Breech birth injury claims

If your child suffered a brain injury or cerebral palsy after a traumatic or difficult breech birth, their injury may have been caused by negligent maternity care.

Safe delivery of a breech baby requires skilled obstetric management of the pregnancy, labour and birth. Mistakes in the planning, monitoring and handling of the birth can result in serious injury, including lifelong disability from traumatic brain injury, HIE and cerebral palsy.

On this page you will find answers to some of the most common questions that families have about breech birth injury: what it means, how it happens and when you should seek help.

Our birth injury solicitors have helped countless families of injured children to understand how their injury occurred and to claim the compensation and support that they need for their child. We can help you answer these questions with advice from trusted, independent medical experts, and secure the compensation and practical support that your baby deserves. If you would like to find out more about your baby’s breech birth injury, and what that means for your baby and family, or you have been contacted by MNSI or NHS Resolution, contact us to talk, free and confidentially, to one of our experienced birth injury solicitors.

What is breech birth?

Towards the end of pregnancy, most babies are positioned head-down in their mother’s uterus and then descend head first through the birth canal during labour and birth. You may hear this position or ‘presentation’ described as ‘cephalic’. 

If your baby is in the breech position (breech presentation) at the end of pregnancy this means that they are positioned the other way around, with their buttocks or feet going first into the birth canal.

Your baby’s breech position may be described as: 

• extended or frank breech (bottom first, legs straight with feet up near their head);
• flexed breech (with their knees bent and their feet near their bottom);
• kneeling breech (one or both legs extended at the hips and bent at the knees);
• footling breech (one or both feet first and lower than their bottom);
• complete breech (with hips and knees bent as if sitting cross-legged).

Breech presentation is very common in early pregnancy, but by the time the pregnancy approaches term at 36 – 37 weeks, most babies have turned to the head-first position. Only 3-4% of babies are still in the breech position at the end of pregnancy.

Babies in the breech presentation must be carefully monitored and breech birth must be planned and skilfully managed by an experienced, senior obstetrician, but it is often only diagnosed when the mother is already in labour.

Which pregnancies have a higher risk of breech birth?

Breech presentation occurs when the baby does not turn to the head-down position during late pregnancy. Breech birth is more likely:

• during your first pregnancy;
• if your placenta is low in the uterus or covering the cervix (placenta praevia); 
• if there is too much (polyhydramnios) or too little (oligohydramnios) amniotic fluid around the baby;
• in a multiple pregnancy (twins, triplets), where one or more of the babies may be in the breech position.

What are the risks of breech birth?

Breech presentation makes labour and delivery more complicated and increases the risk of injury to the mother and baby. If your baby is still in the breech position late in pregnancy, your maternity team should discuss the risks with you and your options, including turning the baby manually by external cephalic version (ECV), planned caesarean or planned vaginal delivery. They should agree a plan with you and take the proper steps to ensure a safe delivery.

Failure to do so increases the risk of severe injury from:

• The baby becoming stuck in the birth canal or difficulty delivering the baby’s head. Head entrapment can occur in premature, breech births where the head is large in relation to the baby’s body and gets stuck in the birth canal after the body has been delivered.  
  
  Poor obstetric management or delivery technique in breech births involving stuck babies can result in traumatic brain injury (such as skull fractures) and intracranial haemorrhage (brain bleeding) from pressure or excessive force during attempts to deliver the baby’s head. The stuck baby is also at risk of asphyxiation and hypoxic brain injury (HIE) from delayed delivery or umbilical cord compression.


• Umbilical cord prolapse or compression. This is where the umbilical cord passes through the cervix before the baby and becomes compressed between the baby and the mother or is wrapped around the baby’s neck. Compression of the umbilical cord restricts the flow of blood and oxygen to the baby, causing fetal distress and HIE brain injury.


• Hypoxia or oxygen deprivation can be caused during delays in a prolonged or complicated breech delivery, including delivery of a breech second twin, resulting in HIE brain injury and cerebral palsy.

Can medical negligence during breech birth cause brain injury?

Negligent mistakes in the management of breech pregnancies and vaginal breech births are a common cause of birth injury and cerebral palsy claims.

We have helped many families of severely injured children after breech birth injury including claims arising from late diagnosis of breech presentation, difficult (stuck) breech delivery, and a recent £18 million settlement for the negligently managed breech delivery of a child whose mother went into spontaneous labour before her planned caesarean section. If you would like to find out more about whether our experienced solicitors can help you with a breech birth injury claim, contact us to talk to a solicitor, free and confidentially. 

Medical negligence claims for breech birth injury resulting in traumatic birth injury, HIE and cerebral palsy often involve one or more of the following mistakes:

• delay or failure to diagnose the baby’s breech presentation;
• failure to discuss with the mother her risks and breech birth options and agree a plan for safe delivery;
• failure to recommend or perform a caesarean birth when indicated;  
• failure to follow proper procedures or guidance;  
• failure to escalate breech labour or delivery to a senior obstetrician;
• poor obstetric technique during vaginal breech delivery;
• fetal heart rate monitoring errors;
• incorrect use of Syntocinon (induction or augmentation of labour);
• delayed delivery (including delayed delivery of second twin);
• lack of neonatal or paediatric attendance at breech birth;
• lack of maternity unit protocols for management of vaginal breech birth;
• planning a vaginal breech delivery in a hospital without facilities for immediate caesarean section.

The Royal College of Obstetricians and Gynaecologists (RCOG) has identified that hospital obstetricians’ lack of experience in delivering breech babies has led to fewer obstetricians having the skills that are essential for safe breech births. RCOG’s guideline, Management of Breech Presentation March 2017, made specific recommendations for the care of women during unplanned breech labour, which emphasised the requirements for safe care, including the involvement of senior, experienced obstetricians at breech births and careful planning of mothers’ maternity care during breech pregnancies, including decision-making based on informed consent.

Read more about the RCOG guidelines for breech pregnancy and birth.