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

Variations in Fetal Position and Presentation |

During pregnancy, the fetus can be positioned in many different ways inside the mother's uterus. The fetus may be head up or down or facing the mother's back or front. At first, the fetus can move around easily or shift position as the mother moves. Toward the end of the pregnancy the fetus is larger, has less room to move, and stays in one position. How the fetus is positioned has an important effect on delivery and, for certain positions, a cesarean delivery is necessary. There are medical terms that describe precisely how the fetus is positioned, and identifying the fetal position helps doctors to anticipate potential difficulties during labor and delivery.

Presentation refers to the part of the fetus’s body that leads the way out through the birth canal (called the presenting part). Usually, the head leads the way, but sometimes the buttocks (breech presentation), shoulder, or face leads the way.

Position refers to whether the fetus is facing backward (occiput anterior) or forward (occiput posterior). The occiput is a bone at the back of the baby's head. Therefore, facing backward is called occiput anterior (facing the mother’s back and facing down when the mother lies on her back). Facing forward is called occiput posterior (facing toward the mother's pubic bone and facing up when the mother lies on her back).

Lie refers to the angle of the fetus in relation to the mother and the uterus. Up-and-down (with the baby's spine parallel to mother's spine, called longitudinal) is normal, but sometimes the lie is sideways (transverse) or at an angle (oblique).

For these aspects of fetal positioning, the combination that is the most common, safest, and easiest for the mother to deliver is the following:

Head first (called vertex or cephalic presentation)

Facing backward (occiput anterior position)

Spine parallel to mother's spine (longitudinal lie)

Neck bent forward with chin tucked

Arms folded across the chest

If the fetus is in a different position, lie, or presentation, labor may be more difficult, and a normal vaginal delivery may not be possible.

Variations in fetal presentation, position, or lie may occur when

The fetus is too large for the mother's pelvis (fetopelvic disproportion).

The uterus is abnormally shaped or contains growths such as fibroids .

The fetus has a birth defect .

There is more than one fetus (multiple gestation).

Position and Presentation of the Fetus

Toward the end of pregnancy, the fetus moves into position for delivery. Normally, the presentation is vertex (head first), and the position is occiput anterior (facing toward the pregnant person's spine) and with the face and body angled to one side and the neck flexed.

Variations in fetal presentations include face, brow, breech, and shoulder. Occiput posterior position (facing forward, toward the mother's pubic bone) is less common than occiput anterior position (facing backward, toward the mother's spine).

Variations in Fetal Position and Presentation

Some variations in position and presentation that make delivery difficult occur frequently.

Occiput posterior position

In occiput posterior position (sometimes called sunny-side up), the fetus is head first (vertex presentation) but is facing forward (toward the mother's pubic bone—that is, facing up when the mother lies on her back). This is a very common position that is not abnormal, but it makes delivery more difficult than when the fetus is in the occiput anterior position (facing toward the mother's spine—that is facing down when the mother lies on her back).

When a fetus faces up, the neck is often straightened rather than bent,which requires more room for the head to pass through the birth canal. Delivery assisted by a vacuum device or forceps or cesarean delivery may be necessary.

Breech presentation

In breech presentation, the baby's buttocks or sometimes the feet are positioned to deliver first (before the head).

When delivered vaginally, babies that present buttocks first are more at risk of injury or even death than those that present head first.

The reason for the risks to babies in breech presentation is that the baby's hips and buttocks are not as wide as the head. Therefore, when the hips and buttocks pass through the cervix first, the passageway may not be wide enough for the head to pass through. In addition, when the head follows the buttocks, the neck may be bent slightly backwards. The neck being bent backward increases the width required for delivery as compared to when the head is angled forward with the chin tucked, which is the position that is easiest for delivery. Thus, the baby’s body may be delivered and then the head may get caught and not be able to pass through the birth canal. When the baby’s head is caught, this puts pressure on the umbilical cord in the birth canal, so that very little oxygen can reach the baby. Brain damage due to lack of oxygen is more common among breech babies than among those presenting head first.

In a first delivery, these problems may occur more frequently because a woman’s tissues have not been stretched by previous deliveries. Because of risk of injury or even death to the baby, cesarean delivery is preferred when the fetus is in breech presentation, unless the doctor is very experienced with and skilled at delivering breech babies or there is not an adequate facility or equipment to safely perform a cesarean delivery.

Breech presentation is more likely to occur in the following circumstances:

Labor starts too soon (preterm labor).

The uterus is abnormally shaped or contains abnormal growths such as fibroids .

Breech, posterior, transverse lie: What position is my baby in?

Fetal presentation, or how your baby is situated in your womb at birth, is determined by the body part that's positioned to come out first, and it can affect the way you deliver. At the time of delivery, 97 percent of babies are head-down (cephalic presentation). But there are several other possibilities, including feet or bottom first (breech) as well as sideways (transverse lie) and diagonal (oblique lie).

Fetal presentation and position

During the last trimester of your pregnancy, your provider will check your baby's presentation by feeling your belly to locate the head, bottom, and back. If it's unclear, your provider may do an ultrasound or an internal exam to feel what part of the baby is in your pelvis.

Fetal position refers to whether the baby is facing your spine (anterior position) or facing your belly (posterior position). Fetal position can change often: Your baby may be face up at the beginning of labor and face down at delivery.

Here are the many possibilities for fetal presentation and position in the womb.

Medical illustrations by Jonathan Dimes

Head down, facing down (anterior position)

A baby who is head down and facing your spine is in the anterior position. This is the most common fetal presentation and the easiest position for a vaginal delivery.

This position is also known as "occiput anterior" because the back of your baby's skull (occipital bone) is in the front (anterior) of your pelvis.

Head down, facing up (posterior position)

In the posterior position , your baby is head down and facing your belly. You may also hear it called "sunny-side up" because babies who stay in this position are born facing up. But many babies who are facing up during labor rotate to the easier face down (anterior) position before birth.

Posterior position is formally known as "occiput posterior" because the back of your baby's skull (occipital bone) is in the back (posterior) of your pelvis.

Frank breech

In the frank breech presentation, both the baby's legs are extended so that the feet are up near the face. This is the most common type of breech presentation. Breech babies are difficult to deliver vaginally, so most arrive by c-section .

Some providers will attempt to turn your baby manually to the head down position by applying pressure to your belly. This is called an external cephalic version , and it has a 58 percent success rate for turning breech babies. For more information, see our article on breech birth .

Complete breech

A complete breech is when your baby is bottom down with hips and knees bent in a tuck or cross-legged position. If your baby is in a complete breech, you may feel kicking in your lower abdomen.

Incomplete breech

In an incomplete breech, one of the baby's knees is bent so that the foot is tucked next to the bottom with the other leg extended, positioning that foot closer to the face.

Single footling breech

In the single footling breech presentation, one of the baby's feet is pointed toward your cervix.

Double footling breech

In the double footling breech presentation, both of the baby's feet are pointed toward your cervix.

Transverse lie

In a transverse lie, the baby is lying horizontally in your uterus and may be facing up toward your head or down toward your feet. Babies settle this way less than 1 percent of the time, but it happens more commonly if you're carrying multiples or deliver before your due date.

If your baby stays in a transverse lie until the end of your pregnancy, it can be dangerous for delivery. Your provider will likely schedule a c-section or attempt an external cephalic version , which is highly successful for turning babies in this position.

Oblique lie

In rare cases, your baby may lie diagonally in your uterus, with his rump facing the side of your body at an angle.

Like the transverse lie, this position is more common earlier in pregnancy, and it's likely your provider will intervene if your baby is still in the oblique lie at the end of your third trimester.

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BabyCenter's editorial team is committed to providing the most helpful and trustworthy pregnancy and parenting information in the world. When creating and updating content, we rely on credible sources: respected health organizations, professional groups of doctors and other experts, and published studies in peer-reviewed journals. We believe you should always know the source of the information you're seeing. Learn more about our editorial and medical review policies .

Ahmad A et al. 2014. Association of fetal position at onset of labor and mode of delivery: A prospective cohort study. Ultrasound in obstetrics & gynecology 43(2):176-182. https://www.ncbi.nlm.nih.gov/pubmed/23929533 Opens a new window [Accessed September 2021]

Gray CJ and Shanahan MM. 2019. Breech presentation. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK448063/ Opens a new window [Accessed September 2021]

Hankins GD. 1990. Transverse lie. American Journal of Perinatology 7(1):66-70. https://www.ncbi.nlm.nih.gov/pubmed/2131781 Opens a new window [Accessed September 2021]

Medline Plus. 2020. Your baby in the birth canal. U.S. National Library of Medicine. https://medlineplus.gov/ency/article/002060.htm Opens a new window [Accessed September 2021]

Where to go next

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 vertex 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

Toward the end of pregnancy, the fetus moves into position for delivery. Normally, the presentation is vertex (head first), and the position is occiput anterior (facing toward the pregnant patient's spine) with the face and body angled to one side and the neck flexed.

Abnormal presentations include face, brow, breech, and shoulder. Occiput posterior position (facing toward the pregnant patient's pubic bone) is less common than occiput anterior position.

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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Presentation and position of baby through pregnancy and at birth

9-minute read

If you are concerned about your baby’s movements, contact your doctor or midwife for advice immediately.

If you baby is in a breech presentation, your doctor may recommend trying a technique called an external cephalic version to try and move your baby while they are still in the uterus for an easier birth.

What does presentation and position mean?

Presentation refers to the part of your baby’s body that is facing downwards in the direction of the birth canal.

Position refers to where your baby’s occiput (the bottom part of the back of their head) is in relation to your body.

If your baby is in a breech presentation , then position refers to where your baby’s sacrum (lower back) is in relation to your body.

People — including medical professionals — sometimes use these terms incorrectly. Sometimes when speaking about babies in breech presentation, the word ‘position’ will be used to refer to their presentation. For example, you may read information or hear people say ‘breech position’ instead of ‘breech presentation’.

What are the different types of presentation my baby could be in during pregnancy and birth?

Most babies present headfirst, also known as cephalic presentation. Most babies that are headfirst will be vertex presentation. This means that the crown of their head sits at the opening of your birth canal.

In rare cases, your baby can be headfirst but in face or brow presentation, which may not be suitable for vaginal birth.

If your baby is in a breech presentation, their feet or bottom will be closest to your birth canal. The 3 most common types of breech presentation are:

frank or extended breech — where your baby’s legs are straight up in front of their body, with their feet up near their face
complete or flexed breech — where your baby is in a sitting position with their legs crossed in front of their body and their feet near their bottom
footling breech — where one or both of your baby’s feet are hanging below their bottom, so the foot or feet are coming first

What are the different positions my baby could be in during pregnancy and birth?

If your baby is headfirst, the 3 main types of presentation are:

anterior – when the back of your baby’s head is at the front of your belly
lateral – when the back of your baby’s head is facing your side
posterior – when the back of your baby’s head is towards your back

Anterior, lateral and posterior fetal presentations

How will I know what presentation and position my baby is in?

Your doctor or midwife can usually work out your baby’s presentation by feeling your abdomen. They may also double check it with a portable ultrasound. Your baby’s presentation is usually checked around 36 weeks .

Your doctor or midwife will also confirm your baby’s head position in labour by examining your belly and using an ultrasound , and they may also do a vaginal examination . During the vaginal examination they are feeling for certain ridges on your baby’s head called sutures and fontanelles that help them work out which way your baby is positioned.

What is the ideal presentation and position for baby to be in for a vaginal birth?

For a vaginal birth, your baby will ideally be headfirst with the back of their head at the front of your belly, also known as being in the anterior position. This position is best for labour and birth since it means that the smallest part of your baby’s head goes down the birth canal first.

Vertex presentation, showing the narrow part of the baby’s head.

When does a baby usually get in the ideal presentation and position for birth?

Your baby will usually be in a headfirst position by 37 weeks of pregnancy. Around 3 in every 100 babies will be in breech presentation after 37 weeks.

Your baby’s position can change with your contractions during labour as they move down the birth canal, so their exact position can change during labour.

What are my options if baby isn't in the ideal presentation or position for a vaginal birth?

If your baby is in a breech presentation, your doctor may recommend a technique called an external cephalic version (ECV) to try and move your baby while they are still in the uterus . An ECV involves your doctor using their hands to apply pressure on your belly and help turn your baby to a headfirst position. It has a 1 in 2 chance of success and is a safe option in most pregnancies.

There is no evidence to show that alternative therapies, such as exercises, acupuncture or chiropractic treatments, help your baby change from a breech presentation to headfirst.

If your baby remains breech, your doctor may discuss having a breech vaginal birth. Not all doctors and hospitals offer this option. They may also suggest you birth your baby with a planned caesarean section .

If your baby’s presentation is headfirst but the position of your baby’s head is not ideal for labour, it can lead to a longer labour, and potential complications . The position of your baby’s head will often change as your labour progresses. If it doesn’t, sometimes you can still give birth without assistance, or you may need your doctor to help turn your baby’s head or help your birth with a vacuum or forceps .

Any procedure or decision for a type of birth will only go ahead with your consent . You will be able to discuss all the options with your doctor, and based on your preferences for yourself and your baby’s safety, make a decision together .

Resources and support

The Royal Australian and New Zealand College of Obstetrics and Gynaecology has a factsheet about the options available to you if your baby is in a breech presentation at the end of your pregnancy .

Mercy Perinatal has information on external cephalic version (ECV) safety and benefits if your baby is in a breech presentation at the end of your pregnancy.

The Women’s Hospital has information about the different presentations and positions your baby could be in, and how it can affect your birthing experience.

Speak to a maternal child health nurse

Call Pregnancy, Birth and Baby to speak to a maternal child health nurse on 1800 882 436 or video call . Available 7am to midnight (AET), 7 days a week.

Learn more here about the development and quality assurance of healthdirect content .

Last reviewed: October 2023

External cephalic version (ecv), malpresentation, breech pregnancy, search our site for.

Foetal Version
Breech Presentation

Need more information?

Breech presentation and turning the baby

In preparation for a safe birth, your health team will need to turn your baby if it is in a bottom first ‘breech’ position.

Breech Presentation at the End of your Pregnancy

Breech presentation occurs when your baby is lying bottom first or feet first in the uterus (womb) rather than the usual head first position. In early pregnancy, a breech position is very common.

Read more on RANZCOG - Royal Australian and New Zealand College of Obstetricians and Gynaecologists website

External Cephalic Version for Breech Presentation - Pregnancy and the first five years

This information brochure provides information about an External Cephalic Version (ECV) for breech presentation

Labour complications

Even if you’re healthy and well prepared for childbirth, there’s always a chance of unexpected problems. Learn more about labour complications.

ECV is a procedure to try to move your baby from a breech position to a head-down position. This is performed by a trained doctor.

Having a baby

The articles in this section relate to having a baby – what to consider before becoming pregnant, pregnancy and birth, and after your baby is born.

Anatomy of pregnancy and birth - pelvis

Your pelvis helps to carry your growing baby and is tailored for vaginal births. Learn more about the structure and function of the female pelvis.

Planned or elective caesarean

There are important things to consider if you are having a planned or elective caesarean such as what happens during and after the procedure.

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13 Weeks Pregnant

Your baby at week 13, at a glance, 13 weeks pregnant is how many months, how big is my baby at 13 weeks, baby's intestines and vocal cords are developing, your body at week 13.

Feeling more like yourself?

Vaginal discharge , sex during pregnancy, having twins, pregnancy symptoms week 13, tips for you this week.

What to Expect When You're Expecting , 5th edition, Heidi Murkoff. WhatToExpect.com, How Much Iron Do You Need During Pregnancy? , June 2022. WhatToExpect.com, Do Twins Really Run in Families? , December 2021 Akron Children’s Hospital, Confessions of Prenatal Ultrasound Techs , February 2022. Oxford University Press, Lachman's Case Studies in Anatomy , February 2013. KidsHealth From Nemours, Week 12 , April 2022. Mayo Clinic, Fetal Development: The 1st Trimester , June 2022. National Institutes of Health, National Library of Medicine, The Fetal Larynx and Pharynx: Structure and Development on Two- and Three-Dimensional Ultrasound , August 2013. American College of Obstetricians and Gynecologists, Vulvovaginal Health , January 2022. American College of Obstetricians and Gynecologists, Multiple Pregnancy , January 2023. Cleveland Clinic, Acid Reflux & GERD , October 2023. KidsHealth From Nemours, How Can I Deal with Heartburn During Pregnancy? , August 2019. UpToDate, Placenta Previa: Management , October 2023. National Institutes of Health, National Library of Medicine, Sex in Pregnancy , April 2011. National Institutes of Health, Office of Dietary Supplements, Folate , November 2022. Centers for Disease Control and Prevention, Folic Acid , June 2022. Centers for Disease Control and Prevention, Show Me the Science – Why Wash Your Hands? , May 2023. National Institutes of Health, National Library of Medicine, Calcium in Diet , January 2023. National Institutes of Health, Office of Dietary Supplements, Iron , June 2023. Academy of Nutrition and Dietetics, Easy Ways to Boost Fiber in Your Daily Diet , March 2021. WhatToExpect.com, Vaginal Discharge During Pregnancy (Leukorrhea) , January 2022. WhatToExpect.com, Best Maternity Underwear, According to Moms-to-Be Who Tried Them , December 2021. WhatToExpect.com, Skin Changes During Pregnancy , November 2022. WhatToExpect.com, Urine Tests During Pregnancy , December 2022. WhatToExpect.com, How to Safely Eat at Restaurants During Pregnancy , June 2022. WhatToExpect.com, Sex Drive Changes During Pregnancy , July 2022. WhatToExpect.com, When to Tell People You're Pregnant , June 2021. WhatToExpect.com, How Many Weeks, Months and Trimesters in a Pregnancy? , May 2022. WhatToExpect.com, What Is the Placenta? What This Organ Does and How It Forms , July 2021. WhatToExpect.com, Pregnancy Symptoms: 14 Early Signs of Pregnancy , May 2023. WhatToExpect.com, Are There Signs You're Pregnant With Twins? , December 2021. WhatToExpect.com, Pregnancy Due Date Calculator and Conception Calculator , September 2023. WhatToExpect.com, What to Do About Bloating During Pregnancy , February 2021. WhatToExpect.com, Your Questions About Sex During Pregnancy, Answered , August 2021. WhatToExpect.com, Heartburn During Pregnancy , October 2022. WhatToExpect.com, Constipation During Pregnancy , October 2022. WhatToExpect.com, Veiny Breasts During Pregnancy , April 2021. WhatToExpect.com, Dizziness During Pregnancy , September 2022.

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The evolution of fetal presentation during pregnancy: a retrospective, descriptive cross-sectional study

Affiliations.

1 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland.
2 Teaching Department of Obstetrics and Gynecology in Ruda Slaska, Medical University of Silesia, Ruda Slaska, Poland.
PMID: 25753199
DOI: 10.1111/aogs.12626

We investigated changes in the frequencies of four primary types of singleton fetal lie/presentation for each gestational week from 18 to 39 weeks in a retrospective, cross-sectional study which analyzed ultrasound examination records of fetal positions, in the outpatient prenatal diagnosis clinics in two cities in Poland. We calculated the prevalence and 95% confidence intervals for each type of lie/presentation. We then identified the gestational age after which no statistically significant changes in terms of prevalence were observed, by comparing the results at each week with the prevalence of cephalic presentation at 39(+0) weeks, used as reference. A total of 18 019 ultrasound examinations were used. From 22 to 36 weeks of gestation, the prevalence of cephalic presentation increased from 47% (45-50%) to 94% (91-96%), before and after which times plateaus were noted. Spontaneous change from breech to cephalic is unlikely to occur after 36 weeks of gestation.

Keywords: Fetal lie; breech; cephalic; external version; fetal presentation.

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- Empowering Women's Health: Pregnancy & Baby

13 WEEKS PREGNANT AND BABY DEVELOPMENT

13 weeks pregnant belly.

Welcome to the second trimester of your pregnancy journey! At 13 weeks pregnant , you’ve officially entered the second trimester, and it’s an exciting time filled with significant changes. This week-by-week pregnancy guide will walk you through the developments your baby is going through and the symptoms you might be experiencing. Let’s go!

Your Baby at 13 Weeks:

At 13 weeks pregnant, your baby is making extraordinary strides in their development. Here’s a closer look at the remarkable changes happening inside the womb:

The Size of a Baby at 13 Weeks: At 13 weeks, your baby is approximately the size of a lemon. Their appearance is becoming more human-like, with distinct facial features, including a more prominent chin and nose.
Movements : Though you can’t feel it yet, your baby is quite active. They are constantly moving, kicking, and even hiccupping, although these movements are too subtle to be noticed by you at this stage.
Fingerprints : By 13 weeks, your baby’s fingers and toes have distinct fingerprints forming. This unique pattern will stay with them for life.
Organs and Systems : Your baby’s organs and systems are rapidly developing. The kidneys are functioning, and the liver is producing bile. The digestive system is taking shape, and the intestines are starting to move from the umbilical cord into the baby’s abdomen.
Skeleton : Your baby’s skeleton is evolving from soft cartilage to firmer bone. However, it will remain somewhat flexible to accommodate growth and movement.
Vocal Cords : Believe it or not, by 13 weeks, your baby already has vocal cords! They may even practice “talking” by making small sounds, but you won’t be able to hear them yet.
Sexual Differentiation : Determining a baby’s gender at 13 weeks of pregnancy can be challenging and often not very accurate since the genitalia may not have developed sufficiently for distinction on an ultrasound.
Lanugo and Vernix : Fine hair called lanugo covers your baby’s skin to keep them warm. Additionally, a waxy substance called vernix is forming to protect their delicate skin from the amniotic fluid.
Sucking Reflex : Your baby’s sucking reflex is developing, which is essential for breastfeeding. They may suck their thumb or fingers in the womb as they practice this instinctual motion.
Placenta : The placenta, your baby’s life support system, is fully functioning by 13 weeks. It’s responsible for providing oxygen, nutrients, and removing waste products from your baby’s bloodstream.

Changes in Your Body: 13 Weeks Pregnant Symptoms

As you progress through your 13th week of pregnancy , it’s important to be aware of the changes happening within your body. Here, we’ll explore in detail the various symptoms and physical transformations that are common during this stage of your pregnancy.

Reduced Morning Sickness : For many women, morning sickness starts to subside around this time. You might notice a decrease in nausea and vomiting, making daily life more comfortable.
Increased Energy : The fatigue that often accompanies the first trimester might begin to lift. You could find yourself with more energy and a renewed sense of vitality.
Growing Breasts : Your breasts may continue to grow and become more tender. This is due to hormonal changes and the preparation of your body for breastfeeding.
Visible Veins : Some women notice that their veins become more prominent, especially in the breasts and abdomen. This is a result of increased blood flow to support the growing baby.
Skin Changes : Hormonal fluctuations can cause changes in your skin. Some women experience a “pregnancy glow,” while others may notice skin issues like acne or pigmentation changes.
Increased Vaginal Discharge : You might observe an increase in vaginal discharge, which is usually thin and white. This is normal and occurs due to increased blood flow to the pelvic area.
Mild Abdominal Discomfort : As your uterus continues to expand, you may feel some mild cramping or discomfort in your lower abdomen. This is usually nothing to worry about and is a natural part of pregnancy.
Constipation and Bloating : Hormonal changes can slow down your digestive system, leading to constipation and bloating. Staying hydrated and consuming fiber-rich foods can help alleviate this.
Mood Swings : Hormonal fluctuations can also affect your mood. You may find yourself experiencing mood swings, which are entirely normal during pregnancy.
Increased Sense of Smell : Your sense of smell might become more acute, and certain odors that didn’t bother you before may now be unpleasant.
Heartburn and Indigestion : As your uterus expands, it can put pressure on your stomach, leading to heartburn and indigestion. Eating smaller, more frequent meals can help.
Round Ligament Pain : Some women experience a sharp, shooting pain on the sides of the abdomen due to the stretching of the round ligaments that support the uterus.
Gum Sensitivity : Hormonal changes can make your gums more sensitive and prone to bleeding. Be gentle when brushing and flossing to avoid irritation.

Remember, every pregnancy is unique, and not everyone will experience the same symptoms. If you have concerns or questions about any symptoms you’re experiencing, don’t hesitate to consult with your healthcare provider for guidance and reassurance.

Tips for Coping: To manage these 13 weeks pregnant symptoms effectively, consider the following tips:

Stay Hydrated and Eat Nutrient-Rich Foods : Proper hydration and a balanced diet are crucial during pregnancy Embrace Your Energy : Take advantage of increased energy levels in the second trimester for productivity and self-care.
Exercise Regularly : Engaging in gentle, pregnancy-safe exercises can boost your energy levels, alleviate mood swings, and promote overall well-being.
Seek Support and Information : Pregnancy can be an emotional journey, and it’s perfectly normal to have questions or concerns

As you reach the 13th week of pregnancy , your body starts to undergo noticeable changes in your belly. At this stage, your uterus has expanded significantly and is approximately the size of a large orange or grapefruit. This growth is a clear indication of your baby’s development and a reminder that you are progressing through your pregnancy journey.

For many women, especially if this isn’t their first pregnancy, a small baby bump becomes visible around this time. This baby bump, different from bloating, marks a significant milestone, making your pregnancy more evident to those around you. It’s a moment of excitement as you begin to visibly carry your growing little one.

With the expansion of your belly, you may find that your regular clothing, especially pants and skirts, start to feel tighter and less comfortable. This is a common experience, and many expectant mothers choose to transition to maternity wear or looser, stretchier clothing that accommodates their expanding abdomen. Skin changes, such as the appearance of stretch marks and darkening, can also occur around the belly area, but these can be managed with proper moisturization.

13 Weeks Pregnant Ultrasound: What to Expect

At a 13 weeks pregnant ultrasound , also known as a first-trimester screening or NT (nuchal translucency) scan, various things can be seen while some aspects of your baby’s development may still be challenging to visualize clearly. Here’s what can typically be seen and what might remain less visible:

What Can Be Seen:

Baby’s General Development : At this stage, your baby is still quite small but has a more distinct human shape. The ultrasound can confirm the presence of a developing fetus with a head, body, and limbs.
Heartbeat : The ultrasound can detect your baby’s heartbeat, which is a reassuring sign of a healthy pregnancy. You may even hear the heartbeat during the scan.
Fetal Movement : Although you can’t feel it yet, your baby is moving around. The ultrasound may capture some of these early movements, but they might not be as pronounced as they will be later in pregnancy.
Nuchal Translucency Measurement : This scan is often performed as part of the first-trimester screening for chromosomal abnormalities, such as Down syndrome. The technician will measure the thickness of the fluid-filled space at the back of your baby’s neck (nuchal translucency). Abnormal measurements could be an indicator of certain genetic conditions.

What Might Not Be Clearly Visible:

Gender : Determining the gender of a baby at 13 weeks of pregnancy can be challenging, and it’s often not very accurate at this stage, as the genitalia may not have developed to the point where it’s distinguishable on the ultrasound. While some medical procedures, such as Non-Invasive Prenatal Testing (NIPT) or chorionic villus sampling (CVS), may provide gender information earlier in pregnancy, these tests are typically performed for other purposes, such as genetic screening.
Fine Details : Fine facial features and small details like fingers and toes may not be clearly visible at this stage due to the baby’s small size.
Internal Organs : While some internal organs are forming, they might not be fully developed or visible on the ultrasound.
Placental Location : The exact location of the placenta may not be easy to determine yet, though this is important information for your healthcare provider.

It’s important to keep in mind that the primary purpose of a 13-week ultrasound is often for early screening and assessment of the baby’s overall health and development. If you’re eager to find out your baby’s sex or see more detailed images, you may need to wait until a later ultrasound, typically performed around the 18-20 week mark. Your healthcare provider will guide you on the appropriate timing and purpose of ultrasound scans during your pregnancy.

10 Easy Tips for 13 Weeks Pregnant:

As you transition into the second trimester during your 13th week of pregnancy, you’ll likely notice significant changes in your experience. Here are ten valuable tips to guide you through this exciting phase:

Continue Prenatal Vitamins : Keep taking your prenatal vitamins to ensure you and your baby receive essential nutrients like folic acid, iron, and calcium.
Stay Hydrated : Drink plenty of water to prevent dehydration, help with digestion, and maintain amniotic fluid levels.
Balanced Diet : Focus on a well-balanced diet with plenty of fruits, vegetables, lean proteins, and whole grains to support your growing baby.
Exercise Regularly : Engage in safe, low-impact exercises like prenatal yoga or walking to boost energy levels and reduce stress.
Rest and Sleep : Prioritize adequate rest and sleep to help your body recover and rejuvenate.
Manage Stress : Practice stress-reduction techniques such as deep breathing, meditation, or prenatal yoga to maintain emotional well-being.
Avoid Harmful Substances : Continue to avoid alcohol, smoking, and illicit drugs to protect your baby’s health.
Educate Yourself : Learn about the stages of pregnancy, labor, and childbirth by attending prenatal classes or reading informative books.
Communicate with Your Healthcare Provider : Share any concerns or questions with your healthcare provider and attend all recommended prenatal appointments.
Support System : Lean on your support network, including friends and family, for emotional support and assistance with tasks as needed.

Commonly Asked Questions About 13 Weeks Pregnant

Q1. Is it normal to still have morning sickness at 13 weeks pregnant?

Yes, it’s entirely normal. While morning sickness often improves during the second trimester, some women may still experience occasional nausea or vomiting at 13 weeks. If it becomes severe or persistent, consult your healthcare provider.

Q2. Can I travel during my 13th week of pregnancy?

Traveling is generally safe during this stage, but it’s essential to consult with your healthcare provider first. Ensure you take breaks during long journeys, stay hydrated, and follow any specific advice your provider gives regarding travel.

Q3. When will I start feeling my baby move at 13 weeks pregnant?

While your baby is moving by this stage, it’s usually too early to feel those movements. Most women start feeling fetal movements, often described as “flutters,” between 18 and 25 weeks of pregnancy.

Q4. Is it safe to have sex at 13 weeks pregnant?

In most cases, it’s safe to have sex during pregnancy, including at 13 weeks. However, if you have any concerns or complications, consult your healthcare provider for personalized guidance.

Q5. What can I do to minimize stretch marks on my belly at 13 weeks pregnant?

While it’s challenging to prevent stretch marks entirely, you can minimize their appearance by keeping your skin well-hydrated with moisturizers or oils. Staying within the recommended weight gain range for your pregnancy can also help reduce the likelihood of stretch marks. Genetics play a role, so some women are more prone to them than others.

13 Weeks Pregnant Checklist

Here’s a handy 13-week pregnancy checklist to help you stay organized and make your journey smoother:

Continue Prenatal Vitamins : Ensure you’re taking your prenatal vitamins regularly as recommended by your healthcare provider.
Stay Hydrated : Drink plenty of water to prevent dehydration, especially if you’re experiencing morning sickness.
Balanced Diet : Maintain a healthy diet with a variety of nutrient-rich foods to support your baby’s development.
Exercise : Engage in regular, safe exercise to boost energy and promote overall well-being.
Rest : Prioritize adequate rest and sleep to help your body recover and rejuvenate.
Attend Prenatal Appointments : Keep up with your scheduled prenatal check-ups and screenings.
Consider Genetic Testing : Discuss with your healthcare provider whether you want to undergo genetic testing or screenings, such as the nuchal translucency (NT) scan.
Plan Maternity Leave : Start planning your maternity leave with your employer if you haven’t already.
Think About Childcare : Begin exploring childcare options if you’ll need them after the baby arrives.
Update Your Wardrobe : Invest in comfortable, maternity-friendly clothing as your belly continues to grow.
Start a Pregnancy Journal : Consider keeping a journal to document your thoughts, feelings, and pregnancy milestones.
Discuss Birth Plan : If you have preferences for labor and delivery, start discussing your birth plan with your healthcare provider.
Explore Parenting Classes : Look into prenatal and parenting classes in your area, which can provide valuable information and support.
Stay Informed : Continue reading reputable pregnancy resources and stay informed about the stages of pregnancy and childbirth.
Emotional Well-being : Take time to focus on your emotional well-being through relaxation techniques or mindfulness practices.
Childproofing : Begin thinking about childproofing your home for when the baby starts crawling.
Financial Planning : Review your budget and start planning for the financial aspects of raising a child.
Bond with Your Partner : Spend quality time with your partner to strengthen your relationship before the baby arrives.
Plan Maternity Photos : If you’re interested, consider scheduling maternity photos to capture this special time.
Celebrate : Take moments to celebrate your pregnancy and the impending arrival of your little one.

In Conclusion, at 13 Weeks Pregnant :

Reaching the 13-week mark of your pregnancy is a significant milestone in your journey to motherhood. By this stage, you’ve already navigated through the uncertainties of the first trimester and are now entering the more stable and comfortable second trimester . This trimester, often called the “honeymoon phase” of pregnancy, brings with it a host of changes, both in your baby’s development and in your own body.

Your baby, although still tiny, is rapidly evolving. They have developed distinct facial features, a beating heart, and even the beginnings of vocal cords. Your little one is constantly moving and growing, though you may not feel those kicks and wiggles just yet.

As for your body, you might notice a reduction in morning sickness, increased energy levels, and changes in your belly size as your uterus expands to accommodate your growing baby. While some discomforts like constipation and heartburn may persist, the worst of the early pregnancy symptoms are often behind you.

This is an ideal time to focus on self-care. Continue taking your prenatal vitamins, eat a balanced diet, and exercise regularly to stay strong and healthy. Don’t forget to stay well-hydrated and manage stress through relaxation techniques.

Your 13-week pregnant belly may be starting to show, and you may be thinking about how to dress comfortably during this exciting time. Keep in mind that it’s perfectly normal for your body to undergo these changes, and there’s no one-size-fits-all experience when it comes to pregnancy.

As you move forward, stay connected with your healthcare provider, attend your prenatal appointments, and discuss any concerns or questions you may have. This is an excellent time to start planning for your birth experience, explore parenting classes, and take care of the emotional well-being of both you and your partner.

While each pregnancy is unique, one thing remains constant: the incredible journey you’re embarking on. Cherish the changes, celebrate the milestones, and savor the anticipation of meeting your little one. The adventure of pregnancy continues, and with each passing week, you’re one step closer to holding your baby in your arms.

Coming Up 14 Weeks Pregnant: Stay tuned for our next blog post where we’ll explore what to expect at 14 weeks pregnant . Each week brings new experiences, so continue to nurture yourself and your growing baby on this incredible adventure.

One Week Pregnancy: Myth or Reality?

4 WEEKS PREGNANT AND BABY DEVELOPMENT – SIGNS AND SYMPTOMS

Week 13 of Your Pregnancy

Welcome to the second trimester. Read on to learn more about common questions, symptoms, and development when you're 13 weeks pregnant.

Developmental Milestones

Prenatal Tests and Doctor's Appointments

Things You Might Consider This Week

Support you may need this week.

Next in Your Pregnancy Week by Week Week 14 of Your Pregnancy

Design By Alice Morgan / Illustration by Tara Anand

You've made it to the second trimester of your pregnancy. At 13 weeks pregnant, some people breathe a sigh of relief as the risk of miscarriage significantly decreases. You might also start feeling like your old self again as the exhaustion and fatigue of the first trimester start to dissipate, and you're one step closer to the estimated due date .

In fact, you might find yourself heading into the most enjoyable weeks of pregnancy, though the experience is different for everyone. Read on for what you need to know about being 13 weeks pregnant.

Pregnancy Week 13 Quick Facts

At 13 weeks, you’re three months pregnant
You have 27 weeks until your due date
You're in your second trimester

Your Unborn Baby's Size at 13 Weeks

At 13 weeks pregnant, your fetus is about 2.91 inches and weighs about .81 ounces . It’s the size of a small peach or plum, according to Olivia Dziadek, MD , OB-GYN and assistant professor at UT Health Houston.

Pregnancy Symptoms Week 13

You may be feeling a little better than you were during your first trimester, but for some, pesky nausea and exhaustion continue a bit longer. Here are some other symptoms you might notice at 13 weeks pregnant:

Increased breast size and tenderness
Gastroesophageal reflux disease (GERD) symptoms
Constipation
Swollen or bleeding gums
Round ligament pain (though it's more commonly experienced in the coming weeks)

Round ligament pain occurs in 10% to 30% of pregnancies, usually at the end of the first trimester and second trimester. It happens as your uterus grows, and the round ligaments—which attach from the uterus to the groin—are strained.

That achy feeling around your bump itself can be improved by stretching, Dr. Dziadek says. You can also ask a health care provider about taking a pain reliever, like Tylenol (acetaminophen), as needed if the pain becomes too much. That said, if you continue to have persistent lower abdominal or pelvic pain, you should call a medical professional.

Combat pregnancy constipation with a few diet changes, such as opting for higher-fiber foods and drinking more water. It can be easy to get out of the habit of drinking enough water during pregnancy, especially if you experienced morning sickness and frequent urination in early pregnancy. Tracking fluid intake or using a large, reusable water bottle may help.

If breast pain is consistent, keep an eye on your caffeine intake , limiting it to a cup of coffee per day, suggests Dr. Dzaidek. And get a physical breast exam. The former can alleviate symptoms, while the latter can provide peace of mind.

Also, don't worry if your first-trimester nausea doesn't disappear the minute you are 13 weeks pregnant. Andrea Faulkner Williams, a mom of four based in Carlsbad, California, says that, at this point, she still had some nausea. "I was still waiting for the nausea to subside," says Williams. "I was pretty discouraged after so many weeks of feeling sick, but what I didn't know was that in just a few weeks, I would feel a lot better and would even be able to bring vegetables and exercise into my life again!"

Your unborn baby is doing lots of work growing organs and body parts this week, Dr. Dzaidek says. Their long bones are hardening, and their skin is thin and see-through but will soon become thicker. If you could peer into your belly, you'd see their neck and lower limbs developing. Their lungs also form tissue that will let them exchange oxygen and carbon dioxide as soon as they are born.

Prenatal Tests and Doctor's Appointments

At 13 weeks pregnant, you may hear fetal cardiac activity on the external Doppler. And while this can happen as early as 10 weeks, it can be a hold-your-breath kind of moment for some, especially if you've been through miscarriage or infertility, says G. Thomas Ruiz, MD , OB-GYN at MemorialCare Orange Coast Medical Center.

Hearing the heartbeat is a sign that "everything's normal," Dr. Ruiz explains, adding that second-trimester miscarriages are "incredibly rare ." Only 1% to 5% of pregnancies end in miscarriage between 13 and 19 weeks.

If you haven't done so already, a health care provider might ask if you want to have non-invasive prenatal testing (NIPT), which is a series of blood tests that help inform your provider of any potential congenital disorders, such as an increased risk for Down's Syndrome, Dr, Dziadek says. According to the American College of Obstetricians and Gynecologists (ACOG), this screening test should be offered to everyone regardless of age or chromosomal abnormality.

Depending on when your last appointment was, you will most likely see your health care provider every four weeks at this point until you start to go more frequently in the third trimester.

Common Questions at This Pregnancy Stage

Why am I peeing so much?

There are a few reasons for increased urination during pregnancy. "The pregnancy hormone hCG, which is what is detected in the urine on a home UPT (urine pregnancy test), can increase blood flow to the pelvis as well as increase the filtration of your kidneys to clear out toxins faster," says Barbara Frank, MD, a Harvard-affiliated OB-GYN and Attn: Grace medical advisor . "This makes you pee more—bottom line!" Progesterone also plays a role. "By the second trimester, this stabilizes, and the increased urination may decrease from hormones but still be present because there is a growing human sitting on your bladder." She adds if you have burning, blood, or a foul smell in the urine, talk to your health care provider.

What hospital will I deliver at?

Dr. Dziadek commonly gets this question around week 13, as parents start to think through the details of the birth and possibly their birth plan. You can ask a health care provider what hospitals are available or alternative options, such as home births or birthing centers. While less than 2% of people in the US give birth outside of a hospital, some people feel it is right for them. Consider which is best for you through shared decision-making with your medical team and partner or family.

If pregnancy loss was on your mind, give yourself a minute to celebrate this milestone of being 13 weeks pregnant. Or you may need to recognize continued anxiety if the improved statistics pointing to a successful pregnancy don't help.

At week 13, Naples, Florida mom of two Beth Booker says, "When I was pregnant with my second child, it was my fourth pregnancy, and I had lost two pregnancies prior. Despite being out of the first trimester, I felt so much anxiety. All the same, my doctor and midwife were incredibly supportive of giving me peace of mind and updates on my baby to keep me at ease through the pregnancy and prescribed me a low dose of medication to keep my mind at ease. My rainbow baby turns 5 in July!"

Research has found that those who experienced a prior pregnancy loss were more likely to experience anxiety or depression in the first trimester . They also tend to have higher levels of pregnancy-related fears.

Make sure to ask all the questions you want to. If you are having pregnancy symptoms that are confusing or concerning, don't be afraid to call a health care provider or ask at an appointment—there are no stupid questions. Dr. Dziadek says her patients frequently want to discuss what symptoms are "normal" and might want further reassurance about weight gain, upcoming testing, and more. So, fire away!

At 13 weeks pregnant, you might want to talk to your support person about how you are feeling about the second trimester. Grabbing a cup of tea with a friend or heading to your therapist can alleviate your worries and help you stay calm and excited about the upcoming months.

You may find that you want to celebrate the second-trimester milestone but remain exhausted and worried that something might still go wrong. Talking to a supportive friend, significant other, or family member frequently can help.

Head over to week 14 of pregnancy

Management of acute abdomen in pregnancy: Current perspectives . Int J Womens Health . 2019.

Second Trimester Pregnancy Loss . American Family Physician . 2007.

Non-invasive prenatal testing . American College of Obstetricians and Gynecologists . 2023.

Out-of-hospital birth . Am Fam Physician . 2021.

Depression and anxiety following early pregnancy loss: Recommendations for primary care providers . Prim Care Companion CNS Disord . 2015.

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A comparison of risk factors for breech presentation in preterm and term labor: a nationwide, population-based case–control study

Anna e. toijonen.

1 Department of Obstetrics and Gynecology, University Hospital (HUS), University of Helsinki, Haartmaninkatu 2, 00290 Helsinki, Finland

3 School of Medicine, University of Helsinki, Helsinki, Finland

Seppo T. Heinonen

Mika v. m. gissler.

2 National Institute for Health and Welfare (THL), Helsinki, Finland

Georg Macharey

To determine if the common risks for breech presentation at term labor are also eligible in preterm labor.

A Finnish cross-sectional study included 737,788 singleton births (24–42 gestational weeks) during 2004–2014. A multivariable logistic regression analysis was used to calculate the risks of breech presentation.

The incidence of breech presentation at delivery decreased from 23.5% in pregnancy weeks 24–27 to 2.5% in term pregnancies. In gestational weeks 24–27, preterm premature rupture of membranes was associated with breech presentation. In 28–31 gestational weeks, breech presentation was associated with maternal pre-eclampsia/hypertension, preterm premature rupture of membranes, and fetal birth weight below the tenth percentile. In gestational weeks 32–36, the risks were advanced maternal age, nulliparity, previous cesarean section, preterm premature rupture of membranes, oligohydramnios, birth weight below the tenth percentile, female sex, and congenital anomaly. In term pregnancies, breech presentation was associated with advanced maternal age, nulliparity, maternal hypothyroidism, pre-gestational diabetes, placenta praevia, premature rupture of membranes, oligohydramnios, congenital anomaly, female sex, and birth weight below the tenth percentile.

Breech presentation in preterm labor is associated with obstetric risk factors compared to cephalic presentation. These risks decrease linearly with the gestational age. In moderate to late preterm delivery, breech presentation is a high-risk state and some obstetric risk factors are yet visible in early preterm delivery. Breech presentation in extremely preterm deliveries has, with the exception of preterm premature rupture of membranes, similar clinical risk profiles as in cephalic presentation.

Introduction

The prevalence of breech presentation at delivery decreases with increasing gestational age. At 28 pregnancy weeks, every fifth fetus lies in the breech presentation and in term pregnancies, less than 4% of all singleton fetuses are in breech presentation at delivery [ 1 , 2 ]. Most likely this is due to a lack of fetal movements [ 3 ] or an incomplete fetal rotation, since the possibility of a spontaneous rotation declines with increasing gestational age. Consequently, preterm labor itself is often associated with breech presentation at delivery, since the fetus was not yet able to rotate [ 4 – 9 ]. This fact makes preterm labor as one of the strongest risk factors for breech presentation.

Vaginal breech delivery in term pregnancies is not only associated with poorer perinatal outcomes compared to vaginal delivery with a fetus in cephalic presentation [ 6 , 10 , 11 ], but also it is debated whether the cause of breech presentation itself is a risk for adverse peri- and neonatal outcomes [ 3 , 12 , 13 ]. Several fetal and maternal features, such as fetal growth restriction, congenital anomaly, oligohydramnios, gestational diabetes, and previous cesarean section, are linked to a higher risk of breech presentation at term, and, furthermore, are associated with an increased risk for adverse perinatal outcomes [ 3 – 5 , 8 , 9 , 14 – 17 ].

The literature lacks studies on the risk factors of breech presentation in preterm pregnancies. It remains unclear whether breech presentation at preterm labor is only caused by the incomplete fetal rotation, or whether breech presentation in preterm labor is also associated with other obstetric risk factors. Most of the studies reviewing risk factors for breech presentation focus on term pregnancies. Our hypothesis is that breech presentation in preterm deliveries is, besides preterm pregnancy itself, associated with other risk factors similar to breech presentation at term. We aim to compare the risks of preterm breech presentation to those in cephalic presentation by gestational age. Such information would be valuable in the risk stratification of breech deliveries by gestational age.

Materials and methods

We conducted a retrospective population-based cross-sectional study. The population included all the singleton preterm and term births, from January 2004 to December 2014 in Finland. The data were collected from the national medical birth register and the hospital discharge register, maintained by the National Institute for Health and Welfare. All Finnish maternity hospitals are obligated to contribute clinical data on births from 22 weeks or birth weight of 500 g to the register. All newborn infants are examined by a pediatrician and given a personal identification number that can be traced in the case of perinatal mortality or morbidity. The hospital discharge register contains information on all surgical procedures and diagnoses (International Statistical Classification of Diseases and Related Health Problems 10th Revision, ICD-10) in all inpatient care and outpatient care in public hospitals.

Authorization to use the data was obtained from the National Institute for Health and Welfare as required by the national data protection law in Finland (reference number THL/652/5.05.00/2017).

The study population included all the women with a singleton fetus in breech presentation at the time of delivery. The control group included all the women with a singleton fetus in cephalic presentation at delivery. Other presentations were excluded from the study ( N = 1671) (Fig. 1 ). Gestational age was determined according to early ultrasonographic measurement which is routinely performed in Finland and it encompasses over 95% of the mothers, or if not available, to the last menstrual period. We excluded neonates delivered before 24 weeks of gestation and birth weight of less than 500 g, because the lower viability may have influenced the mode of the delivery or the outcome. The study population was divided into four categories according to the World Health Organization (WHO) definitions of preterm and term deliveries. WHO defines preterm birth as a fetus born alive before 37 completed weeks of pregnancy. WHO recommends sub-categories of preterm birth, based on gestational age, as extremely preterm (less than 28 pregnancy weeks), very preterm (28–32 pregnancy weeks), and moderate to late preterm (32–37 pregnancy weeks).

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Object name is 404_2019_5385_Fig1_HTML.jpg

Breech presentation for singleton pregnancies during the period of 2004–2014 in Finland

In our study, we assessed four factors that may be associated with breech presentation based on prior reports [ 3 – 5 , 14 , 17 – 20 ]. These factors were: maternal age below 25 and 35 years or more, smoking, pre-pregnancy body mass index (BMI) over 30, and in vitro fertilization. The following factors were also analyzed: nulliparity, more than three previous deliveries, and history of cesarean section. The obstetric risk factors including maternal hypo- or hyperthyroidism (ICD-10 E03, E05), gestational diabetes (ICD-10 O24.4) and other diabetes treated with insulin (ICD-10 O24.0), arterial hypertension or pre-eclampsia (ICD-10 O13, O14), and maternal care for (suspected) damage to fetus by alcohol or drugs (ICD-10 O35.4, O35.5) were assessed in the analysis. The variables that were also included in the analysis were: oligohydramnios (ICD-10 O41.0), placenta praevia (ICD-10 O44), placental abruption (ICD-10 O45), preterm premature rupture of membranes (PPROM) (ICD-10 O42), infant sex, fetal birth weight below the tenth percentile, fetuses with birth weight above the 97th percentile, and fetal congenital anomalies as defined in the register of congenital malformations.

The babies born in breech presentation from the four study groups were compared with the babies born in cephalic presentation with the equal gestational age, according to WHO classification. The calculations were performed using SPSS 19. Statistical differences in categorical variables were evaluated with the Chi-squared test or Fisher’s exact test when appropriate. We calculated odds ratios (ORs) with corresponding 95% confidence intervals (CIs) using binary logistic regression. Each study group was separately adjusted, according to gestational age at delivery, defined by WHO. The adjustment for the risk factors was done by multivariable logistic regression model for all variables. Differences were deemed to be statistically significant with P value < 0.05.

This analysis includes 737,788 singleton births, from these 20,086 were in breech presentation at the time of delivery. Out of all deliveries, 33,489 infants were born preterm. The prevalence of breech presentation at delivery decreased with the increase of the gestational age: 23.5% in extremely preterm delivery, 15.4% very preterm deliveries, and 6.7% in moderate to late preterm deliveries. At term, the prevalence of breech presentation at delivery was 2.5% (Fig. 1 ).

From all deliveries, 2056 fetuses were born extremely preterm (24 + 0 to 27 + 6 gestational weeks). The differences in the possible risk factors for breech presentation at delivery were higher odds of PPROM (aOR 1.39, 95% CI 1.08–1.79, P = 0.010) and a lower risk of placental abruption (aOR 0.59, 95% CI 0.36–0.98, P = 0.040). No statistically significant differences were observed for the other factors (Table (Table1, 1 , Figs. 1 , ,2, 2 , ,3, 3 , ,4 4 ).

Unadjusted and adjusted odds ratios for risk factors in singleton extremely preterm 24 + 0 to 27 + 6 weeks of gestational age fetuses in breech and in cephalic presentations during 2004–2014 in Finland

24–27 Weeks of gestation	Breech ( = 483)	Cephalic ( = 1573)	value	Odds ratio (95% Cl)	Adjusted odds ratio (95% Cl)
Maternal age < 25	17 (3.5%)	37 (2.4%)	0.153	1.51 (0.84–2.71)	1.56 (0.85–2.84)
Maternal age ≥ 35	129 (26.7%)	438 (27.8%)	0.606	0.94 (0.75–1.19)	0.94 (0.73–1.20)
Smoking	77 (15.9%)	251 (16.0%)	0.934	1 (0.76–1.32)	0.98 (0.74–1.30)
Maternal BMI ≥ 25	78 (16.10%)	262 (16.7%)	0.499	0.96 (0.76–1.32)	0.89 (0.62–1.27)
Maternal BMI ≥ 30	33 (6.8%)	104 (6.6%)	0.898	1.04 (0.69–1.55)	1.03 (0.61–1.75)
Nulliparity	221 (45.8%)	727 (46.2%)	0.409	0.98 (0.80–1.20)	0.91 (0.71–1.16)
Parity ≥ 3	66 (13.7%)	220 (14.0%)	0.983	0.97 (0.72–1.31)	1.01 (0.73–1.40)
Maternal hypothyroidism	6 (1.2%)	9 (0.6%)	0.159	2.19 (0.77–6.17)	2.15 (0.74–6.22)
Maternal hyperthyroidism	1 (0.2%)	3 (0.2%)	0.783	1.09 (0.11–10.46)	1.38 (0.14–13.62)
Pre-gestational diabetes treated with insulin	2 (0.4%)	6 (0.4%)	0.577	1.09 (0.22–5.40)	1.27 (0.55–2.96)
Gestational diabetes	20 (4.1%)	48 (3.1%)	0.222	1.37 (0.81–2.34)	1.42 (0.81–2.49)
Pre-eclampsia/hypertension	34 (7.0%)	84 (5.3%)	0.083	1.34 (0.89–2.03)	1.46 (0.95–2.24)
Previous cesarean section	64 (13.3%)	232 (14.7%)	0.294	0.88 (0.66–1.19)	0.85 (0.61–1.17)
IVF	17 (3.5%)	64 (4.1%)	0.828	0.86 (0.50–1.48)	0.94 (0.53–1.65)
Maternal care for (suspected) damage to fetus by alcohol/drugs	0 (0.0%)	3 (0.2%)	0.971
Placenta praevia	9 (1.9%)	29 (1.8%)	0.981	1.01 (0.48–2.15)	1.01 (0.47–2.18)
Placental abruption	20 (4.1%)	101 (6.4%)	0.040	0.63 (0.39–1.03)	0.59 (0.36–0.98)
PPROM	120 (24.8%)	308 (19.6%)	0.010	1.36 (1.07–1.73)	1. 39 (1.08–1.79)
Oligohydramnios	16 (3.3%)	45 (2.9%)	0.625	1.16 (0.65–2.08)	1.16 (0.64–2.11)
Congenital anomaly	122 (25.3%)	435 (27.7%)	0.242	0.88 (0.70–1.12)	0.87 (0.68–1.10)
Female sex	234 (48.4%)	734 (46.7%)	0.584	1.07 (0.88–1.32)	1.06 (0.86–1.30)
Birthweight < 10th percentile	47 (9.7%)	174 (11.1%)	0.486	0.87 (0.62–1.22)	1.16 (0.76–1.78)
Birthweight > 97th percentile	4 (0.8%)	15 (1.0%)	0.905	0.87 (0.29–2.63)	0.94 (0.30–2.89)

BMI body mass index, IVF in vitro fertilization, maternal intoxication, PPROM preterm premature rupture of membranes

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Prevalence of obstetric risk factors for breech presentation compared to cephalic by gestational age. PPROM preterm premature rupture of membranes, PROM premature rupture of membranes

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Obstetric risk factors for breech presentation with adjusted odds ratios by gestational age. PPROM preterm premature rupture of membranes, PROM premature rupture of membranes, aOR adjusted odds ratio

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The determinants of breech presentation by gestational age. PPROM preterm premature rupture of membranes, PROM premature rupture of membranes

The group of very preterm deliveries (28 + 0 to 31 + 6 gestational weeks) included 4582 singleton newborns. Breech presentation at delivery was associated with PPROM (aOR 1.61, 95% CI 1.32–1.96, P < 0.001), oligohydramnios (aOR 1.65, 95% CI 1.03–2.64, P = 0.038), fetal birth weight below the tenth percentile (aOR 1.57, 95% CI 1.19–2.08, P = 0.002), and maternal pre-eclampsia and arterial hypertension (aOR 1.31, 95% CI 1.04–1.66, P = 0.023). Details of risk factors in very preterm breech deliveries are described in Table Table2. 2 . The risk of placenta praevia as well as having a birth weight above the 97th percentile was lower in pregnancies with fetuses in breech rather than in cephalic presentation (Table (Table2, 2 , Figs. Figs.2, 2 , ,3, 3 , ,4 4 ).

Unadjusted and adjusted odds ratios for risk factors in singleton very preterm 28 + 0 to 31 + 6 weeks of gestational age fetuses in breech and in cephalic presentations during 2004–2014 in Finland

28–31 Weeks of gestation	Breech ( = 705)	Cephalic ( = 3877)	value	Odds ratio (95% Cl)	Adjusted odds ratio (95% CI)
Maternal age < 25	10 (1.4%)	108 (2.8%)	< 0.001	0.50 (0.26–0.96)	0.57 (0.29–1.10)
Maternal age ≥ 35	182 (25.8%)	954 (24.6%)	0.095	1.07 (0.89–1.28)	0.97 (0.80–1.18)
Smoking	105 (14.9%)	700 (18.1%)	0.064	0.79 (0.64–0.99)	0.81 (0.64–1.01)
Maternal BMI ≥ 25	109 (15.5%)	532 (13.7%)	0.124	1.15 (0.92–1.44)	1.24 (0.94–1.63)
Maternal BMI ≥ 30	33 (4.7%)	207 (5.3%)	0.053	0.87 (0.60–1.27)	0.64 (0.41–1.01)
Nulliparity	323 (45.8%)	1972 (50.9%)	0.121	0.82 (0.70–0.96)	0.86 (0.71–1.04)
Parity ≥ 3	96 (13.6%)	412 (10.6%)	0.202	1.33 (1.04–1.68)	1.19 (0.91–1.54)
Maternal hypothyroidism	8 (1.1%)	35 (0.9%)	0.888	1.26 (0.58–2.73)	1.06 (0.48–2.34)
Maternal hyperthyroidism	3 (0.4%)	6 (0.2%)	0.227	2.76 (0.69–11.05)	2.38 (0.58–9.72)
Pre-gestational diabetes treated with insulin	5 (0.7%)	16 (0.4%)	0.155	1.72 (0.63–4.72)	1.39 (0.88–2.18)
Gestational diabetes	59 (8.4%)	248 (6.4%)	0.086	1.34 (0.99–1.80)	1.31 (0.96–1.79)
Pre-eclampsia/hypertension	114 (16.2%)	514 (13.3%)	0.023	1.26 (1.01–1.57)	1.31 (1.04–1.66)
Previous cesarean section	128 (18.2%)	519 (15.2%)	0.443	1.23 (1.00–1.52)	1.10 (0.86–1.40)
IVF	22 (3.1%)	169 (4.4%)	0.122	0.71 (0.45–1.11)	0.68 (0.41–1.11)
Maternal care for (suspected) damage to fetus by alcohol/drugs	0 (0.0%)	9 (0.2%)	0.973
Placenta praevia	9 (1.3%)	133 (3.4%)	0.004	0.36 (0.18–0.72)	0.36 (0.18–0.72)
Placental abruption	32 (4.5%)	232 (6.0%)	0.225	0.75 (0.51–1.09)	0.79 (0.54–1.16)
PPROM	188 (26.7%)	764 (19.7%)	< 0.001	1.48 (1.23–1.78)	1.61 (1.32–1.96)
Oligohydramnios	26 (3.7%)	73 (1.9%)	0.038	2.00 (1.27–3.15)	1.65 (1.03–2.64)
Congenital anomaly	183 (26.0%)	946 (24.4%)	0.453	1.09 (0.90–1.31)	1.08 (0.89–1.30)
Female sex	315 (44.7%)	1739 (44.9%)	0.924	0.99 (0.84–1.17)	0.99 (0.84–1.17)
Birthweight < 10th percentile	93 (13.2%)	348 (9.0%)	0.002	1.54 (1.21–1.97)	1.57 (1.19–2.08)
Birthweight > 97th percentile	8 (1.1%)	97 (2.5%)	0.022	0.45 (0.22–0.92)	0.42 (0.20–0.89)

BMI body mass index, IVF in vitro fertilization, PPROM preterm premature rupture of membranes

The moderate to late preterm delivery group (32 + 0 to 36 + 6 gestational weeks) included 26,851 deliveries. Breech presentation in moderate to late preterm deliveries was associated with older maternal age (maternal age 35 years or more aOR 1.24, 95% CI 1.10–1.39, P < 0.001), nullipara (aOR 1.43, 95% CI 1.27–1.60, P < 0.001), maternal BMI less than 25 (maternal BMI ≥ 25 aOR 0.75, 95% CI 0.62–0.91, P = 0.004), previous cesarean section (aOR 1.31, 95% CI 1.12–1.53, P < 0.001), female sex (aOR 1.22, 95% CI 1.11–1.34, P < 0.001), congenital anomaly (aOR 1.37, 95% CI 1.22–1.55, P < 0.001), fetal birth weight below the tenth percentile (aOR 1.31, 95% CI 1.10–1.56, P = 0.003), oligohydramnios (aOR 3.60, 95% CI 2.63–4.92, P < 0.001), and PPROM (aOR 1.58, 95% CI 1.41–1.78, P < 0.001). Breech presentation decreased the odds of having a fetus with birth weight above the 97th percentile (aOR 0.60, 95% CI 0.42–0.85, P = 0.004) (Table (Table3, 3 , Figs. Figs.2, 2 , ,3, 3 , ,4 4 ).

Unadjusted and adjusted odds ratios for risk factors in singleton moderate to late preterm 32 + 0 to 36 + 6 weeks of gestational age fetuses in breech and in cephalic presentations during 2004–2014 in Finland

32–36 Weeks of gestation	Breech ( = 1854)	Cephalic ( = 24 997)	value	Odds ratio (95% Cl)	Adjusted odds ratio (95% CI)
Maternal age < 25	39 (2.1%)	741 (3.0%)	0.020	0.70 (0.51–0.97)	0.68 (0.48–0.94)
Maternal age ≥ 35	451 (24.3%)	5409 (21.6%)	< 0.001	1.16 (1.04–1.30)	1.24 (1.10–1.39)
Smoking	293 (15.8%)	4426 (17.7%)	0.139	0.87 (0.77–0.99)	0.91 (0.79–1.03)
Maternal BMI ≥ 25	202 (10.9%)	3359 (13.4%)	0.004	0.79 (0.68–0.92)	0.75 (0.62–0.91)
Maternal BMI ≥ 30	80 (4.3%)	1175 (4.7%)	0.120	0.91 (0.73–1.15)	1.26 (0.94–1.69)
Nulliparity	1048 (56.5%)	12,235 (48.9%)	< 0.001	1.36 (1.23–1.49)	1.43 (1.27–1.60)
Parity ≥ 3	158 (8.5%)	2665 (10.7%)	0.134	0.78 (0.66–0.92)	0.87 (0.73–1.04)
Maternal hypothyroidism	21 (1.1%)	259 (1.0%)	0.360	1.09 (0.70–1.71)	1.24 (0.78–1.96)
Maternal hyperthyroidism	6 (0.3%)	48 (0.2%)	0.100	1.69 (0.72–3.95)	2.06 (0.87–4.87)
Pre-gestational diabetes treated with insulin	5 (0.3%)	118 (0.5%)	0.066	0.57 (0.23–1.40)	0.76 (0.57–1.02)
Gestational diabetes	159 (8.6%)	2481 (9.9%)	0.099	0.85 (0.72–1.01)	0.86 (0.72–1.03)
Pre-eclampsia/hypertension	161 (8.7%)	2232 (8.9%)	0.394	0.97 (0.82–1.15)	0.93 (0.78–1.10)
Previous cesarean section	255 (13.8%)	3423 (13.7%)	< 0.001	1.01 (0.88–1.15)	1.31 (1.12–1.53)
IVF	75 (4.0%)	900 (3.6%)	0.854	1.13 (0.89–1.44)	0.98 (0.76–1.25)
Maternal care for (suspected) damage to fetus by alcohol/drugs	3 (0.2%)	39 (0.2%)	0.760	1.04 (0.32–3.36)	0.83 (0.25–2.76)
Placenta praevia	36 (1.9%)	624 (2.5%)	0.240	0.77 (0.55–1.09)	0.81 (0.58–1.15)
Placental abruption	27 (1.5%)	414 (1.7%)	0.763	0.88 (0.59–1.30)	0.94 (0.63–1.40)
PPROM	437 (23.6%)	3968 (15.9%)	< 0.001	1.63 (1.46–1.83)	1.58 (1.41–1.78)
Oligohydramnios	55 (3.0%)	191 (0.8%)	< 0.001	3.97 (2.93–5.38)	3.60 (2.63–4.92)
Congenital anomaly	362 (19.5%)	3690 (14.8%)	< 0.001	1.40 (1.24–1.58)	1.37 (1.22–1.55)
Female sex	890 (48.0%)	10,817 (43.3%)	< 0.001	1.21 (1.10–1.33)	1.22 (1.11–1.34)
Birthweight < 10th percentile	205 (11.1%)	2012 (8.0%)	0.003	1.42 (1.22–1.65)	1.31 (1.10–1.56)
Birthweight > 97th percentile	41 (2.2%)	1162 (4.6%)	0.004	0.46 (0.34–0.64)	0.60 (0.42–0.85)

The term and post-term group included 704,299 deliveries, among them 17,044 fetuses in breech presentation. The factors associated with breech presentation amongst these were: maternal age of 35 years or more (aOR 1.24, 95% CI 1.19–1.29, P < 0.001), nullipara (aOR 2.46, 95% CI 2.37–2.55, P < 0.001), maternal BMI less than 25 (BMI ≥ 25 aOR 0.90, 95% CI 0.85–0.96, P < 0.001), maternal hypothyroidism (aOR 1.53, 95% CI 1.28–1.82, P < 0.001), pre-gestational diabetes treated with insulin (aOR 1.24, 95% CI 1.00–1.53, P = 0.049), placenta praevia (aOR 1.45, 95% CI 1.11–1.91, P = 0.007), premature rupture of membranes (PROM) (aOR 1.58, 95% CI 1.45–1.72, P < 0.001), oligohydramnios (aOR 2.02, 95% CI 1.83–2.22, P < 0.001), congenital anomaly (aOR 1.97, 95% CI 1.89–2.06, P < 0.001), female sex (aOR 1.28, 95% CI 1.24–1.32, P < 0.001), and birth weight below the tenth percentile (aOR 1.18, 95% CI 1.12–1.24, P < 0.001) Table Table4 4 includes details for risk factors of term and post-term group (Figs. 2 , ,3, 3 , ,4 4 ).

Unadjusted and adjusted odds ratios for risk factors in singleton term pregnancies in breech and in cephalic presentations during 2004–2014 in Finland

≥ 37 Weeks of gestation	Breech ( = 17 044)	Cephalic ( = 687 255)	value	Odds ratio (95% Cl)	Adjusted odds ratio (95% CI)
Maternal age < 25	304 (1.8%)	15,496 (2.3%)	< 0.001	0.79 (0.70–0.88)	0.57 (0.51–0.64)
Maternal age ≥ 35	3313 (19.4%)	130,687 (19.0%)	< 0.001	1.03 (0.99–1.07)	1.24 (1.19–1.29)
Smoking	2593 (15.2%)	102,333 (14.9%)	0.845	1.03 (0.98–1.07)	1.00 (0.95–1.04)
Maternal BMI ≥ 25	1753 (10.3%)	79,114 (11.5%)	< 0.001	0.88 (0.84–0.93)	0.90 (0.85–0.96)
Maternal BMI ≥ 30	588 (3.4%)	25,854 (3.8%)	0.56	0.91 (0.84–0.99)	1.03 (0.93–1.14)
Nulliparity	10,387 (60.9%)	281,094 (40.9%)	< 0.001	2.25 (2.19–2.33)	2.46 (2.37–2.55)
Parity ≥ 3	910 (5.3%)	68,532 (10.0%)	< 0.001	0.51 (0.48–0.54)	0.75 (0.70–0.81)
Maternal hypothyroidism	131 (0.8%)	3146 (0.5%)	< 0.001	1.68 (1.41–2.01)	1.53 (1.28–1.82)
Maternal hyperthyroidism	22 (0.1%)	634 (0.1%)	0.082	1.40 (0.91–2.14)	1.46 (0.95–2.24)
Pre-gestational diabetes treated with insulin	24 (0.1%)	789 (0.1%)	0.049	1.23 (0.82–1.84)	1.24 (1.00–1.53)
Gestational diabetes	1447 (8.5%)	57,613 (8.4%)	0.418	1.01 (0.96–1.07)	1.02 (0.97–1.08)
Pre-eclampsia/hypertension	600 (3.5%)	21,627 (3.1%)	0.07	1.12 (1.03–1.22)	0.93 (0.85–1.01)
Previous cesarean section	1847 (10.8%)	73,575 (10.7%)	< 0.001	1.01 (0.97–1.06)	1.67 (1.58–1.76)
IVF	483 (2.8%)	14,393 (2.1%)	0.68	1.36 (1.24–1.49)	0.98 (0.89–1.08)
Maternal care for (suspected) damage to fetus by alcohol/drugs	6 (0.0%)	734 (0.1%)	0.001	0.33 (0.15–0.74)	0.27 (0.12–0.60)
Placenta praevia	55 (0.3%)	1418 (0.2%)	0.007	1.57 (1.20–2.05)	1.45 (1.11–1.91)
Placental abruption	23 (0.1%)	995 (0.1%)	0.496	0.93 (0.62–1.41)	0.87 (0.75–1.31)
PROM	582 (3.4%)	12,938 (1.9%)	< 0.001	1.84 (1.69–2.01)	1.58 (1.45–1.72)
Oligohydramnios	453 (2.7%)	7867 (1.1%)	< 0.001	2.36 (2.14–2.60)	2.02 (1.83–2.22)
Congenital anomaly	2846 (16.7%)	62 002 (9.0%)	< 0.001	2.02 (1.94–2.11)	1.97 (1.89–2.06)
Female sex	9321 (54.7%)	336,313 (48.9%)	< 0.001	1.26 (1.22–1.30)	1.28 (1.24–1.32)
Birthweight < tenthth percentile	2153 (12.6%)	63,826 (9.3%)	< 0.001	1.41 (1.35–1.48)	1.18 (1.12–1.24)
Birthweight > 97th percentile	237 (1.4%)	15,679 (2.3%)	< 0.001	0.60 (0.53–0.69)	0.75 (0.65–0.85)

BMI body mass index, IVF in vitro fertilization, PROM premature rupture of membranes

The main novel finding of our study was that the risk associations increase with each gestational age group after 28 weeks of gestation. With the exception of PPROM, the extremely preterm breech deliveries have similar clinical risk profiles as in cephalic presentation when matched for gestational age. However, as gestation proceeds, the risks start to cluster. In moderate to late preterm pregnancies as in term pregnancies, the breech presentation is a high-risk state being associated with several risk factors: PPROM, oligohydramnios, advanced maternal age, nulliparity, previous cesarean section, fetal birth weight below the tenth percentile, female sex, and fetal congenital anomalies. These are in line with the findings of previous studies [ 3 , 5 , 7 , 8 ], that associated breech presentation at term with obstetric risk factors. The prevalence of breech presentation was negatively correlated with the gestational age with a decline from 23.5% in extremely preterm pregnancies to 2.5% at term. The prevalence of breech presentation in preterm pregnancies observed in our trial is similar to that of comparable studies [ 1 , 2 ].

In extremely preterm deliveries, PPROM was the only risk factor for breech presentation and it stayed as a risk for breech presentation through the gestational weeks. This finding is comparable to the previous literature suggesting that PPROM occurs more often at earlier gestational age in pregnancies with the fetus in breech presentation compared with cephalic [ 21 , 22 ]. PPROM might prevent the fetus to change into cephalic presentation. Furthermore, Goodman and colleagues (2013) reported that in pregnancies with a fetus in a presentation other than cephalic had more complications such as oligohydramnios, infections, placental abruption, and even stillbirths. In our study, surprisingly, placental abruption seemed to have a negative correlation with breech presentation among extremely preterm deliveries. This inconsistency between our results and the literature might be due to the small number of cases. Many of the obstetric complications, for example gestational diabetes, late pre-eclampsia, and late intrauterine growth restriction develop during the second or the third trimester of the pregnancy which explains partially why the risk factors for breech presentation are rarer in extremely preterm deliveries.

In very preterm delivery, breech presentation was associated with PPROM, pre-eclampsia, and fetal birth weight below the tenth percentile. Fetal growth restriction is a known risk factor for breech presentation at term, since it is associated with reduced fetal movements due to diminished resources [ 23 – 25 ]. Furthermore, fetal growth restriction is known to be the single largest factor for stillbirth and neonatal mortality [ 26 – 30 ]. Maternal arterial hypertension disturbs placental function which might cause low birth weight [ 31 , 32 ]. Arterial hypertension and pre-eclampsia increased the risk for breech presentation in very preterm births, but not in earlier or later preterm pregnancies. This finding may be due to the bias that pre-eclampsia is a well-described risk factor for PPROM, fetal growth restriction, and preterm deliveries which are also independent markers for breech presentation itself [ 4 , 5 , 31 , 33 , 34 ]. The severity of early pre-eclampsia might affect the fetal wellbeing, reduce fetal movements and growth, which might reduce the spontaneous fetal rotation to the cephalic position [ 35 ]. In addition, the most severe cases might not reach older gestational age before the delivery.

The risk factor for breech presentation in moderate to late preterm breech delivery was PPROM, oligohydramnios, advanced maternal age, nulliparity, previous cesarean section, fetal birth weight below the tenth percentile, female sex, and fetal congenital anomalies. Oligohydramnios is a known significant risk factor for term breech pregnancies [ 25 ] and it is linked to the reduced fetal movements partly due to a restricted intrauterine space [ 24 , 35 ] and nuchal cords [ 35 ]. Additionally, oligohydramnios is associated with placental dysfunction, which might reduce fetal resources and thus has a progressive effect on the fetal movements and prevent the fetus from turning into cephalic presentation [ 3 , 4 , 18 ]. Fetal female sex in moderate to late preterm breech pregnancies remained as a risk factor, as identified previously for term pregnancies [ 3 – 5 ]. It has been debated whether this risk is due to a smaller fetal size or that female fetuses tend to move less [ 9 , 20 ]. The mothers of infants born in breech presentation in moderate to late preterm and term and post-term pregnancies seemed to be older and had an increased risk of having a fetus with a congenital anomaly. The advanced maternal age is associated with negative effects on vascular health, which may have an influence on the developing fetus and increase the incidence of congenital anomalies [ 19 , 34 , 36 ]. Furthermore, congenital anomalies may have a negative influence on fetal movements [ 19 , 35 ]. Whereas, the low birth weight was found as a risk for breech presentation, a birth weight above the 97th percentile was, coherently a protective factor for breech presentation in very to term and post-term pregnancies.

We found that in term pregnancies, breech presentation was associated with advanced maternal age, nulliparity, maternal hypothyroidism, pre-gestational diabetes, placenta praevia, PROM, oligohydramnios, fetal congenital anomaly, female sex of the fetus, and birth weight below the tenth percentile. A previous cesarean section is known to be positively related to the odds of having a fetus in breech presentation at term [ 5 , 14 ], and in our study, this risk factor started to show already in moderate to late preterm pregnancies. Instead of the scar being the cause of breech presentation, it is more likely that the women with a history of breech cesarean section have, during subsequent pregnancies, a fetus in breech presentation again or have a cesarean section for another reason [ 3 , 5 , 37 ]. Our data suggest that the advanced maternal age and nulliparity are the risks for breech presentation at term, but as well as in moderate to late preterm pregnancies. The tight wall of the abdomen and the uterus of nulliparous women might inhibit the fetus from rotating to cephalic presentation [ 9 ]. In a meta-analysis from 2017, older maternal age has been considered to increase the risk of placental dysfunction such as pre-eclampsia and preterm birth [ 36 ] that are also common risk factors for breech presentation [ 4 , 5 ]. Bearing the first child in older maternal age and giving birth by cesarean section may affect the decision not to have another child and might explain the higher rate of nulliparity among moderate to late preterm and term deliveries [ 1 ]. Our study found correlation between maternal hypothyroidism and breech presentation at term. Some studies have demonstrated an association between maternal thyroid hypofunction and adverse pregnancy outcomes such as pre-eclampsia and low birth weight which are, furthermore, risks for breech presentation and may explain partly the higher prevalence of maternal hypothyroidism in term breech deliveries [ 38 – 40 ]. However, the absence of screening of, for example, thyroid diseases may cause bias in the diagnoses.

Our study demonstrated that as gestation proceeds, more obstetric risk factors can be found associating with breech presentation. In the earlier gestation and excluding PPROM, breech deliveries did not differ in obstetric risk factors compared to cephalic. The risk factors in 32 weeks of gestational age are comparable to those in term pregnancy, and several of these factors, such as low birth weight, congenital anomalies and history of cesarean section, are associated with adverse fetal outcomes [ 1 , 4 , 5 , 8 , 14 , 17 ] and must be taken into account when treating breech pregnancies. Risk factors should be evaluated prior to offering a patient an external cephalic version, as the presence of some of these risks may increase the change of failed version or fetal intolerance of the procedure. This study had adequate power to show differences between the risk profiles of breech and cephalic presentations in different gestational phase. Further research, however, is needed for improving the identification of patients at risk for preterm breech labor and elucidating the optimal route for delivery in preterm breech pregnancies.

Our study is unique since it is the first study, to our knowledge, that compares the risks for breech presentation in preterm and term deliveries. The analysis is based on a large nationwide population, which is the major strength of our study. The study population included nearly 34,000 preterm births over 11 years in Finland and 737,788 deliveries overall. The medical treatment of pregnancies is homogenous, since there are no private hospitals treating deliveries. A further strength relates to the important information on the characteristics of the mother, for example smoking during pregnancy and pre-pregnancy body mass index. The retrospective approach is a limitation of the study, another one is the design as a record linkage study, due to which the variables were restricted to the data availability. Therefore, we were not able to assess, for example uterine anomalies or previous breech deliveries to the analysis.

Our results show that the factors associated with breech presentation in very late preterm breech deliveries resemble those in term pregnancies. However, breech presentation in extremely preterm breech birth has similar clinical risk profiles as in cephalic presentation.

Acknowledgements

Open access funding provided by University of Helsinki including Helsinki University Central Hospital.

Abbreviations

ICD-10	International Statistical Classification of Diseases and Related Health Problems 10th Revision
WHO	World Health Organization; BMI, body mass index
PPROM	Preterm premature rupture of membranes
OR	Crude odds ratio
Cl	Confidence interval
aOR	Adjusted odds ratio
PROM	Premature rupture of membranes

Author contribution

AT: Project development, manuscript writing. SH: Project development. MG: Data collection and analysis, manuscript editing. GM: Project development, manuscript editing.

This study was supported by Helsinki University Hospital Research Grants. Authorization to use of the data was obtained from the National Institute for Health and Welfare as required by the national data protection legislation in Finland (reference number THL/652/5.05.00/2017).

Compliance with ethical standards

We declare that we have no conflict of interest.

For this type of study, formal consent is not required. The National Institute for Health and Welfare authorized to use the data (reference number THL/652/5.05.00/2017).

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Your developing baby – week 13

At 13 weeks, your baby is about 3.5 inches long around the size of a plum. By the time you reach week 13, the placenta has fully formed and begun providing your baby with nutrients and oxygen. It also removes the baby’s waste.

Your baby’s:

Veins and internal organs appear through the baby’s nearly see-through (transparent) skin.
Muscles and bones continue to develop and strengthen.
Arms and legs are long and thin. Fingerprints have formed on the baby's tiny fingers.
Hearing starts to develop.

Around week 13, your baby’s able to:

Make a fist with each hand.
Put a thumb in the mouth and make a sucking motion.

Your baby has more muscle tissue and harder, more developed bones. Your little one is starting to roll, kick, and move around a lot — flexing tiny arms and legs, too. You may be able to start feeling these movements around week 18.

This article has been created by a national group of Kaiser Permanente ob-gyns, certified nurse-midwives, pediatricians, lactation consultants and other specialists who came together to provide you with the best pregnancy, birth, postpartum, and newborn information.

Some of the content is used and adapted with permission of The Permanente Medical Group.

Fetal growth and development
Gestation period 13 weeks
First trimester

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You and your baby at 13 weeks pregnant

Your baby at 13 weeks.

Your baby weighs around 25g.

Your baby's ovaries or testes are fully developed inside their body, and the genitals are forming outside their body.

Where there was a swelling between the legs, there will now be a penis or clitoris growing, although you will not usually be able to find out the sex of your baby at an ultrasound scan at this stage.

You at 13 weeks

If you've been feeling sick and tired with morning sickness, you'll probably start to feel better when you're around 13 or 14 weeks pregnant.

You may start to experience an increased sex drive around this time, possibly as a result of pregnancy hormones or increased blood flow to the pelvic area. It is perfectly normal if you do not.

Things to think about

Find out about the pregnancy care you can expect if you're having twins .

You may be able to get help to buy food and milk through the Healthy Start scheme, if you're pregnant or have children under the age of 4 and if you receive certain benefits, or you're pregnant and under 18.

For more information, visit the Healthy Start scheme website .

Start4Life has more about you and your baby at 13 weeks of pregnancy

You can sign up for Start4Life's weekly emails for expert advice, videos and tips on pregnancy, birth and beyond.

Page last reviewed: 13 October 2021 Next review due: 13 October 2024

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13 Weeks Pregnant

Your baby is the size of a

At 13 weeks pregnant, you’re about to begin what is sometimes called the honeymoon period of pregnancy—the second trimester. Your baby bump might start to show at 13 weeks and morning sickness may begin to ease. Keep reading to discover more about what happens at 13 weeks pregnant, including insights on your baby’s growth and development and the signs and symptoms you may experience.

Highlights at 13 Weeks Pregnant

Here are a few things to know and look forward to when you’re 13 weeks pregnant:

Your little one is growing fast now, and their organs are fully formed.

Your baby is starting to move and flex their arms and legs.

Pregnancy symptoms such as morning sickness and fatigue may begin to ease at 13 weeks.

You might notice some colostrum leaking from your breasts during this time. This thick, yellow fluid is considered your baby’s first milk in the first few days after birth.

Your baby bump might be showing now or will be visible very soon, so you could consider snapping some pictures of your belly at 13 weeks pregnant and over the coming weeks to see those changes in action!

Can you tell your baby’s gender at 13 weeks? This is still too early to find out your little one’s gender via ultrasound, but why not have some unscientific fun with our Chinese Gender Predictor:

Chinese Gender Predictor

Can't wait to know whether your little one's a boy or a girl try our fun tool, fill in your info to get started:.

This is a mandatory field.

Please select a due date!

Baby's Due Date*

13 Weeks Pregnant: Your Baby’s Development

Keep up with your baby’s progress and find out what happens at 13 weeks pregnant:

This week, your little one’s organs are fully formed and are hard at work!

The kidneys are starting to produce urine and release it into the amniotic fluid, and the spleen is busy producing red blood cells, which carry oxygen throughout the body.

Your baby's intestines have moved back into the abdomen from the umbilical cord, now that there’s enough room to accommodate them.

Some of the larger bones, including those of the skull, are beginning to harden.

Even though you won’t hear those coos and cries until after you give birth, your baby’s vocal cords have already started to develop.

If you’re 13 weeks pregnant with twins, read more about your babies’ development in our weekly twin pregnancy overview .

How Many Months Is 13 Weeks Pregnant?

You’re 13 weeks pregnant, but how many months is that? At 13 weeks pregnant, you’re at the end of your third month of pregnancy.

Baby's Size at 13 Weeks Pregnant

At 13 weeks, your baby is about the size of a large plum or small peach. Your little one could weigh more than 2 ounces.

Your Baby: What Does 13 Weeks Pregnant Look Like?

It can be hard to picture what’s going on inside your belly at 13 weeks pregnant. Check out the visual below for an idea of what your little one might look like.

Your Body at 13 Weeks Pregnant

You’ve just about made it to your second trimester , which many moms-to-be describe as the honeymoon period of pregnancy.

The discomforts you may have experienced in the first trimester—fatigue, nausea, and frequent urination—often ease up, and you may even feel a surge of energy during this trimester.

By this stage, your blood supply and flow are fully linked to the placenta, which will continue to grow as your pregnancy progresses. By the time you give birth, the placenta may weigh about one and a half pounds.

In a few weeks, your healthcare provider may begin monitoring your fundal height—the distance from your pubic bone to the top of your uterus (the fundus). Measuring the size of your growing uterus helps your provider determine how your baby is doing.

Breast tenderness may continue on and off, and other issues like constipation, bloating, and heartburn are normal at this stage, too, as your increased hormone levels can slow down digestion.

Learn more about prenatal health, fitness, nutrition, and more in our downloadable Pregnancy Guide .

13 Weeks Pregnant: Your Symptoms

Every pregnancy is unique. It’s difficult to predict what to expect at 13 weeks pregnant, but here are some of the symptoms you may be experiencing now or in the coming weeks:

Vaginal discharge. A clear to milky-colored discharge known as leukorrhea may increase around this point in your pregnancy. You might be surprised to learn that this discharge has a unique purpose: It helps keep your vagina and birth canal clear of infection and irritation. If it gets a little messy, panty liners can be a big help. If your discharge is brown or foul-smelling, or if you notice spotting or bleeding at 13 weeks pregnant, contact your healthcare provider for advice.

Changing sex drive. It's perfectly normal for you and your partner to feel an increase or a decrease in sexual desire at various times during pregnancy. If your pregnancy is normal and both of you feel the urge, go ahead and enjoy the intimacy. Don't worry—your baby will be safe! Your uterus and the amniotic sac provide protection for your baby. Talk to your healthcare provider if you’re worried or have questions about this or anything else. Note that your provider might advise you to abstain from sex if you have complications including a history of miscarriage or if you are at risk of preterm labor. Read more about sex during pregnancy .

Heartburn. Heartburn and indigestion can come and go throughout your pregnancy as your baby moves from one position to the next, and as your growing uterus puts pressure on your stomach. Pregnancy hormones also cause the muscle at the top of your stomach to relax, allowing stomach acid to travel up into the esophagus, which causes heartburn; this is more likely to happen if you lie down after having just eaten a large meal. You can reduce the discomfort by sitting upright after eating and avoiding potential triggers such as chocolate, citrus fruits, and fried or spicy foods.

Constipation . Hormones strike again! Progesterone and estrogen play an important role in pregnancy, but right now they might be causing your digestive system to work more slowly than usual. This means that you may be feeling somewhat backed up at 13 weeks pregnant and have some cramping. Adding more fruits, vegetables, and whole-grain foods to your diet increases your fiber intake and helps keep things moving along. Drinking prune juice might also help, as can drinking lots of water and doing regular exercise.

Leaking colostrum. You may start to notice a thick, yellow fluid leaking from your breasts right about now. This is called colostrum , and it’s the milk that appears for the first few days after you give birth. It is completely normal, but you may want to try using disposable or cotton breast pads (without plastic liners) to help absorb any leaking fluid.

How Big Is a Pregnant Belly at 13 Weeks?

At 13 weeks pregnant, your baby is growing quickly and the changes in your body may be accelerating, meaning your pregnancy bump might start to show and become more obvious to others during this time. At 13 weeks pregnant, your uterus may be moving up higher and forward, as well as increasing in size. Your expanding uterus might cause some aches and pains in the muscles and ligaments surrounding it.

You may be wondering if you can feel the baby move at 13 weeks pregnant. Though your little one is moving around inside your uterus and starting to flex their arms and legs, they’re probably still too small for you to feel those movements. If you’re wondering, when can you feel your baby move , this tends to happen around 16 to 20 weeks and is called quickening.

What Does 13 Weeks Pregnant Look Like?

To get a better idea of what your belly might look like around thirteen weeks pregnant, when you’re reaching the end of your third month of pregnancy, check out the image below.

13 Weeks Pregnant: Things to Consider

At 13 weeks pregnant, you have a lot to think about, from sharing the good news to getting regular exercise. Read on for some things to consider:

Have you shared the good news with your family and friends? The beginning of your second trimester is a great time to do this, because the risk of miscarriage is lower after the first three months. Of course, the decision about when to start spreading the wordis totally up to you! Get inspired with our creative pregnancy announcement ideas .

If you work, plan when you'll let your boss know that you’re expecting. Start to think about how you will share the news, and when. You’ll want to keep your employer and colleagues in the loop so they can make plans for accommodating your absence during your maternity leave. You might even like to have a little fun with announcing your pregnancy to co-workers .

Working out? If yes, keep it up! If not, consider consulting your healthcare provider about starting a basic fitness routine. If your provider gives you the all-clear, it could include things like walking, swimming, and maybe yoga. Your body and mind will thank you—both during the last six months of your pregnancy and during your new baby’s first few months when increased levels of energy and fitness will help you deal with all the extra stress that’s placed on your body.

If you are doing abdominal exercises that have you lying flat on your back, you may want to look for alternatives during pregnancy, since the weight from your uterus can cause less blood to return to your heart when you're in that position. Ask your healthcare provider for advice.

It’s also worthwhile to pay attention to the pelvic floor muscles. The benefits of strengthening these muscles include improved bladder control and increased pelvic organ support. (The pelvic organs include the bladder, uterus, small intestine, and rectum.) You can strengthen the pelvic floor by doing small exercises as Kegels . Basically, these involve squeezing and relaxing the muscles in the pelvic and genital area.

Now that you’re pregnant, you may be feeling forgetful or struggling to concentrate; you may also be more intense dreams that you did before. You’re not alone! Read up on the so-called “pregnancy brain” and learn why you may be experiencing more vivid dreams .

13 Weeks Pregnant: Questions for Your Healthcare Provider

Why do I sometimes feel pain in my pelvic area? (Some lower back or pelvic pain at 13 weeks pregnant may be associated with round ligament pain resulting from things like your growing uterus, but consult with your healthcare provider about what’s normal and what isn’t.)

Am I gaining the right amount of weight? If not, what changes can I make to get on the right track?

Is chorionic villus sampling recommended?

13 Weeks Pregnant: Your Checklist

Check out some to-dos to help you along during your pregnancy journey:

□ Start doing research into your child care options. You can ask friends, neighbors, or coworkers for recommendations for in-home care or child care centers.

□ If you work, find out about your maternity leave rights and options, including how many weeks you may have, and how much of that time might be paid. You can also ask if your employer offers any additional benefits.

□ Plan how to share your big news with your wider circle of family and friends.

□ Start making a shortlist of possible names for your little one with the help of our Baby Name Generator .

□ As you enter the second trimester, read up on the trimesters of pregnancy for an overview of what’s to come.

How We Wrote This Article The information in this article is based on expert advice found in trusted medical and government sources, such as the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists. You can find a full list of sources used for this article below. The content on this page should not replace professional medical advice. Always consult medical professionals for full diagnosis and treatment.

Mayo Clinic. Guide to a Healthy Pregnancy, 2nd ed. (Rochester, MN: Mayo Clinic Press, 2018).
American College of Obstetricians and Gynecologists. Your Pregnancy and Childbirth: Month to Month, 6th ed. (Washington, DC: American College of Obstetricians and Gynecologists, 2015).
Mayo Clinic. “Pregnancy Week by Week.”
Kids Health. “Week 8.”
Kids Health. “Week 19.”
Cleveland Clinic. “Complete Blood Count.”
Cleveland Clinic. “Quickening in Pregnancy.”
Mayo Clinic. “Fetal development: The 1st trimester.”
NCBI. “Placental Blood Circulation.”
Mayo Clinic. “Placenta: How it works, what's normal.”
Mayo Clinic. “Pregnancy Weight Gain: What’s Healthy?”
March of Dimes. “Common Discomforts of Pregnancy.”
March of Dimes.
ACOG. “Problems of the Digestive System.”
ACOG. “Exercise During Pregnancy.”
Mayo Clinic. “Pelvic Pain Symptoms.”

Review this article:

Understanding the mental health and intention to leave of the public health workforce in Canada during the COVID-19 pandemic: A cross-sectional study

Emily Belita 1 ,
Sarah E. Neil-Sztramko 2 ,
Vanessa De Rubeis 3 ,
Sheila Boamah 1 ,
Jason Cabaj 4 ,
Susan M. Jack 1 , 2 ,
Cory Neudorf 5 ,
Clemence Ongolo Zogo 6 ,
Carolyn Seale 1 ,
Gaynor Watson-Creed 7 &
Maureen Dobbins 1 , 8

BMC Public Health volume 24 , Article number: 2347 ( 2024 ) Cite this article

Metrics details

There is limited evidence about the mental health and intention to leave of the public health workforce in Canada during the COVID-19 pandemic. The objectives of this study were to determine the prevalence of burnout, symptoms of anxiety and depression, and intention to leave among the Canadian public health workforce, and associations with individual and workplace factors.

A cross-sectional study was conducted using data collected by a Canada-wide survey from November 2022 to January 2023, where participants reported sociodemographic and workplace factors. Mental health outcomes were measured using validated tools including the Oldenburg Burnout Inventory, the 7-item Generalized Anxiety Disorder scale, and the 2-item Patient Health Questionnaire to measure symptoms of depression. Participants were asked to report if they intended to leave their position in public health. Logistic regression was used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) for the associations between explanatory variables such as sociodemographic, workplace factors, and outcomes of mental health, and intention to leave public health.

Among the 671 participants, the prevalence of burnout, and symptoms of depression and anxiety in the two weeks prior were 64%, 26%, and 22% respectively. 33% of participants reported they were intending to leave their public health position in the coming year. Across all outcomes, sociodemographic factors were largely not associated with mental health and intention to leave. However, an exception to this was that those with 16–20 years of work experience had higher odds of burnout (aOR = 2.16; 95% CI = 1.12–4.18) compared to those with ≤ 5 years of work experience. Many workplace factors were associated with mental health outcomes and intention to leave public health. Those who felt bullied, threatened, or harassed because of work had increased odds of depressive symptoms (aOR = 1.85; 95% CI = 1.28–2.68), burnout (aOR = 1.61; 95% CI = 1.16–2.23), and intention to leave (aOR = 1.64; 95% CI = 1.13–2.37).

Conclusions

During the COVID-19 pandemic, some of the public health workforce experienced negative impacts on their mental health. 33% of the sample indicated an intention to leave their role, which has the potential to exacerbate pre-existing challenges in workforce retention. Study findings create an impetus for policy and practice changes to mitigate risks to mental health and attrition to create safe and healthy working environments for public health workers during public health crises.

Peer Review reports

The public health workforce played a critical role as the first line of defense in the COVID-19 pandemic response [ 1 , 2 ]. Public health workers assumed a multitude of essential roles and functions that included but was not limited to surveillance, case management, contact tracing, immunizations, risk communication, policy and protocol development, and health education [ 2 , 3 , 4 ]. These roles were performed within an already strained public health system that has been marred by historical divestments in public health staffing and resources [ 5 , 6 ].

Despite the critical role of public health, much of the existing evidence on work experiences throughout the COVID-19 pandemic has focused on health care workers in acute care settings. Of the limited and emerging research, it has been revealed that some public health workers’ daily responsibilities were executed in difficult work environments fraught with heavy workloads, long working hours, constant redeployment and changing roles, limited resources, and insufficient staff to complete assigned work [ 7 , 8 ]. Additionally, public health leaders and workers were spotlighted throughout the pandemic as they were responsible for communicating and enforcing the institution of public health measures with the public [ 2 , 9 ]. In the United States (US), public health workers have reported experiences of criticism and backlash, as well as reports of bullying and harassment [ 1 , 2 , 9 , 10 ]. Similarly in a study of public health workers in Canada, incidents of harassment including yelling, name calling, and rudeness, attributed to public health mandates and vaccine access, have been reported [ 11 ].

Several systematic reviews have focused on the impact of working during the COVID-19 pandemic on the mental health of health care professionals in hospitals or general practice settings, reporting a high prevalence of stress, anxiety, depression, insomnia, and burnout [ 12 , 13 , 14 ]. There have been limited studies exploring the impact of challenging work circumstances in a public health and pandemic context. Of studies that explored the prevalence of mental health outcomes among public health workers, most were conducted in the US with a few emerging from other countries. Across US studies conducted during the COVID-19 pandemic, the prevalence of adverse mental health outcomes ranged from 30.3 to 41% for anxiety and 29.1–30.8% for depression among public health workers [ 15 , 16 , 17 , 18 ]. Capturing a longitudinal perspective on these trends, one US study using a subsample of 85 public health workers reported decreased but persistent rates of anxiety (46.3% vs. 23.2%) and depression (37.8% vs. 26.8%) between 2020 and 2021 [ 19 ]. As well, two studies from China reported similar rates of anxiety (20.6-49.2%) and depression (27.1-45.7%) among frontline public health workers [ 20 , 21 ]. One study from Canada ( n = 2,055), conducted during a later pandemic stage (November 2022 to January 2023), reported a burnout prevalence of 79% among local, provincial, and national public health workers [ 11 ].

Notably, poor mental health and burnout have been associated with higher intent to leave among health care workers [ 22 , 23 ]. Only one Canadian study thus far, has explored the association between intention to leave and burnout among public health workers during the COVID-19 pandemic, reporting an increased odds of intending to leave or retire early for those experiencing burnout (aOR = 6.13; 95% CI = 3.71–10.13) [ 11 ]. As intent to leave can be a potential precursor for actual workplace departure, it is of critical concern within an already strained public health system [ 24 ]. Response to the COVID-19 pandemic has impacted the career trajectory of US public health workers, with a larger proportion reporting intention to leave within one to two years versus pre-pandemic numbers [ 17 ]. Signs of intention to leave, which serves as a potential precursor for actual workplace departure, deserves critical attention given the downstream implications to available public health workforce capacity in the future. The loss of a substantial proportion of a skilled and experienced workforce weakens the infrastructure of the public health system leaving major gaps in its ability to respond to emerging public health crises and ongoing population health issues [ 2 ].

To date, there has not been a study in Canada to investigate mental health outcomes including symptoms of anxiety and depression, burnout, and intention to leave, among the public health workforce in the context of the COVID-19 pandemic and associations with various socio-demographic and workplace factors. Given that a resilient public health system is contingent on a competent, stable, and healthy workforce, attention toward the current state of the public health workforce in Canada is warranted to support funding and organizational human resource decision-making. To this end, the aims of this study were to determine the prevalence of burnout, symptoms of anxiety and depression, and intention to leave public health among the Canadian public health workforce, and to determine associations with individual characteristics and workplace factors.

Design, setting, and sample

A cross-sectional study was conducted using data collected from an online anonymous survey administered in English and French from November 2022-January 2023. Public health professionals with advanced public health or discipline-specific education/training (e.g., nurses, epidemiologists) or other workers (e.g., family home visitors), who were employed in local public health units or regional health authorities in Canada prior to March 2020 and for ≥ 8 months during the COVID-19 pandemic were eligible to participate in this study. Those who were employed prior to the pandemic were prioritized within this sample given that during the COVID-19 pandemic many public health workers were hired on short term contracts which would have substantial implications on intention to leave. Given this, it was important to prioritize trends among the established public health workforce that had roles prior to the pandemic and who would play integral roles in pandemic recovery once contracts ended. Participants were recruited through online communication channels (e.g., social media, email) of national and provincial public health organizations across Canada.

Sociodemographic and workplace characteristics

Participants were asked to report their age, self-identified gender (woman; man; non-binary; if your gender is not listed, please describe; prefer not to answer), ethnicity (Asian; Black/African; Hispanic; Indigenous; Mixed, White/Caucasian; other; prefer not to answer), and education level. Participants were also asked to report their current role/occupation, field of practice within public health, position level, work location in Canada, and years worked.

Workplace stressors and resources

It is well accepted that employment circumstances can be influenced by both demands and resources [ 25 ]. Job demands are defined as a physical, social or organizational workplace stressor that necessitates increased and ongoing effort, while job resources are the supportive job aspects that help to reduce these demands and promote professional and personal development [ 25 ]. The interplay of these two concepts of demands and resources, can be associated with outcomes of disengagement or exhaustion (burnout) [ 25 ]. Two questions were used to evaluate workplace stressors and resources. The first question related to workplace stressors was: please indicate if while working in public health throughout the COVID-19 pandemic you ever experienced/felt any of the following (e.g., felt inadequately compensated for work; received job-related threats because of work). Response options were yes or no across nine developed items used in a previous US public health workforce study and treated as dichotomous data [ 15 ]. The second focused on the adequacy of workplace resources: thinking about your workplace environment overall while working throughout the COVID-19 pandemic, please rate your level of agreement with the following items (e.g., I always find new and interesting aspects in my work; there are days when I feel tired before I arrive at work). Eighteen items in this question originated from the US-based Public Health Workforce Interest and Needs Survey (PH WINS) [ 26 ]. Response options were on a 5-point Likert scale ranging from strongly disagree to strongly agree. In line with the original developers of this scale, a summed score was not used and each item was treated as an individual variable [ 26 ].

Mental health outcomes

Participants were asked to report burnout, and symptoms of anxiety and depression in the past two weeks and during the first wave of the pandemic. The Oldenburg Burnout Inventory (OLBI) was administered to measure participants’ job burnout [ 27 ]. The OLBI consists of 16 items divided into two 8-item subscales of exhaustion and disengagement. Items were rated on a 4-point scale ranging from 1-strongly agree to 4-strongly disagree, with negatively worded items being reverse-scored. For each subscale, items were summed, and an average score was calculated. A cut-off of ≥ 2.1 for disengagement and ≥ 2.25 for exhaustion was applied, based on scores above or below one standard deviation of the mean as used in previous literature [ 25 , 28 , 29 ]. Overall burnout was defined by the presence of both disengagement and exhaustion. The 7-item Generalized Anxiety Disorder (GAD-7) scale was administered to measure symptoms of anxiety, with higher scores indicating increased anxiety severity and where a score of ≥ 10 was considered to be indicative of potential clinical cases of GAD [ 30 ]. Items were rated on a 4-point scale from 0-not at all to 3-nearly every day. For depressive symptoms, the validated 2-item Patient Health Questionnaire (PHQ-2) was administered using a scale of 0-not at all to 3-nearly every day. A cut-off of ≥ 3 was used to indicate potential depression requiring further screening [ 31 ].

Intention to leave public health

A single-item adapted from a US national workforce survey assessed intention to leave public health to explore the potential future of the public health workforce. Participants were asked, “Are you considering leaving your position/organization in public health within the next year, and if so, why?” [ 26 ]. Response options were coded as: no (including not intending to leave job or intending to take a job in another public health unit or regional health authority) or, yes (including to take another job not in public health; to retire) and, unsure. Participants who reported they were unsure were marked as missing for the analysis. Participants were also asked if their intention to leave was influenced by their experiences working throughout the pandemic (no/yes).

Statistical analysis

All analyses were conducted using SAS 9.4. Descriptive statistics were calculated for sociodemographic (age, gender, ethnicity, and education) and workplace characteristics (current role/occupation, field of practice, position level, work situated, and years worked), and workplace factors using frequency and percentage or mean and standard deviation.

To determine the associations between sociodemographic characteristics, workplace characteristics and workplace stressors with mental health in the past two weeks and intention to leave public health, we used univariate and multivariate logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs). To maintain a reasonable scope for this paper, associations with workplace stressors were reported and, in the future, associations with workplace resources will be explored. Due to small cell sizes, only some demographic/workplace variables were included in the multivariate regression models as explanatory variables. We ran unadjusted models (Supplementary Material) and models adjusted for age, gender, ethnicity, and education. Since there was minimal missing data across covariates, including explanatory and outcome variables, complete case analysis was used. These variables were identified a priori based on previous literature [ 15 , 17 , 32 ]. A secondary analysis was conducted where models were run to determine the associations between sociodemographic, workplace characteristics and stressors with mental health during the first wave of the pandemic.

Among the 671 public health workers in Canada who completed the survey, 7% were aged 18–29 years, 31% aged 30–38 years, 32% aged 40–49 years and the remaining 30% were 50 + years of age. Most participants self-identified their gender as woman ( n = 588; 89%) and were of white ethnicity ( n = 547; 84%). There was variation in the different roles/employment in which participants reported that they currently worked in, with the highest proportion reporting their current role as a nurse ( n = 275; 41%). Similarly, there was variation in position level, with just over half reporting they were a front-line public health/community provider ( n = 382; 57%). Most participants worked in Ontario ( n = 516; 77%). A complete description of sociodemographic and workplace characteristics can be found in Table 1 .

Prevalence of mental health and intention-to-leave public health

During the past two weeks, the prevalence of burnout, depression and anxiety symptoms were 64%, 26%, and 22%, respectively. Prevalence of burnout, depression, and anxiety symptoms from the first wave of the pandemic (March 2020 to Fall 2020), was 81%, 41%, and 53%, respectively (Fig. 1 ).

Prevalence of mental health symptoms during the first wave of the pandemic, and past two weeks among the Canadian public health workforce

Approximately 33% of participants reported they had intentions to leave their public health position ( n = 193), with the highest proportion among people who were aged 50+ ( n = 74; 39%) (Fig. 2 ). Reasons for intending to leave public health include they intended to take a job outside of public health ( n = 138) or to retire ( n = 55). The majority of people also reported their intention to leave was influenced by experiences during the pandemic ( n = 158; 82%).

Prevalence of age among the Canadian public health workforce ( n = 578), stratified by intention to leave public health

Associations between sociodemographic characteristics and mental health, and intention to leave public health

Socio-demographic factors were largely not associated with mental health or intention to leave. However, an exception to this was those participants with 16 to 20 years of work experience, who demonstrated increased odds of disengagement (aOR = 2.44; 95% CI = 1.07–5.58), exhaustion (aOR = 2.84; 95% CI = 1.40–5.76), and overall burnout (aOR = 2.16; 95% CI = 1.12–4.18) compared to those with 0–5 years of work experience. As well, those aged 50 + years experienced an increased odds of intention to leave (aOR = 2.35; 95% CI = 1.04–5.31). Those experiencing anxiety symptoms (aOR = 2.60; 95% CI = 1.69-4.00), depression symptoms (aOR = 2.06; 95% CI = 1.37–3.08), and burnout (aOR = 2.15; 95% CI = 1.45–3.17), had higher odds of intention to leave. Similar associations were observed among adjusted (Table 2 ) and unadjusted estimates, with the exception of a non-significant association with overall burnout in unadjusted estimates (Additional File 1 ).

As well, in the first wave of the pandemic, women had increased odds of anxiety (aOR = 2.38; 95% CI = 1.36–4.16) and exhaustion (aOR = 2.13; 95% CI = 1.08–4.21) compared to men. Although findings within the last two weeks pertaining to anxiety (aOR = 1.20; 95% CI = 0.60–2.36), depression symptoms (aOR = 0.84; 95% CI = 0.47–1.50), burnout (aOR = 1.62; 95% CI = 0.95–2.75), disengagement (aOR = 1.68; 95% CI = 0.93–3.01), exhaustion (aOR = 1.49; 95% CI = 0.87–2.57), and intention to leave public health (aOR = 1.05; 95% CI = 0.59–1.89), compared to men were not statistically significant. Additional associations between sociodemographic characteristics, and mental health during the first wave of the pandemic are identified in Additional File 2 .

Prevalence of workplace resources related to the COVID-19 pandemic

Participants were asked about workplace resources related to the pandemic (Table 3 ). Many participants reported that they agreed/strongly agreed that they had an understanding about how their work relates to the organization’s goals and priorities (86%) and believed that the work they do is important (91%). Many participants also reported positive relationships with leadership reporting that they agreed/strongly agreed that they have a good working relationship with their supervisor (75%) and that their supervisor treats them with respect (77%). Notably, many participants disagreed/strongly disagreed that their training needs were assessed (47%), that they were provided sufficient training to utilize technology needed for their work (41%), and that their creativity and innovation was rewarded (45%).

Prevalence of workplace stressors during the COVID-19 pandemic and associations with mental health and intention to leave

Public health workers experienced a myriad of workplace stressors during the COVID-19 pandemic. Most stressors were prevalent, with the highest proportion of people reporting they felt overwhelmed by workload or family/work balance ( n = 609; 91%). Most participants reported feeling inadequately compensated for work ( n = 484; 73%) and unappreciated at work ( n = 483; 72%). Some of the public health workers in our sample also received job-related threats ( n = 235; 35%), experienced stigma/discrimination because of their work ( n = 360; 54%), and felt bullied, threatened, or harassed because of their public health role ( n = 360; 54%; Table 4 ).

Generally, many stressors were associated with anxiety and depression symptoms, burnout, disengagement, and exhaustion subscales, and intention to leave public health for adjusted (Table 4 ) and unadjusted estimates (Additional File 3 ). For instance, those who reported they felt inadequately compensated for their work had higher odds of anxiety (aOR = 4.86; 95% CI = 2.64–8.97), depression symptoms (aOR = 3.40; 95% CI = 2.06–5.60), burnout (aOR = 2.64; 95% CI = 1.83–3.81) and intention to leave public health (aOR = 1.84; 95% CI = 1.20–2.82). Increased odds of anxiety (aOR = 2.20; 95% CI = 1.35–3.59), depression symptoms (aOR = 2.50; 95% CI = 1.57–3.97), burnout (aOR = 2.61; 95% CI = 1.82–3.76), and intention to leave (aOR = 2.49; 95% CI = 1.60-3.87), were also demonstrated among those who reported feeling unappreciated at work. As well, those who felt bullied, threatened, or harassed because of work had increased odds of depression symptoms (aOR = 1.85; 95% CI = 1.28–2.68), burnout (aOR = 1.61; 95% CI = 1.16–2.23), and intention to leave (aOR = 1.64; 95% CI = 1.13–2.37). Stressors also tended to be significantly associated with mental health outcomes during the first wave of the pandemic (Additional File 4 ).

This study offers a beginning illustration of the state of mental health and intention to leave among a sample of public health workers in Canada during the COVID-19 pandemic. Findings reflect that some of the public health workforce experienced symptoms of anxiety and depression, burnout, and intention to leave in the context of challenging working conditions. The prevalence of adverse mental health outcomes in this study during the first wave of the pandemic for burnout, anxiety, and depression symptoms was 81%, 53%, and 41%, respectively. In the two weeks preceding survey completion, prevalence of burnout, anxiety symptoms, and depression symptoms was 64%, 22%, and 26%, respectively. In a study of 2,055 Canadian public health practitioners, burnout prevalence was comparatively higher (79%) [ 11 ] than our findings (64%) during a similar data collection period (November 2022 – January 2023). However, first wave prevalence rates of anxiety and depression symptoms in our study were higher compared to other studies in the US. Given we asked participants to retrospectively report these outcomes, recall bias likely influenced these rates. In a study of 354 public health workers from 35 states across the US, 39.6% and 29.4% reported symptoms of anxiety and depression, respectively, between August 2020 to January 2021 [ 16 ]. Similar findings were reported by Bryant-Genevier et al. [ 15 , 18 ] in a large study of state, tribal, and territorial health department workers ( n = 26,174) across the US in which half (53%) reported symptoms of at least one adverse mental health condition and 30.3% and 30.8% experienced anxiety and depression respectively between March and April 2021. Slightly lower rates of depression (27.1%) and anxiety (20.6%) were reported in a study of public health workers in China ( n = 2,313), although this was during very early pandemic periods (February to March 2020) where the impact of working through the COVID-19 pandemic may not have yet been fully realized [ 20 ]. Variations in prevalence rates may be associated with the pandemic wave in which data was collected, differences in the implementation of public health measures and severity/volume of COVID-19 cases corresponding to different levels of response and workloads across geographic regions. Additionally, prevalence rates may also be impacted by different moderating factors at the individual (e.g., social, financial), workplace setting, and societal/cultural level that may influence risk for mental health challenges [ 16 ].

In our study, specific subgroups were identified as being at more risk of certain mental health outcomes, requiring more focused attention. For example, within the first wave of the pandemic, in our sample, women had higher odds of anxiety, and exhaustion compared to men, which are similar to results reported in Canada, the US and Japan; increased prevalence or odds of exhaustion [ 11 ] or burnout [ 17 , 33 ] and increased risk of anxiety and depression among women public health workers compared to men have been noted [ 16 ]. Of note, in a study of Canadian public health workers, odds of exhaustion among women were significantly higher compared to men (aOR = 1.56; 95% CI = 1.09–2.25) [ 11 ]. Findings have importance for public health nurses, a largely female dominated field, who represent the largest professional group within the public health workforce [ 33 ]. Public health nurses experienced unique challenges during the COVID-19 pandemic given that their nursing designation was associated with work overload, expectations and organizational obligations to fulfil diverse and multiple types of work roles, and pressures to simultaneously staff the COVID-19 pandemic response efforts while maintaining mandated health promotion work [ 8 ].

As well, those with 16 to 20 years of work experience had twice the odds of disengagement, exhaustion, and overall burnout compared to those with less work experience in our study. This was similarly found in a cross-sectional study of Canadian public health workers in 2022/2023, in which those who had 10 to 19 years of work experience also had higher odds of burnout compared to those with less than 2 years experience (aOR = 2.45; 95% CI = 1.72–3.49) [ 11 ]. High burnout prevalence was also reported among a group of US public health workers ( n = 225) with 15 + years of experience (63.5%) compared to those with less than 1 year of work experience (38.1%) [ 17 ]. In this same study, more experienced workers (10–14 years) were over four times as likely to report burnout versus those with less experience (< 1 year) [ 17 ]. Within these groups of higher work experience, it would be important to consider the potential that additional personal or household demands beyond the work environment may also play a role in influencing mental health outcomes.

Thirty-three percent of participants in our study identified that they were intending to leave their public health position/organization in the following year. This is slightly lower than findings reported in a study of US public health workers who were considering leaving their job because of the pandemic (44%) [ 34 ]. Since the COVID-19 pandemic, rates among public health professionals planning to leave or retire within the next two years has increased from 4.8 to 12% in the US [ 17 ]. Additional findings in our study identify that the highest proportion of those in the age group of ≥ 50 years were intending to leave and those aged 50 + years had almost twice the odds of intention to leave. These rates sound the alarm on attrition and workforce gaps of experienced public health workers across the US and Canada. Due to the temporary suspension of public health services and programs related to maternal-child, chronic disease, substance use, and other non-COVID infectious diseases (e.g., sexually transmitted infections, tuberculosis) during the COVID-19 pandemic [ 35 , 36 ], a sufficient and expert public health workforce will be evermore critical in responding to imminent and growing population and community needs in a post-COVID era. At this juncture, recruitment and retention should be prioritized for funding bodies and health units to ensure a stable and competent public health workforce is available to deal with emerging public health crises.

Challenging work experiences and environments reported by public health workers in our study also mirror difficult conditions reported elsewhere. Our study found higher prevalence rates compared to a US study of 26,174 public health staff [ 15 ] related to overwhelming workloads (91% vs. 72%), receiving job-related threats (72% vs. 11.8%), and feeling bullied, threatened or harassed because of work (54% vs. 23.4%). These differences may be due to a relatively larger proportion of our study sample (80%) having frequent interactions with the public compared to under half (43%) of the US-based study sample [ 15 ] being in public facing roles. Differences may also be attributed to changes in perceptions of the public health workforce across different pandemic waves. Earlier in the pandemic workers were labelled as health care heroes, although as the pandemic progressed and more restrictive public health measures were implemented, hostility and mistrust from the public grew toward public health entities [ 9 , 34 , 37 ]. Growing concerns about workplace violence against public health workers have precipitated conversations and recommendations around their protection including the use of risk management training in health departments, conflict management and de-escalation strategies [ 34 , 38 ].

Also concerning are the positive associations between workplace stressors plaguing most of our study sample and reported mental health outcomes and intention to leave. These relationships also held true among a sample of US public health workers in which experiencing any type or number of workplace violence event (e.g., bullying, harassment, job-related threats) was associated with increased prevalence risk for depression symptoms (PR = 1.95; 95% CI = 1.87–2.03), anxiety symptoms, (PR = 1.87; 95% CI = 1.80–1.94) and post-traumatic stress disorder (PR = 2.0; 95% CI = 1.93–2.07) [ 38 ]. A lack of appreciation at work was also associated with increased anxiety symptoms (aPR = 1.15; 95% CI = 1.10–1.20) and depression symptoms (aPR = 1.15; 95% CI = 1.10–1.21) in a study of US public health workers [ 39 ]. In comparison, our study found higher odds of anxiety (aOR = 2.20; 95% CI = 1.35–3.59) and depression (aOR = 2.50; 95% CI = 1.57–3.97) among those reporting feeling unappreciated at work.

Our study findings, in alignment with other public health workforce studies underscore alarming mental health needs and an anticipated exodus of experienced staff, precipitated by challenging working conditions throughout the COVID-19 pandemic. This calls for attention toward effective interventions to mitigate risks to the mental health of public health workers during pandemics and support the current workforce in pandemic recovery. The lack of significant associations between mental health outcomes and many of the socio-demographic variables but strong associations between mental health and workplace factors provides strong rationale for the need for organizational level interventions that foster positive mental health. An evidence synthesis of 28 reviews on strategies or interventions to support the mental health and resilience of frontline health care workers during the COVID-19 pandemic or previous pandemics determined that none of the reviews included studies in public health, although some of the strategies identified could potentially be modified for a public health setting [ 40 ]. Synthesis findings highlighted three main areas for consideration including: individual and team strategies centred on training and education, peer/social support and behaviour-based interventions targeting mental health; organization and management strategies addressing staffing and workloads, communication, positive workplace culture and effective leadership; and policies on pandemic preparedness, occupational health, and funding for mental health resources [ 40 ]. These strategies align well with a proposed framework by Preston et al. [ 41 ] to sustain resilience and promote the mental health of the public health workforce using a three-tiered system of intervening at the frontline staff level (Tier 1), the program and supervisor level (Tier 2), and at the senior management and executive levels (Tier 3). Preston et al. [ 41 ] further advocate for an upstream approach in the development of organizational policies and practices that set the tone for workplace wellness.

While this study provides one of the first explorations on various mental health outcomes and intention to leave among the public health workforce in Canada during the COVID-19 pandemic, there are limitations to consider. First, our study includes a small sample size limiting power to conduct certain analyses and may potentially explain some of the statistically non-significant findings and wide confidence intervals. However, the results are still important given the limited existing evidence on this topic and indications of concerning challenges experienced by the public health workforce that warrant further exploration. A second limitation considers the risk of sampling bias. It is important to note that it is possible that those who volunteered to participate in the survey may differ from individuals who decided not to participate based on socio-demographic characteristics or mental health and intention to leave outcomes of interest. Related to this, it is difficult to comment specifically on the representativeness of this sample given the lack of robust data on the public health workforce in Canada, which remains a longstanding challenge. A third sample limitation relates to the majority of participants being located in the province of Ontario. While this does represent the most populous province in Canada, there is still an under representation of perspectives and experiences from other provinces and territories and as such, the results may not be generalizable to the entirety of the public health workforce across Canada. In future public health workforce studies, more targeted recruitment approaches at the provincial level may help to remedy this particular challenge. Our team was also unable to conduct sub analyses based on race or ethnicity given the small size and homogeneity of our sample. A related limitation to this is that the response options provided to participants to capture their race did not align with updated Canadian guidance for collecting race-based data. We recognize this as an important area for future investigation to ensure this data is accurately collected and to also capture public health workers that self-identify as multiple races [ 15 ], as a higher prevalence of anxiety and depression has been noted among those that self-identify as multiple races in the US. In addition, given the small sample sizes across position and role categories, we were unable to conduct sub analyses pertaining to these factors, eliciting another future area of exploration comparing the influence of public health roles on mental health and intention to leave outcomes. We also were unable to explore characteristics associated with participants who reported they were unsure about their intention to leave public health. This may be an interesting area for future work, as this may be a distinct subgroup who share similar characteristics. Given that our sample inclusion criteria focused specifically on public health workers employed in local or regional public health organizations, we recognize that the results of this study may not generalize to those working in public health in the academic field or the federal government. As well, the use of a two-item measure to assess symptoms of depression may have limitations with respect to sensitivity or specificity compared to a longer measure such as the PHQ-9, however, for the purposes of this study, it was important to consider survey burden with this study population during data collection.

Study findings provide a beginning perspective on the extent to which the public health workforce was impacted while working throughout the COVID-19 pandemic. Concerning and lingering rates of burnout, anxiety, and depression plaguing the public health workforce signal an important juncture for public health employers and funding bodies to strategically address these issues with impending population and community health needs on the horizon in post-COVID-19 pandemic recovery. With notions of older and experienced workers intending to leave their positions, the public health workforce is at compounded risk of instability. Urgent attention is needed to further understand workforce groups at most risk of mental health outcomes and attrition, and what specific interventions can mitigate these challenges in public health work environments. Our findings suggest that organizational factors and workplace experiences may play more of a critical role in influencing mental health outcomes and intention to leave among the public health workforce compared to individual characteristics. As such, it would be imperative for public health leaders to consider cultivating an environment for employees in which they feel valued, adequately compensated, and a sense of physical and emotional safety.

Data availability

The datasets supporting the conclusions of this article are available upon request from the corresponding author.

Abbreviations

Confidence Interval

7-item Generalized Anxiety Disorder

Oldenburg Burnout Inventory

Adjusted odds ratio

2-item Patient Health Questionnaire

9-item Patient Health Questionnaire

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This project was funded through the Canadian Institutes of Health Research (CIHR) under grant #WI2 179945. The funding body did not play any role in the design, collection, analysis, or interpretation of the data and in manuscript development.

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EB, SNS, SB, JC, SMJ, CN, GWC, MD contributed to the study design. EB, COZ, SNS, and MD led data collection. VD conducted data analysis. EB, VD, and CS developed the first manuscript draft. All authors read and approved the final manuscript.

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Supplementary Material 1: Additional File 1 . Unadjusted association between sociodemographic characteristics, mental health in the past two weeks, and intention-to-leave public health

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Supplementary Material 2: Additional File 2 . The adjusted association between sociodemographic characteristics, mental health during the first wave of the pandemic

12889_2024_19783_MOESM3_ESM.docx

Supplementary Material 3: Additional File 3 . The unadjusted association between workplace stressors and mental health in the past two weeks, and intention-to-leave public health

12889_2024_19783_MOESM4_ESM.docx

Supplementary Material 4: Additional File 4 . The adjusted association between workplace stressors and mental health during the first wave of the pandemic

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Belita, E., Neil-Sztramko, S.E., De Rubeis, V. et al. Understanding the mental health and intention to leave of the public health workforce in Canada during the COVID-19 pandemic: A cross-sectional study. BMC Public Health 24 , 2347 (2024). https://doi.org/10.1186/s12889-024-19783-1

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The evolution of fetal presentation during pregnancy: a retrospective, descriptive cross-sectional study
Introduction. Cephalic presentation is the most physiologic and frequent fetal presentation and is associated with the highest rate of successful vaginal delivery as well as with the lowest frequency of complications 1.Studies on the frequency of breech presentation by gestational age (GA) were published more than 20 years ago 2, 3, and it has been known that the prevalence of breech ...
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The most common clinical correlation of the abnormal fetal lies and presentations is the breech-presenting fetus. ... (weeks) 37-41 <37; >41. Estimated fetal weight (g) 2000-4000 >4000; 1000-2000. Type of breech ... Fetal heart rate patterns, particularly in the second stage of labor, may have pronounced variable decelerations. In breech ...
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Cephalic occiput anterior. Your baby is head down and facing your back. Almost 95 percent of babies in the head-first position face this way. This position is considered to be the best for ...
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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.
Baby and You at 13 Weeks Pregnant: Symptoms and Development
At 13 weeks pregnant, you're turning the corner and may even feel like a new woman after a first trimester of morning sickness, fatigue and other issues. You may experience 13 weeks pregnant symptoms, as well as some indigestion, achiness and tiredness that's typical in the first trimester. Expect to feel a lot more at ease in the second ...
Presentation and position of baby through pregnancy and at birth
If your baby is headfirst, the 3 main types of presentation are: anterior - when the back of your baby's head is at the front of your belly. lateral - when the back of your baby's head is facing your side. posterior - when the back of your baby's head is towards your back. Top row: 'right anterior — left anterior'.
13 Weeks Pregnant: Baby Development, Symptoms & Signs
There are 9,614 active discussions happening now with other February 2025 parents-to-be. Join in. At 13 weeks pregnant, your baby is the size of a lemon. Your baby can suck its thumb now in utero and its intestines have moved from your umbilical cord to its abdomen. Most of your early pregnancy symptoms may be behind you.
Breech Presentation
Breech presentation refers to the fetus in the longitudinal lie with the buttocks or lower extremity entering the pelvis first. The 3 types of breech presentation are frank, complete, and incomplete. 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 ...
The evolution of fetal presentation during pregnancy: a retrospective
A total of 18 019 ultrasound examinations were used. From 22 to 36 weeks of gestation, the prevalence of cephalic presentation increased from 47% (45-50%) to 94% (91-96%), before and after which times plateaus were noted. Spontaneous change from breech to cephalic is unlikely to occur after 36 weeks of gestation.
13 Weeks Pregnant and Baby Development
13 Weeks Pregnant Belly. As you reach the 13th week of pregnancy, your body starts to undergo noticeable changes in your belly. At this stage, your uterus has expanded significantly and is approximately the size of a large orange or grapefruit. This growth is a clear indication of your baby's development and a reminder that you are ...
13 Weeks Pregnant: Symptoms, Milestones, and More
At 13 weeks pregnant, your fetus is about 2.91 inches and weighs about .81 ounces. It's the size of a small peach or plum, according to Olivia Dziadek, MD , OB-GYN and assistant professor at UT ...
Full article: Changes in fetal presentation in the preterm period and
Categorical variables were analyzed using the Chi-squared (if all the values were larger than 10) or Fisher's exact tests. In the analysis to reveal the difference of two groups, ... Focusing on the group showing non-cephalic presentation at 35/36 weeks of gestation ... [Citation 13]. Their study showed that SCV was observed with lower ...
A comparison of risk factors for breech presentation in preterm and
Introduction. The prevalence of breech presentation at delivery decreases with increasing gestational age. At 28 pregnancy weeks, every fifth fetus lies in the breech presentation and in term pregnancies, less than 4% of all singleton fetuses are in breech presentation at delivery [1, 2].Most likely this is due to a lack of fetal movements [] or an incomplete fetal rotation, since the ...
Fetal malpresentation
Breech presentation is the most commonly encountered malpresentation. Since publication of the Term Breech Trial that showed benefits for the fetus in undertaking caesarean section, there has been a large shift in practice. Nonetheless the fact remains that most babies will not be compromised by planning a vaginal birth, and maternal requests for vaginal delivery are not unreasonable. Many ...
13 weeks pregnant: Symptoms, tips, and baby development
Flo Premium. Secret Chats. Symptom Checker. Your cycle. Health 360°. Getting pregnant. It's the final week of your first trimester. Here's what to expect at 13 weeks pregnant.
Your developing baby week 13
At 13 weeks, your baby is about 3.5 inches long around the size of a plum. By the time you reach week 13, the placenta has fully formed and begun providing your baby with nutrients and oxygen. It also removes the baby's waste. Your baby's: Veins and internal organs appear through the baby's nearly see-through (transparent) skin.
Increased nuchal translucency before 11 weeks of gestation: Reason for
At 10 weeks of gestation, NT measurement ≥2.5 mm was only found in 4.6% of euploid fetuses, corresponding with the p95. 13 More recently, reference ranges for NT at 28-44 mm CRL (9 + 4 to 11 + 1 weeks) were established and the 95th percentile ranged from 1.95 to 2.38 mm in a series of 583 chromosomally normal fetuses. 14
You and your baby at 13 weeks pregnant
Your baby at 13 weeks. Your baby weighs around 25g. Your baby's ovaries or testes are fully developed inside their body, and the genitals are forming outside their body. Where there was a swelling between the legs, there will now be a penis or clitoris growing, although you will not usually be able to find out the sex of your baby at an ...
Intrapartum Fetal Heart Rate Monitoring
Fetal Heart Rate Monitoring. A sinusoidal pattern has regular amplitude and frequency and is excluded in the definition of variability.A sinusoidal pattern "Visually apparent, smooth, sine wave-like undulating pattern in FHR baseline with a cycle frequency of 3-5 per minute which persists for 20 minutes or more.".. Variability is absent. This pattern has been associated with severe fetal anemia.
13 Weeks Pregnant: Symptoms and Baby Development
Your baby is starting to move and flex their arms and legs. Pregnancy symptoms such as morning sickness and fatigue may begin to ease at 13 weeks. You might notice some colostrum leaking from your breasts during this time. This thick, yellow fluid is considered your baby's first milk in the first few days after birth.
Understanding the mental health and intention to leave of the public
The public health workforce played a critical role as the first line of defense in the COVID-19 pandemic response [1, 2].Public health workers assumed a multitude of essential roles and functions that included but was not limited to surveillance, case management, contact tracing, immunizations, risk communication, policy and protocol development, and health education [2,3,4].

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

Position and Presentation of the Fetus

Variations in Fetal Position and Presentation

Occiput posterior position

Breech presentation

Other presentations

Breech, posterior, transverse lie: What position is my baby in?

Fetal presentation and position

Head down, facing down (anterior position)

Head down, facing up (posterior position)

Frank breech

Complete breech

Incomplete breech

Single footling breech

Double footling breech

Transverse lie

Oblique lie

What to know if your baby is breech

9 of the most jaw-dropping breech birth photos

Cord prolapse during pregnancy

Augmentation of labor: Why it's used to speed up childbirth

Where to go next

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

Transverse lie

Breech presentation

Types of breech presentations

Face or brow presentation

Occiput posterior position

Position and Presentation of the Fetus

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Presentation and position of baby through pregnancy and at birth

What does presentation and position mean?

What are the different types of presentation my baby could be in during pregnancy and birth?

What are the different positions my baby could be in during pregnancy and birth?

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What is the ideal presentation and position for baby to be in for a vaginal birth?

When does a baby usually get in the ideal presentation and position for birth?

What are my options if baby isn't in the ideal presentation or position for a vaginal birth?

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Breech presentation and turning the baby

Breech Presentation at the End of your Pregnancy

External Cephalic Version for Breech Presentation - Pregnancy and the first five years

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Anatomy of pregnancy and birth - pelvis

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13 Weeks Pregnant

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The evolution of fetal presentation during pregnancy: a retrospective, descriptive cross-sectional study

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