In a typical birth, the baby is head down so that he can breathe oxygen before the umbilical cord is compressed during delivery (called cord prolapse). When the baby is not in the proper position, he is said to be “breeched.” About 4% of babies do not move into position before labor begins. Whether or not the doctor recommends a cesarean depends on the baby’s measurements as well as the breech position.
Nearly 70% of all breeched babies present in this position. If you have a Frank breech baby, he is bottom first above your cervix with his legs pointed straight up and his feet by his ears. Depending on the size of the baby, your doctor may determine that a c-section is not required, but the baby will need additional monitoring. There is less of a risk of cord prolapse (about 0.5%) is because the umbilical cord has less room to fall below the baby and become compressed, which is the biggest concern during a breeched birth.
If your baby is in a Complete breech, he will appear to be sitting cross-legged right above the birth canal. Complete breeches are more common in successive pregnancies. The good news is that babies in this position have the greatest chance to be turned head-down successfully, but depending on how far your labor has progressed, that may not be an option. The risk of cord prolapse increases to 5-10%, so your doctor is likely to recommend a cesarean.
The least common of the breech positions is called Footling breech. It is similar to a Complete breech, with one significant and painful detail: the baby’s feet, rather than nicely crossed like a tiny yogi master, are pointed straight down. You will know your baby is in the Footling breech position because you will feel his itty-bitty feet jabbing your cervix. I probably don't need to clarify that my daughter was in the Footling position. This position has the greatest risk of cord prolapse, 8-20%, and your doctor is extremely likely to recommend a c-section in this case.
For those of you overachievers who are researching ahead, you probably found that babies can get themselves into all sorts positions in the months leading up to birth. In addition to the breeched positions, there are about a dozen transverse (or longitudinal lie) positions where the baby is stretched across the uterus in a horizontal position. However, once labor begins, the contractions typically negotiate the baby either head-down or into one of the breeched positions.