A breech delivery (when a baby is positioned feet- or bottom-first instead of head-first) does not automatically cause hypoxic-ischemic encephalopathy (HIE), but it can increase the risk of situations that reduce a baby’s oxygen supply, which in some cases may cause HIE.

Here’s a parent-friendly overview:

What is HIE?

HIE (hypoxic-ischemic encephalopathy) develops when a baby’s brain experiences a significant reduction in oxygen and/or blood flow around the time of birth.

Does breech presentation cause HIE?

Not by itself.

Many babies born breech are healthy and do not develop HIE. However, during a breech delivery, certain complications—rather than the breech position itself—can increase that risk.

Some of the main complications include:

• Umbilical cord prolapse: The umbilical cord slips through the cervix ahead of the baby and can become compressed, reducing blood flow and oxygen to the baby. This is considered an obstetric emergency.
• Umbilical cord compression: As the baby moves through the birth canal, the cord may be squeezed between the baby and the mother’s pelvis, decreasing oxygen delivery to the baby.
• Entrapment of the after-coming head: In a breech birth, the baby’s body is delivered before the head. If the head becomes stuck, delivery may be delayed while the umbilical cord is compressed, reducing oxygen supply.
• Prolonged or difficult delivery: If the birth takes much longer than expected or requires complex maneuvers, there may be a greater chance of fetal distress and reduced oxygenation.
• Fetal distress: Changes in the baby’s heart rate during labor can indicate that the baby is not getting enough oxygen. Persistent, severe distress that is not relieved promptly may contribute to HIE.
• Placental complications: Although not unique to breech births, problems such as placental abruption can occur during labor and significantly reduce oxygen delivery to the baby.

Important context

Most breech deliveries do not result in HIE. The risk depends on factors such as:

• The type of breech presentation (for example, frank, complete, or footling breech).
• The baby’s size and gestational age.
• Whether labor is progressing normally.
• How quickly complications are recognized and managed.
• The experience of the healthcare team.

Many babies with breech presentation are delivered safely, particularly when the birth is carefully planned and appropriate monitoring and interventions are available.

How is the risk reduced?

Healthcare teams often:

• Identify breech position before labor when possible.
• Discuss whether a planned cesarean birth may be safer in certain situations.
• Closely monitor the baby’s heart rate during labor.
• Prepare to intervene quickly if signs of fetal distress develop.

How doctors determine whether HIE occurred

If there were concerns during a breech delivery, doctors don’t diagnose HIE based on the delivery alone. They consider a combination of findings, including:

• The baby’s condition immediately after birth (such as low muscle tone or difficulty breathing).
• The need for extensive resuscitation.
• Blood gas measurements from the umbilical cord showing significant acidosis.
• Signs of neurological dysfunction, such as seizures or reduced alertness.
• Brain imaging (typically MRI) and other clinical evaluations.

 

If HIE is suspected, treatment such as therapeutic hypothermia (cooling therapy) may be started within the first 6 hours after birth for babies who meet specific criteria.

What should parents ask?

If your baby was born breech and you’re concerned, you can ask your healthcare team:

• Was my baby’s oxygen level or heart rate concerning during labor?
• Were there any complications during the breech delivery?
• Did my baby show any signs of HIE after birth?
• Were cord blood gases checked, and what did they show?
• Does my baby need any follow-up with a pediatric neurologist or developmental specialist?

Bottom line

• Breech presentation alone does not cause HIE.
• Some complications that can occur during a breech delivery may increase the risk of HIE if they lead to reduced oxygen or blood flow to the baby’s brain.
• Most breech babies do not develop HIE, especially when the pregnancy and delivery are carefully managed.

Do You Have a Case?

If your child suffered a brain injury after a complicated breech delivery, you may have questions about whether it could have been prevented.

You should consider contacting the HIE Newborn team as soon as possible if:

• there was a diagnosed or suspected umbilical cord problem
• the birth took much longer than expected or required complex maneuvers
• You had an emergency c-section delivery, and your baby was born with signs of distress or injury (like seizures, difficulty breathing, or the need for intensive medical intervention).
• Your baby has been diagnosed with a condition like hypoxic-ischemic encephalopathy (HIE), cerebral palsy, or another birth-related injury.
• You suspect that something went wrong during labor or delivery, or you have concerns about the medical care you or your baby received.

You do not need to know for certain what happened – that requires a detailed medical review to fully assess which parties were negligent.