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INTRODUCTION

This topic will provide an overview of major issues related to breech presentation, including choosing the best route for delivery. Techniques for breech delivery, with a focus on the technique for vaginal breech delivery, are discussed separately. (See "Delivery of the singleton fetus in breech presentation" .)

TYPES OF BREECH PRESENTATION

● Frank breech – Both hips are flexed and both knees are extended so that the feet are adjacent to the head ( figure 1 ); accounts for 50 to 70 percent of breech fetuses at term.

● Complete breech – Both hips and both knees are flexed ( figure 2 ); accounts for 5 to 10 percent of breech fetuses at term.

Fetal Presentation, Position, and Lie (Including Breech Presentation)

• Key Points |

Abnormal fetal lie or presentation may occur due to fetal size, fetal anomalies, uterine structural abnormalities, multiple gestation, or other factors. Diagnosis is by examination or ultrasonography. Management is with physical maneuvers to reposition the fetus, operative vaginal delivery , or cesarean delivery .

Terms that describe the fetus in relation to the uterus, cervix, and maternal pelvis are

Fetal presentation: Fetal part that overlies the maternal pelvic inlet; vertex (cephalic), face, brow, breech, shoulder, funic (umbilical cord), or compound (more than one part, eg, shoulder and hand)

Fetal position: Relation of the presenting part to an anatomic axis; for transverse presentation, occiput anterior, occiput posterior, occiput transverse

Fetal lie: Relation of the fetus to the long axis of the uterus; longitudinal, oblique, or transverse

Normal fetal lie is longitudinal, normal presentation is vertex, and occiput anterior is the most common position.

Abnormal fetal lie, presentation, or position may occur with

Fetopelvic disproportion (fetus too large for the pelvic inlet)

Fetal congenital anomalies

Uterine structural abnormalities (eg, fibroids, synechiae)

Multiple gestation

Several common types of abnormal lie or presentation are discussed here.

Transverse lie

Fetal position is transverse, with the fetal long axis oblique or perpendicular rather than parallel to the maternal long axis. Transverse lie is often accompanied by shoulder presentation, which requires cesarean delivery.

Breech presentation

There are several types of breech presentation.

Frank breech: The fetal hips are flexed, and the knees extended (pike position).

Complete breech: The fetus seems to be sitting with hips and knees flexed.

Single or double footling presentation: One or both legs are completely extended and present before the buttocks.

Types of breech presentations

Breech presentation makes delivery difficult ,primarily because the presenting part is a poor dilating wedge. Having a poor dilating wedge can lead to incomplete cervical dilation, because the presenting part is narrower than the head that follows. The head, which is the part with the largest diameter, can then be trapped during delivery.

Additionally, the trapped fetal head can compress the umbilical cord if the fetal umbilicus is visible at the introitus, particularly in primiparas whose pelvic tissues have not been dilated by previous deliveries. Umbilical cord compression may cause fetal hypoxemia.

Predisposing factors for breech presentation include

Preterm labor

Uterine abnormalities

Fetal anomalies

If delivery is vaginal, breech presentation may increase risk of

Umbilical cord prolapse

Birth trauma

Perinatal death

Face or brow presentation

In face presentation, the head is hyperextended, and position is designated by the position of the chin (mentum). When the chin is posterior, the head is less likely to rotate and less likely to deliver vaginally, necessitating cesarean delivery.

Brow presentation usually converts spontaneously to vertex or face presentation.

Occiput posterior position

The most common abnormal position is occiput posterior.

The fetal neck is usually somewhat deflexed; thus, a larger diameter of the head must pass through the pelvis.

Progress may arrest in the second phase of labor. Operative vaginal delivery or cesarean delivery is often required.

Position and Presentation of the Fetus

If a fetus is in the occiput posterior position, operative vaginal delivery or cesarean delivery is often required.

In breech presentation, the presenting part is a poor dilating wedge, which can cause the head to be trapped during delivery, often compressing the umbilical cord.

For breech presentation, usually do cesarean delivery at 39 weeks or during labor, but external cephalic version is sometimes successful before labor, usually at 37 or 38 weeks.

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StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

StatPearls [Internet].

Breech presentation.

Caron J. Gray ; Meaghan M. Shanahan .

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Last Update: November 6, 2022 .

• Continuing Education Activity

Breech presentation refers to the fetus in the longitudinal lie with the buttocks or lower extremity entering the pelvis first. The three types of breech presentation include frank breech, complete breech, and incomplete breech. In a frank breech, the fetus has flexion of both hips, and the legs are straight with the feet near the fetal face, in a pike position. This activity reviews the cause and pathophysiology of breech presentation and highlights the role of the interprofessional team in its management.

• Describe the pathophysiology of breech presentation.
• Review the physical exam of a patient with a breech presentation.
• Summarize the treatment options for breech presentation.
• Explain the importance of improving care coordination among interprofessional team members to improve outcomes for patients affected by breech presentation.
• Introduction

Breech presentation refers to the fetus in the longitudinal lie with the buttocks or lower extremity entering the pelvis first. The three types of breech presentation include frank breech, complete breech, and incomplete breech. In a frank breech, the fetus has flexion of both hips, and the legs are straight with the feet near the fetal face, in a pike position. The complete breech has the fetus sitting with flexion of both hips and both legs in a tuck position. Finally, the incomplete breech can have any combination of one or both hips extended, also known as footling (one leg extended) breech, or double footling breech (both legs extended). [1] [2] [3]

Clinical conditions associated with breech presentation include those that may increase or decrease fetal motility, or affect the vertical polarity of the uterine cavity. Prematurity, multiple gestations, aneuploidies, congenital anomalies, Mullerian anomalies, uterine leiomyoma, and placental polarity as in placenta previa are most commonly associated with a breech presentation.  Also, a previous history of breech presentation at term increases the risk of repeat breech presentation at term in subsequent pregnancies. [4] [5] These are discussed in more detail in the pathophysiology section.

• Epidemiology

Breech presentation occurs in 3% to 4% of all term pregnancies. A higher percentage of breech presentations occurs with less advanced gestational age. At 32 weeks, 7% of fetuses are breech, and 28 weeks or less, 25% are breech.

Specifically, following one breech delivery, the recurrence rate for the second pregnancy was nearly 10%, and for a subsequent third pregnancy, it was 27%. Prior cesarean delivery has also been described by some to increase the incidence of breech presentation two-fold.

• Pathophysiology

As mentioned previously, the most common clinical conditions or disease processes that result in the breech presentation are those that affect fetal motility or the vertical polarity of the uterine cavity. [6] [7]

Conditions that change the vertical polarity or the uterine cavity, or affect the ease or ability of the fetus to turn into the vertex presentation in the third trimester include:

• Mullerian anomalies: Septate uterus, bicornuate uterus, and didelphys uterus 
• Placentation: Placenta previa as the placenta is occupying the inferior portion of the uterine cavity. Therefore, the presenting part cannot engage
• Uterine leiomyoma: Mainly larger myomas located in the lower uterine segment, often intramural or submucosal, that prevent engagement of the presenting part.
• Prematurity
• Aneuploidies and fetal neuromuscular disorders commonly cause hypotonia of the fetus, inability to move effectively
• Congenital anomalies:  Fetal sacrococcygeal teratoma, fetal thyroid goiter
• Polyhydramnios: Fetus is often in unstable lie, unable to engage
• Oligohydramnios: Fetus is unable to turn to vertex due to lack of fluid
• Laxity of the maternal abdominal wall: Uterus falls forward, the fetus is unable to engage in the pelvis.

The risk of cord prolapse varies depending on the type of breech. Incomplete or footling breech carries the highest risk of cord prolapse at 15% to 18%, while complete breech is lower at 4% to 6%, and frank breech is uncommon at 0.5%.

• History and Physical

During the physical exam, using the Leopold maneuvers, palpation of a hard, round, mobile structure at the fundus and the inability to palpate a presenting part in the lower abdomen superior to the pubic bone or the engaged breech in the same area, should raise suspicion of a breech presentation.

During a cervical exam, findings may include the lack of a palpable presenting part, palpation of a lower extremity, usually a foot, or for the engaged breech, palpation of the soft tissue of the fetal buttocks may be noted. If the patient has been laboring, caution is warranted as the soft tissue of the fetal buttocks may be interpreted as caput of the fetal vertex.

Any of these findings should raise suspicion and ultrasound should be performed.

Diagnosis of a breech presentation can be accomplished through abdominal exam using the Leopold maneuvers in combination with the cervical exam. Ultrasound should confirm the diagnosis.

On ultrasound, the fetal lie and presenting part should be visualized and documented. If breech presentation is diagnosed, specific information including the specific type of breech, the degree of flexion of the fetal head, estimated fetal weight, amniotic fluid volume, placental location, and fetal anatomy review (if not already done previously) should be documented.

• Treatment / Management

Expertise in the delivery of the vaginal breech baby is becoming less common due to fewer vaginal breech deliveries being offered throughout the United States and in most industrialized countries. The Term Breech Trial (TBT), a well-designed, multicenter, international, randomized controlled trial published in 2000 compared planned vaginal delivery to planned cesarean delivery for the term breech infant. The investigators reported that delivery by planned cesarean resulted in significantly lower perinatal mortality, neonatal mortality, and serious neonatal morbidity. Also, there was no significant difference in maternal morbidity or mortality between the two groups. Since that time, the rate of term breech infants delivered by planned cesarean has increased dramatically. Follow-up studies to the TBT have been published looking at maternal morbidity and outcomes of the children at two years. Although these reports did not show any significant difference in the risk of death and neurodevelopmental, these studies were felt to be underpowered. [8] [9] [10] [11]

Since the TBT, many authors since have argued that there are still some specific situations that vaginal breech delivery is a potential, safe alternative to planned cesarean. Many smaller retrospective studies have reported no difference in neonatal morbidity or mortality using these specific criteria.

The initial criteria used in these reports were similar: gestational age greater than 37 weeks, frank or complete breech presentation, no fetal anomalies on ultrasound examination, adequate maternal pelvis, and estimated fetal weight between 2500 g and 4000 g. In addition, the protocol presented by one report required documentation of fetal head flexion and adequate amniotic fluid volume, defined as a 3-cm vertical pocket. Oxytocin induction or augmentation was not offered, and strict criteria were established for normal labor progress. CT pelvimetry did determine an adequate maternal pelvis.

Despite debate on both sides, the current recommendation for the breech presentation at term includes offering external cephalic version (ECV) to those patients that meet criteria, and for those whom are not candidates or decline external cephalic version, a planned cesarean section for delivery sometime after 39 weeks.

Regarding the premature breech, gestational age will determine the mode of delivery. Before 26 weeks, there is a lack of quality clinical evidence to guide mode of delivery. One large retrospective cohort study recently concluded that from 28 to 31 6/7 weeks, there is a significant decrease in perinatal morbidity and mortality in a planned cesarean delivery versus intended vaginal delivery, while there is no difference in perinatal morbidity and mortality in gestational age 32 to 36 weeks. Of note, due to lack of recruitment, no prospective clinical trials are examining this issue.

• Differential Diagnosis
• Face and brow presentation
• Fetal anomalies
• Fetal death
• Grand multiparity
• Multiple pregnancies
• Oligohydramnios
• Pelvis Anatomy
• Preterm labor
• Primigravida
• Uterine anomalies
• Pearls and Other Issues

In light of the decrease in planned vaginal breech deliveries, thus the decrease in expertise in managing this clinical scenario, it is prudent that policies requiring simulation and instruction in the delivery technique for vaginal breech birth are established to care for the emergency breech vaginal delivery.

• Enhancing Healthcare Team Outcomes

A breech delivery is usually managed by an obstetrician, labor and delivery nurse, anesthesiologist and a neonatologist. The ultimate decison rests on the obstetrician. To prevent complications, today cesarean sections are performed and experienced with vaginal deliveries of breech presentation is limited. For healthcare workers including the midwife who has no experience with a breech delivery, it is vital to communicate with an obstetrician, otherwise one risks litigation if complications arise during delivery. [12] [13] [14]

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Disclosure: Caron Gray declares no relevant financial relationships with ineligible companies.

Disclosure: Meaghan Shanahan declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

• Cite this Page Gray CJ, Shanahan MM. Breech Presentation. [Updated 2022 Nov 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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• [What effect does leg position in breech presentation have on mode of delivery and early neonatal morbidity?]. [Z Geburtshilfe Neonatol. 1997] [What effect does leg position in breech presentation have on mode of delivery and early neonatal morbidity?]. Krause M, Fischer T, Feige A. Z Geburtshilfe Neonatol. 1997 Jul-Aug; 201(4):128-35.
• The effect of intra-uterine breech position on postnatal motor functions of the lower limbs. [Early Hum Dev. 1993] The effect of intra-uterine breech position on postnatal motor functions of the lower limbs. Sival DA, Prechtl HF, Sonder GH, Touwen BC. Early Hum Dev. 1993 Mar; 32(2-3):161-76.
• The influence of the fetal leg position on the outcome in vaginally intended deliveries out of breech presentation at term - A FRABAT prospective cohort study. [PLoS One. 2019] The influence of the fetal leg position on the outcome in vaginally intended deliveries out of breech presentation at term - A FRABAT prospective cohort study. Jennewein L, Allert R, Möllmann CJ, Paul B, Kielland-Kaisen U, Raimann FJ, Brüggmann D, Louwen F. PLoS One. 2019; 14(12):e0225546. Epub 2019 Dec 2.
• Review Breech vaginal delivery at or near term. [Semin Perinatol. 2003] Review Breech vaginal delivery at or near term. Tunde-Byass MO, Hannah ME. Semin Perinatol. 2003 Feb; 27(1):34-45.
• Review [Breech Presentation: CNGOF Guidelines for Clinical Practice - Epidemiology, Risk Factors and Complications]. [Gynecol Obstet Fertil Senol. 2...] Review [Breech Presentation: CNGOF Guidelines for Clinical Practice - Epidemiology, Risk Factors and Complications]. Mattuizzi A. Gynecol Obstet Fertil Senol. 2020 Jan; 48(1):70-80. Epub 2019 Nov 1.

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Breech Births

In the last weeks of pregnancy, a baby usually moves so his or her head is positioned to come out of the vagina first during birth. This is called a vertex presentation. A breech presentation occurs when the baby’s buttocks, feet, or both are positioned to come out first during birth. This happens in 3–4% of full-term births.

What are the different types of breech birth presentations?

• Complete breech: Here, the buttocks are pointing downward with the legs folded at the knees and feet near the buttocks.
• Frank breech: In this position, the baby’s buttocks are aimed at the birth canal with its legs sticking straight up in front of his or her body and the feet near the head.
• Footling breech: In this position, one or both of the baby’s feet point downward and will deliver before the rest of the body.

What causes a breech presentation?

The causes of breech presentations are not fully understood. However, the data show that breech birth is more common when:

• You have been pregnant before
• In pregnancies of multiples
• When there is a history of premature delivery
• When the uterus has too much or too little amniotic fluid
• When there is an abnormally shaped uterus or a uterus with abnormal growths, such as fibroids
• The placenta covers all or part of the opening of the uterus placenta previa

How is a breech presentation diagnosed?

A few weeks prior to the due date, the health care provider will place her hands on the mother’s lower abdomen to locate the baby’s head, back, and buttocks. If it appears that the baby might be in a breech position, they can use ultrasound or pelvic exam to confirm the position. Special x-rays can also be used to determine the baby’s position and the size of the pelvis to determine if a vaginal delivery of a breech baby can be safely attempted.

Can a breech presentation mean something is wrong?

Even though most breech babies are born healthy, there is a slightly elevated risk for certain problems. Birth defects are slightly more common in breech babies and the defect might be the reason that the baby failed to move into the right position prior to delivery.

Can a breech presentation be changed?

It is preferable to try to turn a breech baby between the 32nd and 37th weeks of pregnancy . The methods of turning a baby will vary and the success rate for each method can also vary. It is best to discuss the options with the health care provider to see which method she recommends.

Medical Techniques

External Cephalic Version (EVC)  is a non-surgical technique to move the baby in the uterus. In this procedure, a medication is given to help relax the uterus. There might also be the use of an ultrasound to determine the position of the baby, the location of the placenta and the amount of amniotic fluid in the uterus.

Gentle pushing on the lower abdomen can turn the baby into the head-down position. Throughout the external version the baby’s heartbeat will be closely monitored so that if a problem develops, the health care provider will immediately stop the procedure. ECV usually is done near a delivery room so if a problem occurs, a cesarean delivery can be performed quickly. The external version has a high success rate and can be considered if you have had a previous cesarean delivery.

ECV will not be tried if:

• You are carrying more than one fetus
• There are concerns about the health of the fetus
• You have certain abnormalities of the reproductive system
• The placenta is in the wrong place
• The placenta has come away from the wall of the uterus ( placental abruption )

Complications of EVC include:

• Prelabor rupture of membranes
• Changes in the fetus’s heart rate
• Placental abruption
• Preterm labor

Vaginal delivery versus cesarean for breech birth?

Most health care providers do not believe in attempting a vaginal delivery for a breech position. However, some will delay making a final decision until the woman is in labor. The following conditions are considered necessary in order to attempt a vaginal birth:

• The baby is full-term and in the frank breech presentation
• The baby does not show signs of distress while its heart rate is closely monitored.
• The process of labor is smooth and steady with the cervix widening as the baby descends.
• The health care provider estimates that the baby is not too big or the mother’s pelvis too narrow for the baby to pass safely through the birth canal.
• Anesthesia is available and a cesarean delivery possible on short notice

What are the risks and complications of a vaginal delivery?

In a breech birth, the baby’s head is the last part of its body to emerge making it more difficult to ease it through the birth canal. Sometimes forceps are used to guide the baby’s head out of the birth canal. Another potential problem is cord prolapse . In this situation the umbilical cord is squeezed as the baby moves toward the birth canal, thus slowing the baby’s supply of oxygen and blood. In a vaginal breech delivery, electronic fetal monitoring will be used to monitor the baby’s heartbeat throughout the course of labor. Cesarean delivery may be an option if signs develop that the baby may be in distress.

When is a cesarean delivery used with a breech presentation?

Most health care providers recommend a cesarean delivery for all babies in a breech position, especially babies that are premature. Since premature babies are small and more fragile, and because the head of a premature baby is relatively larger in proportion to its body, the baby is unlikely to stretch the cervix as much as a full-term baby. This means that there might be less room for the head to emerge.

Want to Know More?

• Creating Your Birth Plan
• Labor & Birth Terms to Know
• Cesarean Birth After Care

Compiled using information from the following sources:

• ACOG: If Your Baby is Breech
• William’s Obstetrics Twenty-Second Ed. Cunningham, F. Gary, et al, Ch. 24.
• Danforth’s Obstetrics and Gynecology Ninth Ed. Scott, James R., et al, Ch. 21.

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• A 28-year-old G1P0 woman at 37 weeks of gestation presents to her obstetrician for a prenatal care appointment. She describes feeling some soreness under her ribs in the past few weeks and feels her baby kicking in her lower abdomen. An ultrasound is performed and is seen in the image. The obstetrician describes management approaches, including an external cephalic version before labor.
• flexion of the hips and knees
• some deflexion of one hip and knee
• flexion of both hips with extension of both knees
• 3-4% of all deliveries
• 22-25% of births before 28 weeks of gestation
• 7-15% of births at 32 weeks of gestation
• 3-4% of births at term
• prematurity
• uterine malformations
• uterine fibroids
• polyhydramnios
• placenta previa
• multiple gestations
• subcostal discomfort (due to fetal head in the uterine fundus)
• feeling of kicking in the lower abdomen
• presence of soft mass (buttocks) and absence of hard fetal skull on transabdominal examination of the lower uterine segment
• when cervix is dilated
• detection of breech presentation prior to 37 weeks does not warrant intervention
• fetal head in the uterine fundus
• buttocks in the lower uterine segment
• extension angle > 90 degrees
• at 37 weeks gestation or later
• perform trial of vaginal delivery if the version is successful
• may be planned for breech presentation, without a trial of external cephalic version
• may be performed if trial of vaginal delivery is unsuccessful after external cephalic labor
• ↑ up to 4-fold with breech presetnation
• associated with malformations, prematurity, and intrauterine fetal demise
• 17% of preterm breech deliveries
• 9% of term breech deliveries
• abnormalities include CNS malformations, neck masses, and aneuploidy
• - Breech Presentation

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Bringing Care to Life

The Breech Birth

Breech births can go well but they are sometimes dangerous for the baby—especially a first baby—because no one knows if the woman’s pelvis is big enough for a baby’s head to birth. This video shows how to determine whether a baby is in a breech position and how to assist the birth.

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• Labor & Delivery

What Causes Breech Presentation?

Learn more about the types, causes, and risks of breech presentation, along with how breech babies are typically delivered.

What Is Breech Presentation?

Types of breech presentation, what causes a breech baby, can you turn a breech baby, how are breech babies delivered.

FatCamera/Getty Images

Toward the end of pregnancy, your baby will start to get into position for delivery, with their head pointed down toward the vagina. This is otherwise known as vertex presentation. However, some babies turn inside the womb so that their feet or buttocks are poised to be delivered first, which is commonly referred to as breech presentation, or a breech baby.

As you near the end of your pregnancy journey, an OB-GYN or health care provider will check your baby's positioning. You might find yourself wondering: What causes breech presentation? Are there risks involved? And how are breech babies delivered? We turned to experts and research to answer some of the most common questions surrounding breech presentation, along with what causes this positioning in the first place.

During your pregnancy, your baby constantly moves around the uterus. Indeed, most babies do somersaults up until the 36th week of pregnancy , when they pick their final position in the womb, says Laura Riley , MD, an OB-GYN in New York City. Approximately 3-4% of babies end up “upside-down” in breech presentation, with their feet or buttocks near the cervix.

Breech presentation is typically diagnosed during a visit to an OB-GYN, midwife, or health care provider. Your physician can feel the position of your baby's head through your abdominal wall—or they can conduct a vaginal exam if your cervix is open. A suspected breech presentation should ultimately be confirmed via an ultrasound, after which you and your provider would have a discussion about delivery options, potential issues, and risks.

There are three types of breech babies: frank, footling, and complete. Learn about the differences between these breech presentations.

Frank Breech

With frank breech presentation, your baby’s bottom faces the cervix and their legs are straight up. This is the most common type of breech presentation.

Footling Breech

Like its name suggests, a footling breech is when one (single footling) or both (double footling) of the baby's feet are in the birth canal, where they’re positioned to be delivered first .

Complete Breech

In a complete breech presentation, baby’s bottom faces the cervix. Their legs are bent at the knees, and their feet are near their bottom. A complete breech is the least common type of breech presentation.

Other Types of Mal Presentations

The baby can also be in a transverse position, meaning that they're sideways in the uterus. Another type is called oblique presentation, which means they're pointing toward one of the pregnant person’s hips.

Typically, your baby's positioning is determined by the fetus itself and the shape of your uterus. Because you can't can’t control either of these factors, breech presentation typically isn’t considered preventable. And while the cause often isn't known, there are certain risk factors that may increase your risk of a breech baby, including the following:

• The fetus may have abnormalities involving the muscular or central nervous system
• The uterus may have abnormal growths or fibroids
• There might be insufficient amniotic fluid in the uterus (too much or too little)
• This isn’t your first pregnancy
• You have a history of premature delivery
• You have placenta previa (the placenta partially or fully covers the cervix)
• You’re pregnant with multiples
• You’ve had a previous breech baby

In some cases, your health care provider may attempt to help turn a baby in breech presentation through a procedure known as external cephalic version (ECV). This is when a health care professional applies gentle pressure on your lower abdomen to try and coax your baby into a head-down position. During the entire procedure, the fetus's health will be monitored, and an ECV is often performed near a delivery room, in the event of any potential issues or complications.

However, it's important to note that ECVs aren't for everyone. If you're carrying multiples, there's health concerns about you or the baby, or you've experienced certain complications with your placenta or based on placental location, a health care provider will not attempt an ECV.

The majority of breech babies are born through C-sections . These are usually scheduled between 38 and 39 weeks of pregnancy, before labor can begin naturally. However, with a health care provider experienced in delivering breech babies vaginally, a natural delivery might be a safe option for some people. In fact, a 2017 study showed similar complication and success rates with vaginal and C-section deliveries of breech babies.

That said, there are certain known risks and complications that can arise with an attempt to deliver a breech baby vaginally, many of which relate to problems with the umbilical cord. If you and your medical team decide on a vaginal delivery, your baby will be monitored closely for any potential signs of distress.

Ultimately, it's important to know that most breech babies are born healthy. Your provider will consider your specific medical condition and the position of your baby to determine which type of delivery will be the safest option for a healthy and successful birth.

ACOG. If Your Baby Is Breech .

American Pregnancy Association. Breech Presentation .

Gray CJ, Shanahan MM. Breech Presentation . [Updated 2022 Nov 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.

Mount Sinai. Breech Babies .

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Related Articles

This paper is in the following e-collection/theme issue:

Published on 6.6.2024 in Vol 8 (2024)

YouTube as a Source of Patient Information on External Cephalic Version: Cross-Sectional Study

Authors of this article:

Original Paper

• Merle R van Dijk 1 , MD   ; 
• Anne-Fleur van der Marel 1 , MD   ; 
• Leonie E van Rheenen-Flach 1 , MD   ; 
• Wessel Ganzevoort 2, 3 , MD, PhD   ; 
• Etelka Moll 1 , MD, PhD   ; 
• Fedde Scheele 1, 4 , Prof Dr, MD   ; 
• Joost Velzel 5 , MD, PhD  

1 Department of Obstetrics and Gynecology, Onze Lieve Vrouwen Gasthuis, Amsterdam, Netherlands

2 Department of Obstetrics and Gynecology, Amsterdam University Medical Centre, Amsterdam, Netherlands

3 Amsterdam Reproduction & Development Research Institute, Amsterdam, Netherlands

4 Faculty of Science, Athena Institute, Vrije Universiteit, Amsterdam, Netherlands

5 Department of Obstetrics and Gynecology, Northwest Clinics, Alkmaar, Netherlands

Corresponding Author:

Merle R van Dijk, MD

Department of Obstetrics and Gynecology

Onze Lieve Vrouwen Gasthuis

Oosterpark 9

Amsterdam, 1061AC

Netherlands

Phone: 31 0205999111

Email: [email protected]

Background: With the global increase of cesarean deliveries, breech presentation is the third indication for elective cesarean delivery. Implementation of external cephalic version (ECV), in which the position of the baby is manipulated externally to prevent breech presentation at term, remains suboptimal. Increasing knowledge for caretakers and patients is beneficial in the uptake of ECV implementation. In recent decades, the internet has become the most important source of information for both patients and health care professionals. However, the use and availability of the internet also bring about concerns since the information is often not regulated or reviewed. Information needs to be understandable, correct, and easily obtainable for the patient. Owing to its global reach, YouTube has great potential to both hinder and support spreading medical information and can therefore be used as a tool for shared decision-making.

Objective: The objective of this study was to investigate the available information on YouTube about ECV and assess the quality and usefulness of the information in the videos.

Methods: A YouTube search was performed with five search terms and the first 35 results were selected for analysis. A quality assessment scale was developed to quantify the accuracy of medical information of each video. The main outcome measure was the usefulness score, dividing the videos into useful, slightly useful, and not useful categories. The source of upload was divided into five subcategories and two broad categories of medical or nonmedical. Secondary outcomes included audience engagement, misinformation, and encouraging or discouraging ECV.

Results: Among the 70 videos, only 14% (n=10) were defined as useful. Every useful video was uploaded by educational channels or health care professionals and 80% (8/10) were derived from a medical source. Over half of the not useful videos were uploaded by birth attendants and vloggers. Videos uploaded by birth attendants scored the highest on audience engagement. The presence of misinformation was low across all groups. Two-thirds of the vloggers encouraged ECV to their viewers.

Conclusions: A minor percentage of videos about ECV on YouTube are considered useful. Vloggers often encourage their audience to opt for ECV. Videos with higher audience engagement had a lower usefulness score compared to videos with lower audience engagement. Sources from medically accurate videos should cooperate with sources with high audience engagement to contribute to the uptake of ECV by creating more awareness and a positive attitude of the procedure, thereby lowering the chance for a cesarean delivery due to breech presentation at term.

Introduction

Breech presentation occurs in 3%-4% of singleton full-term pregnancies, and there remains controversy about the preferred mode of delivery in the clinical community [ 1 , 2 ]. Planned cesarean delivery (CD) in cases of breech presentation leads to a reduction in perinatal morbidity compared to vaginal breech delivery [ 3 ]. However, CD is a high-risk procedure associated with an increase in maternal morbidity and possible complications in future pregnancies [ 4 ]. Vaginal breech delivery remains common in many contexts and is considered a high-risk obstetrics procedure.

External cephalic version (ECV) is a medical intervention involving the application of abdominal pressure by health care professionals to facilitate the external rotation of a fetus from a breech presentation to a cephalic presentation. ECV is generally considered a safe procedure, associated with a low incidence of complications, and can effectively avert the need for a CD. ECV has been shown to reduce the incidence of breech presentation at term, resulting in less high-risk vaginal deliveries and CD for breech presentation [ 5 ]. The number of ECV procedures necessary to prevent one CD is estimated to be 2.6 (95% CI 2.0-3.9), with a success rate of approximately 50% [ 6 , 7 ]. With the global increase of CD, breech presentation is the third indication for elective CD [ 8 ]. However, implementation of ECV to prevent breech presentation at term remains suboptimal, since not all caretakers are providing ECV and not all patients opt for the offered attempt [ 9 ]. Increasing knowledge for caretakers and patients would be beneficial in the uptake of the implementation.

In recent decades, a change has become evident in how patients and their communities obtain information on health-related subjects [ 10 ]. Currently, the internet is the most important source of information for both patients and health care professionals. Specifically, social medial plays a key role as a source of health information [ 11 ]. YouTube, as the most popular video-sharing website with over 5 billion daily views, includes an expanding library of health education videos [ 12 ]. However, the use and availability of YouTube are also associated with concerns since the content is not regulated or reviewed.

For patients, gathering correct information to come to a well-informed choice is important. This information needs to be understandable, accurate, and easily obtainable for the patient, and YouTube shows great potential in this regard. Studies have shown that videos posted on YouTube wield a profound influence on young adults by shaping and influencing their preferences, behaviors, and perceptions, becoming a primary source of information, entertainment, and cultural engagement in their lives [ 13 - 15 ]. Because of its global reach, YouTube has high potential to both hinder and support spreading medical information and can therefore be used as a tool for shared decision-making [ 16 ].

The quality of patient-education videos on YouTube has been studied in the context of several obstetric aspects, including CD, pain management after CD, abnormally invasive placenta, and medication use during pregnancy [ 17 - 21 ]. However, no study has yet evaluated the quality and content of YouTube videos on ECV. Therefore, in this study, we aimed to evaluate the accuracy of medical information about ECV available on YouTube.

Search Strategy

A systematic search of videos uploaded on YouTube was performed in March 2022 with the following five search terms: “external cephalic version,” “ECV,” “fetal version,” “turning a breech baby,” and “turning baby.” The search was performed using the Google Chrome browser operated in Incognito mode and no personal YouTube or Google account was used. Search results were sorted by relevance, replicating a default YouTube search. The first 35 results were collected per search term, since 90% of YouTube users do not watch videos past the 30th resulting video [ 22 ]. Inclusion criteria were (1) videos related to cephalic version, (2) English language, and (3) acceptable audio-visual quality. Exclusion criteria were (1) length>1 hour, (2) irrelevant videos, and (3) duplicates. Videos were evaluated by two authors (MRvD and AFvdM), representing the demographic of the viewers. At the time of reviewing the videos, MRvD was a PhD candidate with 1 year of clinical experience in gynecology and obstetrics and AFvdM was a medical student in her final year. Discrepancies were discussed with authors LEvRF and JV, who are both obstetricians.

Video Assessment and Outcome Scores

For each video, the following quantitative data were collected: day of upload, years since upload, duration of the video in minutes, number of views, total number of likes and dislikes, and uploader’s username. To assess audience engagement, the like ratio ([likes× 100]/[likes+dislikes]), view ratio (number of views/days on platform), and video power index (VPI) ([like ratio×view ratio]/100) were determined for each video.

Usefulness Score

Score components and calculation.

Since there are no established assessment tools for evaluating the accuracy of medical information on videos about ECV, a self-developed usefulness score instrument was used. The usefulness score consisted of three parts: the ECV Royal College of Obstetricians & Gynaecologists (RCOG)–specific score [ 5 , 23 ], modified DISCERN (mDISCERN) score [ 24 ], and presence of misinformation. The total usefulness score was then calculated as the sum of the ECV RCOG and mDISCERN scores with points subtracted for misinformation. A maximum of 30 points could be rewarded to every video. The total usefulness score was used to categorize videos as not useful (<9 points), slightly useful (9-13 points), and useful (>13 points). Every video with a discrepancy of 4 points or more in the usefulness score between the two reviewers was reassessed. For the analyses, the average score of the two reviewers was used. The items and scoring scheme for the ECV RCOG–specific score and mDISCERN score are shown in Table 1 .

a A maximum of 30 points could be rewarded to every video. The total score is derived as the sum of the scores from all components of both scoring systems and then subtracting points deducted for misinformation; the total score was used to categorize videos as not useful (<9 points), slightly useful (9-13 points), and useful (>13 points).

b RCOG: Royal College of Obstetricians & Gynecologists.

c mDISCERN: modified DISCERN score; a validated tool that measures the reliability of patient information concerning treatment choice [ 24 ]. The modification was used to prevent overlap with certain questions in the RCOG-based score.

RCOG-Based Score

The ECV RCOG–specific score is based on the patient information web page of the RCOG No. 20a [ 5 , 23 ]. The informational pamphlet issued by the RCOG provides comprehensive details essential for individuals to make informed decisions and provide informed consent for undergoing this medical procedure. Each video could score a maximum of 20 points on the ECV RCOG–specific score, depending on information being not mentioned (0 points), mentioned (1 point), or clearly explained (2 points).

mDISCERN Score

The quality and reliability of each video was assessed by a modification of the DISCERN score, a validated tool that measures the reliability of patient information concerning treatment choices [ 24 ]. We used the mDISCERN to avoid redundancy with many items in the ECV RCOG–specific score and the original DISCERN tool. The mDISCERN score is based on 4 questions with a scale rated from 0 to 2, where 0 points were given if criteria were unfulfilled and 2 points were given if criteria were entirely fulfilled. A maximum of 8 points could be granted to each video.

Presence of Misinformation

Points could be deducted from the total usefulness score if either proven or unproven misinformation was given about the procedure, risks, pain, success rate, or the chance of the baby turning back in breech position. Unproven misinformation included videos mentioning incorrect or nonresearched success rates to turn a baby into a cephalic position by, for instance, postural management. With 2 points deducted in each case, the presence of misinformation could deduct a total of 16 points from the total usefulness score.

Ethical Considerations

All videos in this study are publicly available on YouTube and all analyses were performed on deidentified data. This study is an observational study in which no action or behavior was imposed on participants. Therefore, this study is not subject to the Dutch Medical Scientific Research Involving Human Subjects Act [ 25 ].

Video Classification

The primary outcome of the evaluation was the usefulness score. We performed several secondary analyses and report the scores obtained for prespecified groups. First, videos were categorized according to the source of upload into childbirth attendants, paramedics, vloggers, health care professionals, educational channels, and other. Second, videos were divided into medical videos, which included health care professionals, paramedics, and partly educational channels, and nonmedical videos, which included vloggers, childbirth attendants, and partly educational channels. Videos classified by educational channels were categorized according to the presenter’s profession. Third, all videos uploaded by vloggers were evaluated according to whether ECV was encouraged or discouraged.

Statistical Analysis

The intraclass correlation was used to measure the reliability between the two reviewers with regard to the total usefulness score. The intraclass correlation is used to assess the consistency of measurements between raters. Among the multiple models available for this assessment, we selected the two-way mixed-effect model since we wanted to determine the level of agreement between the two raters. According to Koo and Li [ 26 ], based on the 95% CI, a value below 0.50 indicates poor correlation and a value above 0.90 indicates excellent correlation. Continuous variables are presented as mean (SD) and categorical variables are presented as n (%). For comparisons between groups, the χ 2 , Kruskal-Wallis, and Mann-Whitney U tests were used as appropriate. SPSS (version 28) was used for the analysis, where P <.05 was considered statistically significant.

Video Selection

On March 16, 2022, 175 videos were selected from YouTube. Multimedia Appendix 1 shows a flowchart of the selection process of the included videos. After removing duplicates and applying the exclusion criteria, 70 videos remained for evaluation. Multimedia Appendix 2 provides an overview of all included videos. The mean duration of all videos was 8.9 minutes (SD 9.3) and the mean VPI was 203.8 (SD 449.8).

The mean total usefulness score was 7.6 (SD 5.6). The intraclass correlation coefficient of the usefulness score between the two reviewers was 0.942, indicating excellent agreement [ 26 ]. Videos were categorized into useful (14.3%), slightly useful (22.9%), and not useful (61.4%) ( Table 2 ). Videos scored as not useful had the highest audience engagement and videos scored as useful had the lowest audience engagement.

Over 60% of the videos defined as not useful were uploaded by vloggers and childbirth attendants. Most videos included in this category were found with the search term “turning a breech baby.” The majority of the videos defined as slightly useful were uploaded by educational channels and health care professionals (37.5% and 18.8%, respectively). All videos defined as useful were uploaded by educational channels and health care professionals, with 90% of the videos found with the search term “external cephalic version.”

a No statistical analyses were performed for these variables since there was no relevance for the aim of this research.

b View ratio: number of views/days on platform.

c Like ratio: likes×100/(likes+dislikes).

d Video power index: (like ratio×view ratio)/100.

e Usefulness score: total ECV RCOG–specific score+total mDISCERN score–misinformation; the score has a maximum of 30 points and videos are accordingly classified as not useful (<9 points), slightly useful (9-13 points), and useful (>13 points).

f RCOG: Royal College of Obstetricians & Gynecologists.

g mDISCERN: modified DISCERN score [ 24 ]; a validated tool that measures the reliability of patient information concerning treatment choice.

Source of Upload

The included videos were evenly spread across the upload categories. Three videos could not be categorized in the predefined subgroups and were thus included in the “other” group. These videos included a news channel and a government organization, whereas one source was miscellaneous. Characteristics of the source of upload are shown in Table 3 . Childbirth attendants appear to be the most influential sources on this topic, scoring the highest on audience engagement (view ratio, like ratio, and VPI). Excluding the “other” group, paramedics scored the lowest on audience engagement factors.

Usefulness scores were calculated for each category. Educational channels scored the highest, followed by health care professionals. Childbirth attendants scored the lowest on the total usefulness score, with vloggers scoring only slightly above. There was a statistically significant difference in usefulness scores according to the source of upload ( P <.001).

When comparing the mean score for each ECV RCOG–specific score statement, “putting pressure on the mothers’ belly” and “aim for vaginal birth” scored the highest, whereas the statements “50% chance of succeeding” and “chance of turning back” scored the lowest. The questions “Are the aims clear and achieved?” and “Is the information presented balanced and unbiased?” had the highest mean scores of the four mDISCERN statements. Points that were deducted most often came from the misinformation categories proven risks and unproven procedure .

c Like ratio: (likes×100)/(likes+dislikes).

Medical Versus Nonmedical Videos

All evaluated videos were divided into medical (n=32) and nonmedical (n=38) videos and their characteristics are summarized in Table 4 . Overall, nonmedical videos had higher audience engagement than medical videos.

Approximately one-quarter of the medical videos were considered useful, whereas only 5.3% of the nonmedical videos were considered useful. Almost all of the nonmedical videos were considered not useful, whereas 34.4% of the medical videos were considered not useful. The medical videos that were categorized as not useful scored low on the ECV RCOG–specific score and average on the mDISCERN. Moreover, over 75% of medical videos were uploaded by educational channels and health care professionals. The majority of nonmedical videos were uploaded by childbirth attendants and vloggers. Two-thirds of the medical videos were found with the search term “external cephalic version,” whereas most of the nonmedical videos were found with the search terms “turning a breech baby” and “ECV.”

e Usefulness score: total ECV RCOG score+total mDISCERN score–misinformation; the score has a maximum of 30 points and videos are accordingly classified as not useful (<9 points), slightly useful (9-13 points), and useful (>13 points).

Framing of the Videos

Lastly, we evaluated whether videos uploaded by vloggers were encouraging or discouraging of ECV. As shown in Table 5 , ECV was not mentioned in 4 videos in favor of other methods to attempt to turn the baby from a breech to cephalic position. Almost all vloggers (12/15, 80%) encouraged ECV to their followers. Videos encouraging ECV had higher audience engagement compared to videos discouraging ECV, with a particularly large difference in the VPI (313.0 vs 17.2). The like ratio did not differ between the groups (mean 92.6 vs 93.6, P =.47). Three-quarters of the encouraging videos were uploaded by vloggers who experienced a successful ECV.

a View ratio: number of views/days on platform.

b Like ratio: (likes×100)/(likes+dislikes).

c VPI: video power index; (like ratio×view ratio)/100.

Principal Results

In this study, according to the accuracy of medical information and content quality, only a minority of videos related to ECV on YouTube were found to be useful. Strikingly, the group with the highest audience engagement scored the lowest on usefulness and the groups with lower audience engagement had higher usefulness scores. The presence of misinformation was low. Importantly, vloggers, the group with the highest audience engagement and the lowest usefulness score, largely encouraged their audience to opt for ECV.

Comparison With Prior Work

In general, our findings are consistent with previous research evaluating the quality of health-related subjects on YouTube [ 16 , 20 , 27 , 28 ]. In a study performed by Lee et al [ 27 ] in 2014 evaluating YouTube videos on cholecystolithiasis, 56.5% of the videos were classified as misleading and only 13.8% were classified as useful or very useful. Similarly, we found that very useful videos about ECV had a significantly lower mean view average than that of the misleading videos. In a study on content analysis of infertility-related videos on YouTube performed in 2018, Kelly-Hendrick et al [ 29 ] found that videos delivered from a personal point of view had significantly more likes than informational-educational videos. These findings suggest that people who are looking for videos on health-related subjects appear to rely more on personal experiences and information from their peers. This results in overexposure to scientifically inaccurate videos, although these are not necessarily misleading and may even encourage pregnant people to opt for ECV.

Among the search terms, medical videos with accurate information were largely identified when using medical terms, whereas nonmedical videos were identified with nonmedical terminology in the YouTube search.

As a result of an aging YouTube collection along with continuously developing ECV guidelines, medical videos on YouTube also contain misinformation. For example, medical videos contained misinformation on risks by stating that a previous cesarean section is a contraindication for ECV, whereas the RCOG guideline states that ECV is safe and successful in women with one previous cesarean section [ 5 ]. YouTube does not filter these outdated videos, underpinning that responsible information providers should also have a plan for updating or removing outdated videos.

In the evaluated videos, alternatives for ECV to encourage spontaneous fetal version were often mentioned. The childbirth attendants advised yoga postures, warm and cold compresses, and acupuncture in combination with misbutton and chiropractic treatment to support a baby in turning to be in a cephalic position. This is in contradiction with the RCOG guideline statement that there is no evidence that postural management alone promotes spontaneous version to a cephalic presentation [ 5 ]. People who refuse ECV might be interested in alternative methods for spontaneous version. Therefore, future research should focus on the association between spontaneous version aided by chiropractors and postural management in combination with moxibustion and acupuncture.

The importance of appropriate and encouraging information about ECV for breech presentation is evident, since ECV is of great significance to reduce the CD rate [ 30 ]. In 2014, Vlemmix et al [ 9 ] found that less than half of pregnant people with a breech baby at term had an ECV in the Netherlands, 20%-30% of pregnant people refused an ECV, and it was estimated that approximately 4%-33% of patients were not given the option of having an ECV by their health care providers. YouTube can be valuable as a source of information for this young generation that is adept at using digital technology for communication and information gathering.

Strengths and Limitations

This study has several strengths and limitations. First, we used the validated mDISCERN score and the customized ECV RCOG–specific score based on the RCOG guideline. However, it must be acknowledged that the partly self-developed usefulness score remains somewhat subjective due to the absence of validated tools for evaluating social media content. Although high agreement was achieved between the two video reviewers, this limitation underscores the pressing need for a standardized scoring instrument in modern research. The increasing prevalence of video content across various fields demands a reliable method of assessing video quality and content. Without a standardized and validated scoring instrument, the evaluation is prone to subjectiveness, inconsistency, and lack of scientific accuracy. Establishing and validating this instrument is essential for contemporary research to conduct meaningful studies, make informed decisions, and enhance the medical accuracy of video content. Such studies can help pave the way for more precise assessments and comparisons.

Second, the RCOG guideline was used as the up-to-date and high-quality standard, although this is not necessarily the standard in all contexts.

Third, the methods of the search may have been selective. We only used five search terms, only the first 35 results were retained, and the search was conducted in “Incognito” mode. Because a YouTube search is dynamic and dependent on algorithms, the findings may be variable based on new uploaded videos and personal algorithms.

Finally, we only searched YouTube and omitted other social media platforms that play a role as a source of information for patients with unregulated content. However, YouTube is most likely to be the platform that patients use in the search of health information, as it is the largest video-sharing website with the highest number of videos without time limits and has a user-friendly search function that does not require an account to watch videos.

Implications and Directions for Future Research

While our study has shed light on the medical accuracy of YouTube videos about ECV, it is important to acknowledge that we did not explicitly address the potential impact of various video characteristics, including video length, characteristics of the audience, the uploader’s username, or word-of-mouth recommendations, on the usefulness scores of the videos. These factors are of great importance in understanding the dynamics of online health content consumption. For example, video length could affect viewers’ engagement and retention of information, while the uploader’s name or reputation can influence viewers’ trust in the content. YouTube adds a view when a video is watched for over 30 seconds; however, YouTube does not disclose the actual watched duration. Furthermore, individual user data are anonymized and demographic information of the viewer is only available for the uploader. Future research should explore these additional factors comprehensively, as they have the potential to significantly influence viewers’ interactions with health-related videos, ultimately impacting their overall usefulness and the quality of health information accessible on the platform.

This study highlights the compelling need for health care professionals to collaborate with social media influencers to create medically accurate videos with a broad reach and high viewership. In an era where online content holds substantial sway, leveraging the reach and engagement of influencers can significantly enhance the dissemination of credible health information and promote public awareness. Partnerships between hospitals and vloggers can bridge the gap between traditional health care communication channels and the rapidly evolving digital landscape, thereby improving health literacy and encouraging informed decision-making among the public. Balancing content popularity with medical accuracy will be a paramount challenge, requiring careful oversight to ensure that influencers and health care professionals collaboratively contribute to a well-informed and healthier society.

Conclusions

Despite the fact that only few YouTube videos on ECV were considered to be useful, the level of misinformation on ECV in the videos was low. The mismatch between audience engagement and information accuracy was striking, although the vlogs with the highest engagement were appropriately encouraging their audience to opt for an ECV. The findings from this study provide the insight that informational videos should contain valid information along with encouraging stories from the patient perspective using nonmedical terminology to have a maximum impact. This can likely best be achieved by collaboration between medical and community stakeholders. This would generate more awareness about ECV, support pregnant people with a baby in breech presentation, and lower the chance for a high-risk delivery because of term breech presentation.

Data Availability

The data sets generated and analyzed during this study are available from the corresponding author on reasonable request.

Authors' Contributions

MRvD performed the data collection, built and corrected the data set, performed statistical analyses, contributed to the acquisition and interpretation of the data, and initially drafted the manuscript. AFvdM performed the data collection, built and corrected the data set, and performed the statistical analyses. LEvRF designed the study and critically revised the manuscript. WG, EM, and FS critically revised the manuscript. JV designed the study, contributed to the acquisition and interpretation of the data, performed statistical analyses, and critically revised the manuscript.

Conflicts of Interest

None declared.

Flowchart of the selection of included YouTube videos. ECV: external cephalic version.

Baseline characteristics of included videos.

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Abbreviations

Edited by A Mavragani; submitted 19.06.23; peer-reviewed by R Sun, Y Zhang, D Chao; comments to author 25.10.23; revised version received 14.11.23; accepted 25.04.24; published 06.06.24.

©Merle R van Dijk, Anne-Fleur van der Marel, Leonie E van Rheenen-Flach, Wessel Ganzevoort, Etelka Moll, Fedde Scheele, Joost Velzel. Originally published in JMIR Formative Research (https://formative.jmir.org), 06.06.2024.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Formative Research, is properly cited. The complete bibliographic information, a link to the original publication on https://formative.jmir.org, as well as this copyright and license information must be included.

Video analysis project

We are gathering breech birth videos for a research project, looking at the events that happen during explusion (from rumping until the birth of the head). 

We will be analyizing the following: 

• the timing of vaginal breech births, specifically how long each body part takes (legs, arms, and head)
• cardinal movements of the breech baby as it navigates the maternal pelvis
• the use and timing of maneuvers 

I would like to submit a video. What do I do?  

Step #1: Background information

Give us some background information on this birth by filling out this brief survey (all responses are confidential). Please write "unknown" if you do not have all of the information. 

Step #2: Send the video 

Submit your video via wetransfer.com or transfernow.net (free file-sharing services) to [email protected]. This will allow you to share large files without losing quality or resolution. 

Step #3: Permission form (optional but recommended)

By submitting the video, you agree that you have permission to share the video for private BWB analysis. If the parents would like their video shared for either private educational purposes or for public educational uses, please complete the form below. You can either download and complete the PDF below and email to [email protected], or you can submit the release form online.

Online permission form

I, ___________________________, grant permission to Breech Without Borders the rights of my image, in video or still, and of the likeness and sound of my voice as recorded on audio or video tape without payment or any other consideration. I understand that my image may be edited, copied, exhibited, published or distributed and waive the right to inspect or approve the finished product wherein my likeness appears.

I will be consulted about the use of the photographs or video recording for any purpose other than those listed below:

Press Release Details

Nvidia nim revolutionizes model deployment, now available to transform world’s millions of developers into generative ai developers.

• 150+ Partners Across Every Layer of AI Ecosystem Embedding NIM Inference Microservices to Speed Enterprise AI Application Deployments From Weeks to Minutes
• NVIDIA Developer Program Members Gain Free Access to NIM for Research, Development and Testing

TAIPEI, Taiwan, June 02, 2024 (GLOBE NEWSWIRE) -- COMPUTEX -- NVIDIA today announced that the world’s 28 million developers can now download NVIDIA NIM ™ — inference microservices that provide models as optimized containers — to deploy on clouds, data centers or workstations, giving them the ability to easily build generative AI applications for copilots, chatbots and more, in minutes rather than weeks.

These new generative AI applications are becoming increasingly complex and often utilize multiple models with different capabilities for generating text, images, video, speech and more. NVIDIA NIM dramatically increases developer productivity by providing a simple, standardized way to add generative AI to their applications.

NIM also enables enterprises to maximize their infrastructure investments. For example, running Meta Llama 3-8B in a NIM produces up to 3x more generative AI tokens on accelerated infrastructure than without NIM. This lets enterprises boost efficiency and use the same amount of compute infrastructure to generate more responses.

Nearly 200 technology partners — including Cadence, Cloudera , Cohesity , DataStax , NetApp , Scale AI and Synopsys — are integrating NIM into their platforms to speed generative AI deployments for domain-specific applications, such as copilots, code assistants and digital human avatars. Hugging Face is now offering NIM — starting with Meta Llama 3 .

“Every enterprise is looking to add generative AI to its operations, but not every enterprise has a dedicated team of AI researchers,” said Jensen Huang, founder and CEO of NVIDIA. “Integrated into platforms everywhere, accessible to developers everywhere, running everywhere — NVIDIA NIM is helping the technology industry put generative AI in reach for every organization.”

Enterprises can deploy AI applications in production with NIM through the NVIDIA AI Enterprise software platform. Starting next month, members of the NVIDIA Developer Program can access NIM for free for research, development and testing on their preferred infrastructure.

40+ NIM Microservices Power Gen AI Models Across Modalities NIM containers are pre-built to speed model deployment for GPU-accelerated inference and can include NVIDIA CUDA ® software, NVIDIA Triton Inference Server ™ and NVIDIA TensorRT™-LLM software.

Over 40 NVIDIA and community models are available to experience as NIM endpoints on ai.nvidia.com , including Databricks DBRX , Google’s open model Gemma, Meta Llama 3, Microsoft Phi-3, Mistral Large, Mixtral 8x22B and Snowflake Arctic.

Developers can now access NVIDIA NIM microservices for Meta Llama 3 models from the Hugging Face AI platform. This lets developers easily access and run the Llama 3 NIM in just a few clicks using Hugging Face Inference Endpoints, powered by NVIDIA GPUs on their preferred cloud.

Enterprises can use NIM to run applications for generating text, images and video, speech and digital humans. With NVIDIA BioNeMo ™ NIM microservices for digital biology, researchers can build novel protein structures to accelerate drug discovery.

Dozens of healthcare companies are deploying NIM to power generative AI inference across a range of applications, including surgical planning, digital assistants, drug discovery and clinical trial optimization.

With new NVIDIA ACE NIM microservices , developers can easily build and operate interactive, lifelike digital humans in applications for customer service, telehealth, education, gaming and entertainment.

Hundreds of AI Ecosyst em Partners Embedding NIM Platform providers including Canonical , Red Hat , Nutanix and VMware (acquired by Broadcom) are supporting NIM on open-source KServe or enterprise solutions. AI application companies Hippocratic AI , Glean , Kinetica and Redis are also deploying NIM to power generative AI inference.

Leading AI tools and MLOps partners — including Amazon SageMaker, Microsoft Azure AI, Dataiku, DataRobot, deepset , Domino Data Lab, LangChain , Llama Index , Replicate , Run.ai, Saturn Cloud , Securiti AI and Weights & Biases — have also embedded NIM into their platforms to enable developers to build and deploy domain-specific generative AI applications with optimized inference.

Global system integrators and service delivery partners Accenture, Deloitte, Infosys, Latentview , Quantiphi , SoftServe, TCS and Wipro have created NIM competencies to help the world’s enterprises quickly develop and deploy production AI strategies.

Enterprises can run NIM-enabled applications virtually anywhere, including on NVIDIA-Certified Systems ™ from global infrastructure manufacturers Cisco, Dell Technologies , Hewlett-Packard Enterprise , Lenovo and Supermicro, as well as server manufacturers ASRock Rack , ASUS , GIGABYTE , Ingrasys , Inventec , Pegatron , QCT, Wistron and Wiwynn. NIM microservices have also been integrated into Amazon Web Services , Google Cloud , Azure and Oracle Cloud Infrastructure .

Titans of Industry Amp Up Gener ative AI With NIM Industry leaders Foxconn, Pegatron, Amdocs , Lowe’s, ServiceNow and Siemens are among the businesses using NIM for generative AI applications in manufacturing, healthcare, financial services, retail, customer service and more:

• Foxconn — the world’s largest electronics manufacturer — is using NIM in the development of domain-specific LLMs embedded into a variety of internal systems and processes in its AI factories for smart manufacturing, smart cities and smart electric vehicles.
• Pegatron — a Taiwanese electronics manufacturing company — is leveraging NIM for Project TaME, a Taiwan Mixtral of Experts model designed to advance the development of local LLMs for industries.
• Amdocs — a leading global provider of software and services to communications and media companies — is using NIM to run a customer billing LLM that significantly lowers the cost of tokens, improves accuracy by up to 30% and reduces latency by 80%, driving near real-time responses.
• Lowe’s — a FORTUNE ® 50 home improvement company — is using generative AI for a variety of use cases. For example, the retailer is leveraging NVIDIA NIM inference microservices to elevate experiences for associates and customers.
• ServiceNow — the AI platform for business transformation — announced earlier this year that it was one of the first platform providers to access NIM to enable fast, scalable and more cost-effective LLM development and deployment for its customers. NIM microservices are integrated within the Now AI multimodal model and are available to customers that have ServiceNow’s generative AI experience, Now Assist, installed.
• Siemens — a global technology company focused on industry, infrastructure, transport and healthcare — is integrating its operational technology with NIM microservices for shop floor AI workloads. It is also building an on-premises version of its Industrial Copilot for Machine Operators using NIM.

Availability Developers can experiment with NVIDIA microservices at ai.nvidia.com at no charge. Enterprises can deploy production-grade NIM microservices with NVIDIA AI Enterprise running on NVIDIA-Certified Systems and leading cloud platforms. Starting next month, members of the NVIDIA Developer Program will gain free access to NIM for research and testing.

Watch Huang’s COMPUTEX keynote to learn more about NVIDIA NIM.

About NVIDIA NVIDIA (NASDAQ: NVDA) is the world leader in accelerated computing.

For further information, contact: Anna Kiachian NVIDIA Corporation +1-650-224-9820 [email protected]

Certain statements in this press release including, but not limited to, statements as to: the benefits, impact, performance, features, and availability of NVIDIA’s products and technologies, including NVIDIA NIM, NVIDIA CUDA, NVIDIA Triton Inference Server, NVIDIA TensorRT-LLM software, NVIDIA Developer program, NVIDIA BioNeMo, NVIDIA-Certified Systems, and NVIDIA AI Enterprise; our collaborations and partnerships with third parties and the benefits and impacts thereof; third parties using or adopting our products or technologies; every enterprise looking to add generative AI to its operations; and NVIDIA NIM helping the technology industry put generative AI in reach for every organization are forward-looking statements that are subject to risks and uncertainties that could cause results to be materially different than expectations. Important factors that could cause actual results to differ materially include: global economic conditions; our reliance on third parties to manufacture, assemble, package and test our products; the impact of technological development and competition; development of new products and technologies or enhancements to our existing product and technologies; market acceptance of our products or our partners' products; design, manufacturing or software defects; changes in consumer preferences or demands; changes in industry standards and interfaces; unexpected loss of performance of our products or technologies when integrated into systems; as well as other factors detailed from time to time in the most recent reports NVIDIA files with the Securities and Exchange Commission, or SEC, including, but not limited to, its annual report on Form 10-K and quarterly reports on Form 10-Q. Copies of reports filed with the SEC are posted on the company's website and are available from NVIDIA without charge. These forward-looking statements are not guarantees of future performance and speak only as of the date hereof, and, except as required by law, NVIDIA disclaims any obligation to update these forward-looking statements to reflect future events or circumstances.

© 2024 NVIDIA Corporation. All rights reserved. NVIDIA, the NVIDIA logo, BioNeMo, CUDA, NVIDIA NIM, NVIDIA Triton Inference Server and TensorRT are trademarks and/or registered trademarks of NVIDIA Corporation in the U.S. and other countries. Other company and product names may be trademarks of the respective companies with which they are associated. Features, pricing, availability and specifications are subject to change without notice.

A photo accompanying this announcement is available at: https://www.globenewswire.com/NewsRoom/AttachmentNg/4fe99b19-66e7-4473-b9ff-f1380eae0ff8

NVIDIA NIM revolutionizes model deployment for every layer of the AI ecosystem.

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