In most cases, the caregiver will suspect the baby might be in a breech position by palpating the pregnant woman's belly during a routine pregnancy visit. If you are more than 34 weeks pregnant and your caregiver feels that your baby is breech, they will probably order an ultrasound to confirm this is actually the case.
It is sometimes difficult to distinguish a hard round bottom from a hard round head when feeling your baby. In most cases, one end of the baby feels harder and rounder than the other. If the baby's head (or bottom) is deeply engaged in the woman's pelvis, this can make detecting a breech position more difficult.
Even the most experienced caregivers can miss a breech. There is even a saying that "You haven't been looking after pregnant women long enough until you've missed a breech". It is also easy to suspect a breech, but find out with an ultrasound that the baby is actually head down. The rule generally is "If in doubt have an ultrasound".
Some women can tell that their baby is breech because of the large round hard bulge under their ribs. Many will comment on how severe their heartburn is, and how it improves when their baby moves head down.
Caregivers missing a breech baby is more common when the baby is in the
frank breech position, because the baby has their feet sitting either side of their head, making their head and feet feel softer and irregular in shape, more like a bottom. Their bottom can then be mistaken for a deeply engaged head because it cannot be fully felt. In this case, the breech baby may not be discovered until the woman is in labour and an internal vaginal examination is done. The cervix needs to be well open (usually 4 cms or more, to feel the baby adequately), and the caregiver feels the baby's bottom and genitals, instead of their head. The caregiver may suggest a caesarean operation, or discuss continuing the labour for a vaginal birth.