Birth Injuries That Can Happen During Breech Deliveries

When a baby is positioned with their feet or bottom down instead of head-first, it’s called a breech presentation. This position affects roughly 3 to 4 out of every 100 full-term pregnancies. While most breech babies in the United States are delivered by cesarean section today, vaginal breech births still happen, and they carry different risks than typical head-first deliveries.

Understanding these risks isn’t about creating fear. It’s about having clear, accurate information so families and healthcare providers can make informed decisions together. The injuries that can occur during breech births range from mild and temporary to serious and long-lasting, but knowing what to watch for makes a real difference in outcomes.

Why Breech Position Increases Injury Risk During Birth

In a typical delivery, the baby’s head comes first. The head is the largest and firmest part of the baby’s body, so when it passes through the birth canal, it naturally stretches the cervix and pelvic opening. This creates a path for the rest of the body to follow more easily.

With breech babies, this process works in reverse. The smaller body parts come first, whether it’s the buttocks, feet, or knees. This means the cervix and birth canal may not be fully opened by the time the baby’s head needs to pass through. The head is the last and largest part to deliver, and if there isn’t enough room or time, the baby can get stuck or experience trauma during extraction.

The umbilical cord is also at greater risk. In breech position, the cord can slip down alongside or ahead of the baby during labor, a situation called cord prolapse. When this happens, the cord can become compressed, cutting off the baby’s oxygen supply. Time becomes critical.

How Often Birth Injuries Happen in Breech Deliveries

The numbers tell an important story. Among vaginal breech deliveries, severe birth injuries occur in about 0.8% of cases, while milder injuries happen in roughly 1.5% of births. These rates are significantly higher than what we see in standard head-first vaginal deliveries.

When compared directly to head-first births, breech babies are nearly eight times more likely to need transfer for treatment of birth injuries, even in well-equipped community hospital settings. The risk of complications during or immediately after birth is also notably elevated. Studies show that the rate of death during labor or shortly after birth for breech babies is about 14.4 per 1,000 births. That’s approximately eight to nine times higher than the risk for head-first births, even when researchers exclude babies with existing congenital problems from the data.

These statistics underscore why medical guidelines have shifted so strongly toward cesarean delivery for breech presentations. The decision isn’t made lightly. It reflects decades of data showing measurably different outcomes between delivery methods.

Brachial Plexus Injuries and Nerve Damage From Breech Birth

One of the more common injuries in vaginal breech deliveries is damage to the brachial plexus, a network of nerves that runs from the spine through the neck and into each arm. This injury occurs in about 0.6% of live breech vaginal births.

During delivery, if the baby’s head or shoulders need to be maneuvered or pulled to complete the birth, those nerves can stretch or tear. The result is weakness or even paralysis in the affected arm. You might hear this called Erb’s palsy or Klumpke’s palsy, depending on which part of the nerve network is damaged.

Many brachial plexus injuries improve with physical therapy over time, especially when the nerves were stretched rather than torn. Babies with this injury often start therapy within weeks of birth. The exercises help maintain range of motion and encourage nerve healing. In cases where the damage is more severe, when nerves have torn completely, surgical repair might be necessary. Recovery can take months to years, and some children retain permanent weakness or limited mobility in the arm.

Parents usually first notice something is wrong when their baby doesn’t move one arm as much as the other, or when that arm hangs limply at the side. If you notice this, documentation and early evaluation matter. The sooner treatment begins, the better the potential for recovery.

Broken Bones During Breech Delivery

Fractures happen in approximately 0.5% of vaginal breech deliveries. The most commonly broken bone is the clavicle, or collarbone, though long bones in the arms and legs can also break during the delivery process.

These fractures typically occur when the healthcare provider needs to apply traction, pulling carefully on the baby’s arms, legs, or body, to help complete the delivery. While providers are trained to minimize this force, the mechanics of breech birth sometimes require maneuvering that puts stress on these bones.

The good news is that fractures in newborns generally heal well. Baby bones are still developing and have remarkable healing capacity. A clavicle fracture usually heals within a few weeks without any intervention beyond gentle handling and pain management. You might notice your baby is fussy when you pick them up on one side, or you might feel a small bump where the bone is healing. That’s called a callus, and it’s a normal part of the process.

Long bone fractures, like those in the arm or leg, may require temporary splinting to keep the bone stable while it heals. Your pediatrician will monitor healing with follow-up visits and, if needed, X-rays. Most infants recover completely with no lasting effects, though the first few weeks require extra care during diaper changes, dressing, and holding.

Head Entrapment and Why It Creates Emergency Situations

Head entrapment is one of the most serious complications that can occur during vaginal breech delivery. It happens when the baby’s body delivers, but the head becomes stuck, unable to pass through the cervix or the mother’s pelvis.

This is a medical emergency. Once the body is born, the umbilical cord is often compressed between the baby’s head and the birth canal. That means the baby’s oxygen supply is compromised or cut off entirely. Every second counts. Healthcare providers have only minutes to free the baby’s head and complete the delivery before oxygen deprivation causes permanent brain damage or death.

Head entrapment is more likely when labor begins before the cervix is fully dilated, when the baby’s head is larger relative to the birth opening, or when the baby is in a footling breech position (feet first). In footling breech, the feet and legs are so much smaller than the head that they don’t adequately prepare the birth canal for what needs to follow.

This is precisely why cervical dilation and careful assessment of the baby’s size and position matter so much in breech deliveries. It’s also why many hospitals won’t attempt vaginal breech birth unless very specific conditions are met, including having experienced providers and immediate access to an operating room. The stakes are simply too high when complications arise.

Umbilical Cord Prolapse in Breech Presentations

Umbilical cord prolapse means the cord slips into the vagina before the baby, or alongside the baby during labor. This happens in about 2.2% of breech labors, significantly higher than the 0.1% rate seen in head-first presentations.

When the cord prolapses, it can become compressed by the baby’s body pressing against the walls of the birth canal. Compression reduces or stops blood flow through the cord, which means the baby isn’t getting oxygen. This can happen suddenly and requires immediate intervention.

In most cases of cord prolapse, an emergency cesarean section is performed as quickly as possible. While waiting for surgery, healthcare providers may manually hold the baby’s presenting part away from the cord to relieve pressure, or they may position the mother in a way that uses gravity to reduce compression.

Certain types of breech position carry higher risk for prolapse. Footling breech and kneeling breech (where one or both feet or knees are the lowest part) create more space for the cord to slip through before the baby’s body fills the birth canal. This unpredictability is one reason these positions almost always warrant cesarean delivery.

If you’re in labor with a breech baby and there’s a sudden change in the baby’s heart rate pattern, or if you notice the umbilical cord in the vaginal opening, tell your medical team immediately. Minutes matter with prolapse.

Bruising, Swelling, and Facial Injuries From Difficult Extraction

Not all breech birth injuries are fractures or nerve damage. Soft tissue injuries like bruising, swelling, and scrapes are fairly common, especially when the delivery requires significant maneuvering or the use of instruments like forceps.

You might see bruising on your baby’s bottom, thighs, or genitals if they were born in a frank breech position (bottom first with legs extended upward). Facial bruising or swelling can occur if forceps were used to help deliver the head, or if the baby’s face pressed against pelvic bones during birth.

Cephalohematoma is another common finding. This is a collection of blood between the skull bone and the membrane covering it, creating a soft, raised bump on the baby’s head. It looks alarming, but it’s generally harmless and resolves on its own over a few weeks to months as the blood is reabsorbed.

Facial nerve injury can happen if pressure is placed on the nerve during delivery, typically when forceps are used. This might cause temporary weakness on one side of the face, and you might notice that one side of the baby’s mouth doesn’t move symmetrically when they cry, or one eye doesn’t close completely. Most facial nerve injuries from birth trauma recover fully within a few weeks to months without treatment.

These injuries can be upsetting to see on your newborn, but they’re usually temporary and heal well. Your pediatrician will examine your baby after birth and let you know what to expect as these injuries resolve.

Brain Injuries and Oxygen Deprivation Risks in Breech Births

Intracranial hemorrhage (bleeding inside the skull) and other central nervous system injuries are extremely rare in breech births, but they can occur when delivery becomes prolonged or traumatic. Recent population studies have found very few cases of intracranial bleeding specifically attributed to breech delivery mechanics, but the risk increases when extraction is delayed or requires significant force.

The bigger concern with breech births is oxygen deprivation, or asphyxia. This can result from cord prolapse, cord compression, or head entrapment. When a baby doesn’t receive adequate oxygen during or immediately after birth, it can lead to hypoxic-ischemic encephalopathy, or HIE. This is a type of brain injury caused by lack of oxygen and blood flow.

Breech babies are 3.3 times more likely than head-first babies to have Apgar scores below 7 at five minutes after birth. The Apgar score is a quick assessment of a baby’s condition, measuring heart rate, breathing, muscle tone, reflexes, and color. A score below 7 at five minutes signals that the baby experienced significant stress during birth and may need resuscitation or other immediate medical intervention.

Low Apgar scores don’t automatically mean permanent injury, but they do indicate that the baby needs close monitoring and possibly treatment. Some babies who experience oxygen deprivation during birth are candidates for therapeutic hypothermia. This is controlled cooling of the body, which has been shown to reduce the risk of long-term brain damage when started within six hours of birth.

If your baby experienced complications during a breech delivery and had low Apgar scores or required resuscitation, make sure you understand the follow-up plan. Neurological monitoring and developmental assessments in the months ahead will help identify any concerns early.

Which Types of Breech Position Carry the Highest Risk

Not all breech positions are equal when it comes to injury risk. The three main types are frank breech, complete breech, and footling or kneeling breech.

Frank breech is when the baby’s buttocks are down, but the legs are extended straight up along the body, with feet near the head. This is the most common breech position and generally the safest for vaginal delivery if that route is chosen, because the buttocks create a relatively large presenting part.

Complete breech is when the baby is sitting cross-legged, with both hips and knees bent. This position is less common and carries moderate risk.

Footling or kneeling breech is when one or both feet or knees are the lowest part, positioned to come out first. This is the highest-risk breech presentation. Because the feet and legs are so much smaller than the head, they don’t dilate the cervix adequately. This increases the chance of cord prolapse and head entrapment significantly. Vaginal delivery is almost never recommended for footling breech babies.

The position of the baby matters as much as any other factor when providers assess whether vaginal breech delivery is even an option. If your baby is in a footling or kneeling position, cesarean delivery is the standard and safest recommendation.

Delivery Methods and How They Affect Injury Risk

The method used to deliver a breech baby has a direct impact on injury risk. Cesarean section carries its own risks, primarily to the mother, but it significantly reduces the risk of birth trauma to the baby. That’s why roughly 87% of breech babies in the United States are now born by planned cesarean.

When vaginal breech delivery is attempted, the use of instruments (particularly forceps) can increase the risk of severe injury. Forceps may be used to help guide the baby’s head through the birth canal, but they require significant skill and experience. When used by less experienced providers, or when conditions aren’t ideal, forceps can contribute to facial injuries, skull fractures, or nerve damage.

Vacuum extraction is generally not used in breech births because it’s ineffective and potentially harmful when the baby isn’t head-first.

The experience and skill level of the delivering provider matters enormously. Vaginal breech delivery is a dying art because it’s performed so rarely now. Many obstetricians completing training today have never attended a vaginal breech birth. When it is attempted, it should only be by providers with specific training and regular experience in breech delivery techniques.

Timing matters too. Extended labor, failure of labor to progress, or attempting vaginal delivery when the cervix isn’t fully dilated all increase the risk of head entrapment and hypoxia. These are the reasons why strict selection criteria exist for vaginal breech delivery, and why immediate access to surgical backup is non-negotiable.

Signs of Birth Injury Parents Should Watch for After Breech Delivery

Some birth injuries are obvious immediately after delivery. Others become apparent in the hours, days, or weeks that follow. Knowing what to watch for helps ensure your baby gets timely evaluation and treatment.

Immediately after birth, watch for:

• Difficulty breathing or irregular breathing patterns
• Weak or absent crying
• Limpness or very poor muscle tone
• One arm or leg that doesn’t move as much as the other
• Unusual positioning of a limb or resistance to moving it
• Seizures or abnormal movements
• Extreme irritability or difficulty being consoled

In the days and weeks after birth, notice:

• Continued weakness or lack of movement in an arm or leg
• Failure to use both sides of the body equally
• One side of the face that doesn’t move symmetrically when crying
• Swelling on the head that doesn’t improve or gets larger
• Feeding difficulties or poor weight gain
• Developmental delays or missing milestones

If you notice any of these signs, don’t wait to bring them up with your pediatrician. Early documentation matters, both for your child’s medical care and if questions arise later about the cause of an injury. Keep notes about what you’re observing, when symptoms started, and how they’re changing. Take photos if there’s visible swelling, bruising, or positioning issues.

Birth injuries can be hard to think about, especially when you’re recovering from delivery yourself. But your observations in those early days and weeks are valuable. You know your baby better than anyone, and if something feels wrong, speak up.

Preventing Breech Birth Injuries Through Medical Interventions

Prevention starts before labor begins. When a baby is found to be breech in the final weeks of pregnancy, providers typically discuss two main options: external cephalic version and planned cesarean delivery.

External cephalic version, or ECV, is a procedure where the provider manually attempts to turn the baby from outside the abdomen. It’s usually performed around 37 weeks of pregnancy. The success rate is about 50%, meaning it works for roughly half of women who try it. ECV is done under ultrasound guidance, often with medication to relax the uterus. It carries small risks, including placental abruption or changes in the baby’s heart rate, which is why it’s performed in a hospital setting where emergency cesarean is available if needed.

If ECV is successful, the baby stays head-down, and vaginal delivery becomes safer. If it’s unsuccessful or not attempted, the conversation turns to delivery method.

Planned cesarean delivery is now the recommended approach for most breech presentations. The timing is usually scheduled around 39 weeks of pregnancy to balance the risk of early delivery against the risk of going into labor with a breech baby. While cesarean section is major surgery with real risks to the mother (including bleeding, infection, and increased complications in future pregnancies), it substantially reduces the risk of birth trauma to the baby.

Vaginal breech delivery is still performed in select situations, but only when strict criteria are met. These typically include:

• Frank or complete breech position (not footling)
• Estimated baby weight between specific ranges (not too large, not too small)
• Adequate maternal pelvis size
• Provider experienced in vaginal breech delivery
• Continuous fetal monitoring during labor
• Immediate access to cesarean section if complications arise

Even when these conditions are met, many hospitals and providers no longer offer vaginal breech delivery because of the risks and liability concerns. The shift toward cesarean delivery for breech presentations has been driven by evidence showing better outcomes for babies, even though it means more surgical births.

Making Informed Decisions About Breech Delivery

If you’re expecting a breech baby, you’re facing decisions that feel weighted with responsibility. The information here can help you understand the landscape, but the specific circumstances of your pregnancy matter enormously.

Your conversations with your healthcare provider should cover your baby’s exact position, their estimated size, your pelvis measurements, your previous birth history if applicable, and the experience available at your hospital. Ask about the specific risks and benefits of each option in your situation. Ask what would trigger a decision to move to cesarean during labor if vaginal delivery is attempted. Ask who would be in the room and what backup is available if complications occur.

It’s also worth understanding that going into labor with a breech baby (even if you’re planning a cesarean) changes the risk profile. Emergency cesarean during active labor carries different risks than a calm, scheduled surgery. This is part of why timing matters when planning cesarean delivery for breech presentation.

When Birth Injury Occurs

If your baby experiences a birth injury during a breech delivery, your immediate focus will be on their medical care and recovery. Many birth injuries improve with time and treatment, but some result in long-term or permanent effects that require ongoing therapy, medical equipment, or supportive care.

Birth injuries can result from unavoidable complications of a difficult delivery, even when providers do everything correctly. However, they can also result from decisions or actions that fell below the accepted standard of care. If something about your delivery feels wrong, if protocols weren’t followed, if warnings were ignored, if interventions were delayed, then it’s worth seeking a professional review of what happened.

Medical records are essential. Request complete copies of your prenatal records, labor and delivery records, and your baby’s hospital records. These documents contain the timeline of events, monitoring strips, notes about decision-making, and details about complications. They form the foundation of any medical review or legal evaluation.

You don’t have to decide immediately whether something went wrong. Your energy right now should be on your baby’s care and your own recovery. But preserving information and understanding your options matters. There are resources available specifically for families dealing with birth injuries, including support groups, medical specialists who focus on birth injury rehabilitation, and legal professionals who handle these cases.

Moving Forward After a Breech Birth

Whether your breech baby was born without complications or experienced injuries during delivery, the postpartum period is challenging. You’re recovering physically while caring for a newborn, processing what happened during birth, and possibly managing medical appointments and therapies you didn’t expect.

Give yourself permission to feel whatever you’re feeling. Birth experiences that differ from what you planned or hoped for can be genuinely traumatic, even when the outcome is good. If your baby was injured, you may feel grief, anger, guilt, or a complicated mix of emotions. These feelings are valid. Talking with a counselor who specializes in birth trauma can help.

Focus on what you can control now. If your baby needs physical therapy, occupational therapy, or medical follow-up, those appointments serve two purposes: they support your baby’s recovery, and they create documentation of progress or ongoing needs. Stay organized with records, take notes during appointments, and don’t hesitate to ask questions or advocate for your child.

Remember that you’re not alone in this. Thousands of families navigate birth injury recovery every year. Many children with breech birth injuries go on to reach their developmental milestones and live full, active lives. The path might look different than you imagined, but that doesn’t mean the destination is any less bright.