Nursing care
Breech Presentation nursing care: what to assess and what to do first
Written and reviewed by Dana Whitfield, RN, MSN · 5 min read · Updated September 2026
Short answer
Breech presentation means the fetal buttocks or feet present first instead of the head, and it is confirmed by Leopold's manoeuvres and ultrasound. External cephalic version is attempted between 36 and 37 weeks with continuous fetal heart monitoring throughout the procedure. A footling breech is delivered by Caesarean because of the high risk of cord prolapse.
The clinical picture
Breech presentation occurs in roughly 3 to 4% of term pregnancies, and is more common earlier in pregnancy since most fetuses turn to vertex spontaneously by term. Frank breech, where the hips are flexed and the legs extend up toward the face, is the most common type. Complete breech has both hips and knees flexed, resembling a cross-legged seated position.
Footling breech, where one or both feet present below the buttocks, carries a distinct risk profile because a foot or leg can slip through a partially dilated cervix before the presenting part fills the pelvis, leaving room for the umbilical cord to prolapse alongside or ahead of it. Risk factors for any breech type include prematurity, multiple gestation, polyhydramnios or oligohydramnios, uterine anomalies, and placenta praevia.
Assessment: what to look for and in what order
Start with Leopold's manoeuvres: palpate the fundus for a firm, round head versus a softer, less defined breech, then palpate the lower uterine segment to identify what occupies the pelvic inlet. A firm, ballotable mass in the fundus with a softer mass in the pelvis suggests breech rather than vertex presentation.
Confirm any suspected breech with ultrasound, which also identifies the specific type, since frank, complete and footling breech carry different management. Assess fetal heart rate and pattern, and once membranes rupture, assess immediately for cord prolapse by checking for a palpable cord at the introitus or a sudden, sustained fetal heart rate deceleration, since footling breech in particular puts this at the top of the assessment list the moment the membranes go.
Immediate interventions
For a stable breech identified before 37 weeks with no contraindication, external cephalic version is offered between 36 and 37 weeks, timed to allow the fetus to remain vertex once turned while still leaving room to plan delivery. The procedure uses external pressure on the maternal abdomen to manually rotate the fetus, and continuous fetal heart monitoring runs before, during and after the attempt to catch cord compression or fetal distress immediately.
If cord prolapse is identified, position the patient in knee-chest or Trendelenburg to relieve pressure on the cord, apply manual upward pressure on the presenting part through a gloved hand in the vagina to keep it off the cord, administer oxygen, and call for immediate emergency Caesarean, since this is delivered surgically without delay. Footling breech is managed as a Caesarean delivery specifically because of this elevated cord prolapse risk, not attempted vaginally even when labour is already established.
Ongoing nursing management
After a successful external cephalic version, continue fetal monitoring for a period afterward to confirm the fetal heart pattern remains reassuring, and document the version clearly since presentation can revert to breech in a minority of cases before labour begins.
For a patient proceeding to planned Caesarean for breech presentation, provide standard preoperative teaching and monitoring, and continue fetal surveillance up to the time of surgery. For a patient labouring with a frank or complete breech under a provider experienced in vaginal breech delivery, maintain continuous fetal monitoring throughout, since progress of descent and fetal heart pattern both guide whether vaginal delivery continues to be appropriate.
Patient and family education
Explain what breech presentation means in plain terms, and that most babies who are breech before 36 weeks still turn head-down on their own. If version is being planned, explain the procedure honestly: some discomfort during the manual pressure, continuous monitoring throughout, and that it does not always succeed on the first attempt.
For a patient learning her baby is footling breech, explain clearly why this specific position leads to a recommendation for Caesarean rather than a trial of labour, focused on the risk of the umbilical cord slipping down ahead of the baby and losing its blood and oxygen supply. Reassure her that this is a well-established, planned surgical delivery rather than an emergency response to a complication that has already occurred, provided it is identified and managed before labour is established.
How this appears on the NCLEX
Expect a stem describing Leopold's findings or an ultrasound result confirming breech and asking for the next appropriate step, where the answer at 36 to 37 weeks is typically external cephalic version with fetal monitoring, provided no contraindication is stated in the stem.
A second common pattern gives a footling breech diagnosis and asks the nurse to anticipate the delivery plan; the correct answer is Caesarean delivery, and the correct rationale is cord prolapse risk, not simply that breech deliveries are difficult. A third pattern presents ruptured membranes in a breech patient with a cord visible or palpable at the introitus; this is testing recognition of cord prolapse and the immediate response of relieving pressure on the cord and calling for emergency delivery.
The next step on this is the same as on everything else here: answer questions and read the rationales. Our maternity and newborn practice questions are the closest set to what this page covers.
Common questions
At what gestational age is external cephalic version usually attempted?
It is typically attempted between 36 and 37 weeks. This window allows enough time for planned delivery if the version succeeds, while giving the fetus less time to turn back to breech before labour.
Why is footling breech delivered by Caesarean instead of trying labour?
A footling presentation leaves space around the presenting part in the pelvis, which allows the umbilical cord to prolapse alongside or ahead of the foot once the membranes rupture. Caesarean delivery avoids this specific risk of cord compression and fetal hypoxia.
What monitoring is required during external cephalic version?
Continuous fetal heart rate monitoring is required before, during and after the procedure. This catches cord compression or fetal distress immediately so the attempt can be stopped and managed without delay.
What is the first nursing action if the umbilical cord is visible at the vaginal opening after membranes rupture?
Position the patient in knee-chest or Trendelenburg position and apply manual pressure to lift the presenting part off the cord, then call immediately for emergency Caesarean. Administering oxygen and continuing to monitor the fetal heart rate follow alongside these actions.