issues.

3. Planned Cesarean Delivery:

A planned c-section delivery is usually recommended for all term footling breeches; however, some of the physician guidelines indicate that a c-section should be done for any footling breech delivery prior to birth because of logistical issues. Recommendations should be based on each individual patient.

9. Caring & Counseling:

Patients often feel anxious when learning about breech presentation. They need:

• Clear explanations
• Written educational materials
• Emotional support
• A chance to ask questions

Good communication helps build trust between patients and health professionals, which usually leads to better outcomes.

10. Ways to Prevent Breech:

While there is no way to guarantee prevention of breech presentation, having:

• Prompt antenatal care
• Early and regular ultrasound
• Monitoring for excessive amniotic fluid
• Control of maternal health conditions (diabetes, hypertension, etc.)

may help to identify breech presentation in the early stages of development.

11. Some Common Questions Asked:

1. How often do babies in footling breech presentations turn during pregnancy?

Yes, as long as you are before 36 weeks along.

2. Are vaginal deliveries possible?

Most likely yes, depending on your specific clinical situation; however, most obstetricians perform individual assessments.

3. Are footling breech pregnancies dangerous?

Yes, but with modern obstetric care, most patients experience safe outcomes - it just takes some detailed planning.

12.Must Read Related Articles:

Ectopic Pregnancy Diagnosis and Ultrasound Findings

Cesarean Section vs Normal Delivery: Evidence-Based Comparison

Gestational Diabetes: Diet and Monitoring Guide

Missed Abortion: Causes, Symptoms and Care

Author:

Dr. Humaira Latif

Registered Medical Doctor

Gynae & OBS Specialist

MBBS, KMU Peshawar

14 Years Clinical & Practical Experience

Ultrasound Specialist

This Article Represents Evidence-Based Obstetric Knowledge & Clinical Experience in Relation to Maternal-Fetal Care.

13.References & Related Resources:

1. Gray CJ; Shanahan MM. Breech Presentation. StatPearl Publishing, Updated November 6, 2022
2. American College of Obstetricians and Gynecologists (ACOG). Management of Breech Presentation, Practice Bulletin No. 221, June 2020.
3. Royal College of Obstetricians and Gynaecologists (RCOG). Management of Breech Presentation; Green-top Guideline No. 20b, March 2017.
4. Hofmeyr GJ et al., External Cephalic Version for Breech Presentation, Cochrane Database of Systematic Reviews, Published July 22, 2015; updated evidence selection, 2023.