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...neverthenless!

20.000 km by bike, why “… neverthenless” .

Panamericana 2022

My name is Darius Braun and I will start my adventure on July 18, 2022, cycling over 20,000 kilometers along the Panamericana.

Riding the Panamericana by bicycle – a distance of well over 20,000 kilometers from North to South America – is a risky but appealing project for intrepid and adventurous people.

For me, this project is much more than just an adventure. Apart from the fact that I want to make it at all, I want to get the message out to the world that it is worth believing in yourself, no matter how hopeless a situation may seem. And by that I don’t mean the hardships of the cycling adventure that await me, but the suffering that lies behind me and that I have already overcome.

After a brain tumor operation at the age of 15, I was completely paralyzed on my left side, could no longer walk, and had speech and concentration problems. I was lucky to be able to start a new life at all. Even my family at that time would have considered it completely illusory that I could ever dare and realize such a journey again. At that time, there was no prospect whatsoever of being able to even remotely match my earlier successes as a competitive athlete.

In the course of my recovery, I worked hard on myself and today I feel very well prepared to set out on the great adventure. With my leitmotif “And yet”, as a former brain tumor patient, I want to show and prove that it is important not to give up on yourself and that anything can be possible.

With this extraordinary cycling adventure I want to realize my biggest life dream, which I have had since childhood. My goal is to gain experience for myself personally and share it with the world. With this, I want to inspire and encourage people in difficult life situations, who may have a similar fate as me, to believe in themselves and to realize their dreams.

With my bike tour, I want to bring the topic of brain tumors into the focus of the public in order to create more awareness for this terrible disease. At the same time, I would like to use my project to encourage people to donate to the German Brain Tumor Aid. This will enable those affected to get the resources they need to fight the disease.

Darius Braun

Once across Germany on bike

The true face of the Andes

From “Pucallpa” my journey led me further south. The day before departure, I checked my bike again and realized that some parts were missing. My

The depths of the Amazon

From “El Coca” we went over the “Rio Napo”, one of the countless tributaries of the Amazon, about 200 km to “Nuevo Rocafuerte”, a small

To the center of the world

Shortly after the border town “Ipiales” I crossed the border to Ecuador. The border crossing went smoothly and after a few minutes I was now

The estimated route should lead over 20,000 km through North and South America. I want to start deliberately from Calgary to ride the western part of the Trans Canadian Trail. Here begins the wild romantic Canada, as one knows it from adventure travel reports or from nature photographs. In addition, it was always a wish of mine to ride the Panamericana, which is why I will then follow this route to South America.

Since sports and sustainability play an elementary role for me in life, I came up with the idea to travel the route by bicycle, which allows me to cover relatively long distances in an environmentally friendly way. At the same time, it gives me enough time to enjoy landscapes, get in touch with people and participate in their lives. With the help of my travel blog I can report about my experiences and adventures on the route, create more awareness for brain tumor diseases and their consequences and inspire people.

Duration and distance

Since I want to give my adventure a time frame, it seemed fitting to set 14 months for this endeavor. Due to the varying nature of the entire route and many impassabilities, such as poorly constructed roads or enormous altitude differences of over 4000 meters, I consider an average distance of 60-70 km per day, viewed over the entire route, to be realistic.

Based on this, this distance can be completed in about 4 hours at an average speed of 15 km/h. Thus I need for the approx. 22,000 km about 350 days. This leaves a buffer of at least 70 days for unscheduled repairs, sightseeing and regeneration.

Travel time

Due to the geographic conditions and the prevailing wind directions from the northwest, it is recommended to do the tour from north to south. Since the Rocky Mountains have to be crossed right at the beginning of the route between Calgary and Vancouver and the best travel period for this is between July and the end of September, I will start my trip on July 18, 2022.

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Become a sponsor and support my project

ADDED VALUE FOR YOUR COMPANY

Since my adventure is also about overcoming self-imposed limits and showing other people to face any challenge despite limitations, I want to be motivating and inspiring for other people.

With the help of a travel blog on my homepage, Facebook, Instagram and YouTube I want to share all impressions and moments. Among other things, I can also show the important role of your company through social networks, link you on my homepage and pictures and thus draw attention to your company. Among other things, I could present your logo through advertising space on clothing or the bike bags. In addition, I would offer you after the adventure a travel lecture in your company, internally as well as for the public to hold.

Thus, you can present a direct example to the population which social projects are supported by your help. For these reasons I am sure that it could be of interest for you to support me in my project.

• Download Handout Darius Braun

Donations received from the Germany Tour 2020

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Always on the bright side of life.

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Ein Fahrrad, das Nötigste und endlose Strassen. Hier gibts die Geschichte dazu.

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Canada , central america , mexico , north america , south america , sustainable travel , travel stories , united states, slow and steady: cycling the pan-american highway.

• Published October 25, 2018

Johannes Preuß decided to make his first long-distance cycling tour a big one. Sure, he had gone on a few day-trips, shorter rides between his hometown of Meppen, Germany, and the university he attended 80 miles (140 kilometers) away. He’d even completed a three-day trek that took him to his sister’s place in Cologne. But the journey Johannes is currently on is an entirely different beast, and that beast is called the Pan-American Highway — a loose network of roads stretching from the Arctic to Argentina.

To save money for such a grand endeavor, Johannes shut himself away in a small town in the Austrian Alps, where he waited tables for a few months. Once his budget was secured, he returned home to Germany and turned his attention to more detailed preparation — countless hours of researching, acquiring, and customizing equipment, which included a new bike and specialized gear that would ready him for all possible weather conditions. Then, after all the calculating and packing was finished, he set off.

The tour generally takes about 18 months, and covers roughly 15,000 miles (24,000 kilometers) when it’s all said and done — an impressive feat to complete in a car, let alone on a bicycle. Though most of the cyclists who tackle this monster of a highway choose to start in Prudhoe Bay, Alaska, Johannes decided to fly into Inuvik, a small community in Canada’s Northwest Territories, instead. To him, this choice would add extra adventure to the trip as he was forced to travel through extremely isolated territory along the famous Dempster Highway . But still, his eyes — just like any other Pan American cyclist — were on the finish line a world away in Ushuaia, a resort town on the southernmost point of Argentina.

“Most of the time, I plan for the next few days, but not any further,” he explained. “Whenever people tell me to go to a certain place, I do it. Of course, you need to know where you can get food and water along the way, but that’s about it.”

“I met a nice group of young people at a campground on the Dempster Highway,” Johannes recalled. “One woman gave me her contact information and told me that I should email her when I was around Prince George, and she would invite me to her parent’s place.”

It was over a month later when Johannes finally pedaled into Prince George, but his friend hadn’t forgotten him. He stayed with her family for two nights and left with gifts of food and even a little cash for his next campsite.

For someone traveling alone for the first time, these encounters are not easily forgotten.

“I would describe myself as a shy person, especially when I meet new people,” Johannes said. “But this has changed. Now, I approach people, talk to them — I want to hear their stories.”

But would he change anything about his experience? Not at all. Traveling by bicycle has proved to be an entirely unique way to experience a new destination. Instead of transporting himself by plane, train, or car, Johannes is immersed in his surroundings, moving through the main arteries of the country’s culture and interacting with locals along the way — there’s no hiding from it or from them.

”People react differently when they see someone on a fully packed bicycle,” he added. ”They often see me and ask what I am doing and where I am going. It is always a nice talk.” 


At the time of writing, Johannes is a little over two months into his ride and is closing in on the American border. To cross, he’ll take a ferry from Vancouver Island to Seattle, Washington, and stick close to the Pacific Coast for most of his time in the U.S., another checkpoint on his list completed.

To keep up with Johannes’s journey, follow along on Instagram !

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Panamericana Reise-Infos

Wertvolle Reise-Infos und Tipps von erfahrenen Panamericana Reisenden. Für die Vorbereitung einer Panamericana Reise und für die aktuellen Infos unterwegs.

Gute Informationen und praktische Tipps für eine Panamericana Tour sind auf den meisten Websites der Panamericana Reisenden zu finden. Auf ihren Reise-Blogs geben sie ihre gesammelten Reiseerfahrungen kostenlos weiter und teilen sie so mit der Gemeinschaft der Globetrotter.

Detailliert werden die eigenen Übernachtungsplätze in Nordamerika, Zentralamerika und Südamerika in »Campinglisten« dokumentiert, die Abläufe an den Grenzübergängen und bei der Fahrzeug-Verschiffung beschrieben und die Adressen von Werkstätten gesammelt.

Mit PanamericanaInfo sollen diese wertvollen Informationen in den Tiefen des Internets einfacher und schneller zu finden sein. Dazu wird in entsprechenden Kategorien zu den Infos auf den Websites der Panamericana Reisenden verlinkt.

Übersicht der Reise-Infos

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Panamericana – Traumstraße für Abenteurer Übernachtungsplätze – Stellplätze und Campingplätze Abstellplätze – Unterstellplätze, RV-Storages Grenzen – Infos zu den Formalitäten an den Grenzübergängen Werkstätten – Adressen in Nordamerika und Südamerika GPS Navigation – GPS Karten für Nordamerika und Südamerika Reisewarnungen – Vorfälle in Nordamerika und Südamerika Reisen mit Kind – mit Kindern in Nordamerika und Südamerika Reisen mit Hund – mit Hunden auf der Panamericana Reise-Videos & Filme – Videos und Filme von der Panamericana

Verschiffung

Verschiffung zwischen Nordamerika und Südamerika Verschiffung zwischen Europa und Nordamerika Verschiffung zwischen Europa und Südamerika Fähren in Kanada und USA Fähren zwischen Baja California und Festland Mexiko Einbruch / Diebstahl bei der Verschiffung

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Foren – Foren und Gruppen für Panamericana Reisende Interessante Websites für Panamericana Reisende Tipps und Infos von Reisenden auf der Panamericana Wissenswertes für die Reise Panamericana Bücher – Reiseführer für die Panamericana Tourismus Websites der Länder in Nordamerika und Südamerika Automobilclubs in Nordamerika und Südamerika Projekte zum Mithelfen – Volontär während der Panamericana Tour

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Matador Original Series

Cycling the Entire Pan-American Highway and Finding Inner Peace Along the Way

T he thin air of the high Andes made cycling even relatively flat ground surrounding Lake Titicaca difficult to traverse. At 12,500 feet in elevation, crossing terrain that would be an easy pedal closer to sea level takes an immense amount of energy. After slowing to catch my breath, I glanced up ahead. I could see the arch I would soon pass under as I left Peru behind for new adventures in Bolivia. Approaching the arch, I leaned my bike against the customs building and went inside.

I quickly found myself in front of the officer who would stamp my passport and — if all went well — grant me entrance to Bolivia . I held a tense breath as the officer counted on his fingers to determine if I overstayed the 90 days allowed by my visa. He stopped counting at 82 days, en route from Alaska to the tip of South America along what’s known as the Pan-American Highway, a 19,000-mile hemisphere-spanning route. My relief was visible as he proceeded to stamp my passport.

Taking a lifelong passion for cycling to the next level

Photo: Natalie Corbett

I’ve been big into cycling for most of my 35 years. From a young age, I found freedom in being on two wheels. And that feeling is something that has persisted, if not grown with me, into adulthood. The idea of traveling long distances and camping along the way had always been on the periphery. After graduating from university in 2012, I took my first long bike trip across the western United States.

It being my first-ever bike tour, I was incredibly nervous. I had never attempted anything like this before. On this trip, I learned what it meant to stealth camp (the process of camping at unmarked backcountry spots), how to pack, what NOT to pack, and how to push myself beyond what I thought was possible. I got to explore the western states at my own pace and by my own power. I felt empowered and liberated. While I made many mistakes along the way and suffered through wind, rain, and pain, I was hooked.

I started planning my next big trip almost immediately upon returning and eventually settled on cycling the entire Pan-American Highway from Prudhoe Bay, Alaska , to Ushuaia, Tierra del Fuego, Argentina — a trip that would take me to places I had never heard of over the better part of two-and-a-half years. En route, I would cross nearly every type of geographic setting, across towering mountains and through major metropolises, twice crossing US-Canada borders before pedaling south through the plains east of the Rockies towards Mexico.

In the years leading up to my departure, I spent countless hours researching places I wanted to go, things to avoid, and what documents and preparation I would need to cross the borders into 17 different countries. In addition to the US, Canada, and Mexico, the Pan-American Highway passes through the whole of Central America, crosses continents into Colombia, and heads down the western edge of South America through Ecuador, Peru, and Chile before cutting east into Argentina .

In total I’d experience seasons on both ends of the global spectrum — summer in Alaska and summer in Patagonia, with winters ideally spent in warmer climes. Though, as I’d see firsthand, much as the sun shines on Mexico year-round, the snow lives in the high country at all times, and weather can come out of seemingly nowhere to disrupt what I’d expected to be a smooth day.

I finally set out on my adventure in the summer of 2017.

Embarking on a country-hopping cycling journey

Planning for a trip like this doesn’t stop once your adventure begins but continues non-stop as you progress in your travels. My route was never fixed. Every night I would look at my maps, both digital and paper, searching for areas to camp the following day, places to refill food and water, and cool landmarks to view or learn a little about the local history. I would often choose several camping spot options, one at a shorter and longer distance so I could easily adjust my daily plans based on weather, my energy levels, and my overall desire to “try hard” on any given day. Giving my body enough time to acclimate to the daily grind of pedaling for eight to 12 hours, day-in and day-out in the wind and rain, up mountains, and through clouds of mosquitoes, was imperative.

Cycling across the Andean plateau I’d experience moderate weather in the Altiplano (high plain) and pass through Boreal forest and past Patagonian lakes. The ability to shed a layer (or add one) would be imperative, as would having waterproof options and a rain fly for the tent. Still, I learned early on that I packed too much and needed to adjust the placement of things.

Knowing what food to bring on a short trip is not all that different than in a large one; while the allotted budget may be different, the goal of carrying just enough to get by stays the same. Preparing your food for a trip this large is not something that you can really do once and then stick to for the entire trip. You have to account for variations in the seasons and regions you are visiting. When I was in Alaska and the Yukon, I would routinely have to carry multiple days’ worth of food at a time because distances between towns are far greater there than in more densely populated areas.

My diet consisted mainly of eating boxes of Pop-Tarts for their high sugar and calories during my daily rides and a bag of pasta for dinner with a box of Cheez-Its for dessert. This persisted until I reached Mexico and began to supplement my energy at the many roadside taco stands. For much of the trip I was able to get by carrying only enough for one or two meals at a time because I could replenish my supplies as I rode for the day.

Preparing for international border crossings

For the most part, the administrative part of crossing borders by bicycle is the same as in a vehicle or arriving via air. After spending a month exploring Alaska I neared Canada and had my first experience with this. The most complicated thing about this border was giving away the marijuana I had on me and couldn’t legally transport across the international boundary. This first jaunt across borders was easy, helped by friendly relations between the two countries.

In my case along the Pan-American Highway, the majority of border crossings were as easy as this first one. I would bike up to the building, get in line, get stamped out, bike a few meters into the next country, get stamped in, and proceed on with my day. Until I reached Bolivia, the most time I had spent changing countries was about an hour.

There, in the high Andes gasping for oxygen, was when my luck finally ran out.

Getting out of Peru had proved easy enough. After I passed underneath the arch into Bolivia and made my way to customs, I had a feeling that I was in for an interesting ride. In researching the trip, I had learned that I would need somewhere around $200 to buy my visa-on-arrival for Bolivia, and I was prepared to spend that much. But it turned out that was not all I needed.

The customs official wanted to see proof of a return flight to the US (which I didn’t have) and a reservation and address of the hotel I was staying in during my visit. I learned the hard way that writing in “wild camping” doesn’t count — I tried. After some negotiation and a fair amount of frustration, I was introduced to a man named Juan who would prove to be exactly the person I needed to meet. Not only was he able to take and print my official photo for my visa, but he also helped me reserve a hotel room and book a flight home while spending less than 15 Bolivianos (just over $2). I went back to the customs office and was swiftly given a visa and stamped into the country, thus ending a few tense hours in between countries.

Lesson learned: Research diplomatic relations between two border countries — and your home country — beforehand, and know which countries require visas for entry, and any proof of reservations.

Reflecting on life-changing journey

I am a white transwoman from the United States — the first transgender woman to bike the Pan American highway. Your cultural mileage — in terms of privilege, overall experience, and ease of travel — may vary depending on your country of origin, ethnicity, skin color, and gender identity. One cannot plan for every eventuality and happenstance to occur on a commute to work, let alone over the course of two-and-a-half years and 30,000 kilometers. For me, this trip reinforced that life requires an open mind and an open plan.

To get the most out of a trip like this you have to have a flexibility that allows you to deviate from your original idea and make spur of the moment decisions to turn left instead of right, or to follow a man named Juan to the little shack nearby where an old laptop and printer can make any document you need appear.

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breech presentation anatomy definition

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

StatPearls [Internet].

Breech presentation.

Caron J. Gray ; Meaghan M. Shanahan .

Affiliations

Last Update: November 6, 2022 .

Continuing Education Activity

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

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

Introduction

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

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

Epidemiology

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

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

Pathophysiology

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

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

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

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

History and Physical

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

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

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

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

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

Treatment / Management

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

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

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

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

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

Differential Diagnosis

• Face and brow presentation
• Fetal anomalies
• Fetal death
• Grand multiparity
• Multiple pregnancies
• Oligohydramnios
• Pelvis Anatomy
• Preterm labor
• Primigravida
• Uterine anomalies

Pearls and Other Issues

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

Enhancing Healthcare Team Outcomes

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

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

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

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

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

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

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INTRODUCTION

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

TYPES OF BREECH PRESENTATION

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

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

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

• Key Points |

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

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

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

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

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

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

Abnormal fetal lie, presentation, or position may occur with

Fetopelvic disproportion (fetus too large for the pelvic inlet)

Fetal congenital anomalies

Uterine structural abnormalities (eg, fibroids, synechiae)

Multiple gestation

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

Transverse lie

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

Breech presentation

There are several types of breech presentation.

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

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

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

Types of breech presentations

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

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

Predisposing factors for breech presentation include

Uterine abnormalities

If delivery is vaginal, breech presentation may increase risk of

Umbilical cord prolapse

Birth trauma

Perinatal death

Face or brow presentation

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

Brow presentation usually converts spontaneously to vertex or face presentation.

Occiput posterior position

The most common abnormal position is occiput posterior.

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

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

Position and Presentation of the Fetus

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

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

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

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• Overview  
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• Diagnosis  
• Management  
• Follow up  
• Resources  

Breech presentation refers to the baby presenting for delivery with the buttocks or feet first rather than head.

Associated with increased morbidity and mortality for the mother in terms of emergency cesarean section and placenta previa; and for the baby in terms of preterm birth, small fetal size, congenital anomalies, and perinatal mortality.

Incidence decreases as pregnancy progresses and by term occurs in 3% to 4% of singleton term pregnancies.

Treatment options include external cephalic version to increase the likelihood of vaginal birth or a planned cesarean section, the optimal gestation being 37 and 39 weeks, respectively.

Planned cesarean section is considered the safest form of delivery for infants with a persisting breech presentation at term.

Breech presentation in pregnancy occurs when a baby presents with the buttocks or feet rather than the head first (cephalic presentation) and is associated with increased morbidity and mortality for both the mother and the baby. [1] Cunningham F, Gant N, Leveno K, et al. Williams obstetrics. 21st ed. New York: McGraw-Hill; 1997. [2] Kish K, Collea JV. Malpresentation and cord prolapse. In: DeCherney AH, Nathan L, eds. Current obstetric and gynecologic diagnosis and treatment. New York: McGraw-Hill Professional; 2002. There is good current evidence regarding effective management of breech presentation in late pregnancy using external cephalic version and/or planned cesarean section.

History and exam

Key diagnostic factors.

buttocks or feet as the presenting part

• fetal head under costal margin
• fetal heartbeat above the maternal umbilicus

Other diagnostic factors

Subcostal tenderness.

• pelvic or bladder pain

Risk factors

• premature fetus

small for gestational age fetus

Nulliparity, fetal congenital anomalies, previous breech delivery, uterine abnormalities, abnormal amniotic fluid volume, placental abnormalities, female fetus, diagnostic investigations.

1st investigations to order.

transabdominal/transvaginal ultrasound

Treatment algorithm.

<37 weeks' gestation, ≥37 weeks' gestation not in labor, ≥37 weeks' gestation in labor: no imminent delivery, ≥37 weeks' gestation in labor: imminent delivery, contributors, natasha nassar, phd.

Associate Professor

Menzies Centre for Health Policy

Sydney School of Public Health

University of Sydney

Disclosures

NN has received salary support from Australian National Health and a Medical Research Council Career Development Fellowship; she is an author of a number of references cited in this topic.

• Christine L. Roberts, MBBS, FAFPHM, DrPH

Research Director

Clinical and Population Health Division

Perinatal Medicine Group

Kolling Institute of Medical Research

CLR declares that she has no competing interests.

• Jonathan Morris, MBChB, FRANZCOG, PhD

Professor of Obstetrics and Gynaecology and Head of Department

JM declares that he has no competing interests.

Peer reviewers

John w. bachman, md.

Consultant in Family Medicine

Department of Family Medicine

Mayo Clinic

JWB declares that he has no competing interests.

• Rhona Hughes, MBChB

Lead Obstetrician

Lothian Simpson Centre for Reproductive Health

The Royal Infirmary

RH declares that she has no competing interests.

• Brian Peat, MD

Director of Obstetrics

Women's and Children's Hospital

North Adelaide

South Australia

BP declares that he has no competing interests.

• Lelia Duley, MBChB

Professor of Obstetric Epidemiology

University of Leeds

Bradford Institute of Health Research

Temple Bank House

Bradford Royal Infirmary

LD declares that she has no competing interests.

• Justus Hofmeyr, MD

Head of the Department of Obstetrics and Gynaecology

East London Private Hospital

East London

South Africa

JH is an author of a number of references cited in this topic.

Differentials

• Antenatal corticosteroids to reduce neonatal morbidity and mortality
• Caesarean birth

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• Pregnancy Classes

Breech Births

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

What are the different types of breech birth presentations?

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

What causes a breech presentation?

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

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

How is a breech presentation diagnosed?

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

Can a breech presentation mean something is wrong?

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

Can a breech presentation be changed?

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

Medical Techniques

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

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

ECV will not be tried if:

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

Complications of EVC include:

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

Vaginal delivery versus cesarean for breech birth?

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

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

What are the risks and complications of a vaginal delivery?

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

When is a cesarean delivery used with a breech presentation?

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

Want to Know More?

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

Compiled using information from the following sources:

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

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Highlights & basics, diagnostic approach, risk factors, history & exam, differential diagnosis.

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PATIENT RESOURCES

Patient Instructions

Quick reference.

Key Factors

Fetal head under costal margin, fetal heartbeat above the maternal umbilicus.

Other Factors

Pelvic or bladder pain.

Diagnostics Tests

1st Tests to Order

Treatment options.

presumptive

<37 weeks' gestation

specialist evaluation

corticosteroid

magnesium sulfate

≥37 weeks' gestation not in labor

unsuccessful ECV with persistent breech

Classifications

Types of breech presentation

Baby's buttocks lead the way into the birth canal

Hips are flexed, knees are extended, and the feet are in close proximity to the head

65% to 70% of breech babies are in this position.

Baby presents with buttocks first

Both the hips and the knees are flexed; the baby may be sitting cross-legged.

One or both of the baby's feet lie below the breech so that the foot or knee is lowermost in the birth canal

This is rare at term but relatively common with premature fetuses.

Common Vignette

Other Presentations

33% of births less than 28 weeks' gestation

14% of births at 29 to 32 weeks' gestation

9% of births at 33 to 36 weeks' gestation

6% of births at 37 to 40 weeks' gestation.

• Natasha Nassar, PhD
• John W. Bachman, MD

Clinical exam

Palpation of the abdomen to determine the position of the baby's head

Palpation of the abdomen to confirm the position of the fetal spine on one side and fetal extremities on the other

Palpation of the area above the symphysis pubis to locate the fetal presenting part

Palpation of the presenting part to confirm presentation, to determine how far the fetus has descended and whether the fetus is engaged.

Ultrasound examination

Premature fetus.

Prematurity is consistently associated with breech presentation. [ 6 ] [ 9 ] This may be due to the smaller size of preterm infants, who are more likely to change their in utero position.

Increasing duration of pregnancy may allow breech-presenting fetuses time to grow, turn spontaneously or by external cephalic version, and remain cephalic-presenting.

Larger fetuses may be forced into a cephalic presentation in late pregnancy due to space or alignment constraints within the uterus.

Low birth-weight is a risk factor for breech presentation. [ 9 ] [ 11 ] [ 12 ] [ 13 ] [ 14 ] Term breech births are associated with a smaller fetal size for gestational age, highlighting the association with low birth-weight rather than prematurity. [ 6 ]

Women having a first birth have increased rates of breech presentation, probably due to the increased likelihood of smaller fetal size. [ 6 ] [ 9 ]

Relaxation of the uterine wall in multiparous women may reduce the odds of breech birth and contribute to a higher spontaneous or external cephalic version rate. [ 10 ]

Congenital anomalies in the fetus may result in a small fetal size or inappropriate fetal growth. [ 9 ] [ 12 ] [ 14 ] [ 15 ]

Anencephaly, hydrocephaly, Down syndrome, and fetal neuromuscular dysfunction are associated with breech presentation, the latter due to its effect on the quality of fetal movements. [ 9 ] [ 14 ]

The risk of recurrent breech delivery is 8%, the risk increasing from 4% after one breech delivery to 28% after three. [ 16 ]

The effects of recurrence may be due to recurring specific causal factors, either genetic or environmental in origin.

Women with uterine abnormalities have a high incidence of breech presentation. [ 14 ] [ 17 ] [ 18 ] [ 19 ]

Fifty-four percent of breech-presenting fetuses are female. [ 14 ]

Both oligohydramnios and polyhydramnios are associated with breech presentation. [ 1 ] [ 12 ] [ 14 ]

Low amniotic fluid volume decreases the likelihood of a fetus turning to a cephalic position; an increased amniotic fluid volume may facilitate frequent change in position.

An association between placental implantation in the cornual-fundal region and breech presentation has been reported, although some studies have not found it a risk factor. [ 8 ] [ 20 ] [ 21 ] [ 22 ] [ 10 ] [ 14 ]

The association with placenta previa is also inconsistent. [ 8 ] [ 9 ] [ 22 ] Placenta previa is associated with preterm birth and may be an indirect risk factor.

Pelvic or vaginal examination reveals the buttocks and/or feet, felt as a yielding, irregular mass, as the presenting part. [ 26 ] In cephalic presentation, a hard, round, regular fetal head can be palpated. [ 26 ]

The Leopold maneuver on examination suggests breech position by palpation of the fetal head under the costal margin. [ 26 ]

The baby's heartbeat should be auscultated using a Pinard stethoscope or a hand-held Doppler to indicate the position of the fetus. The fetal heartbeat lies above the maternal umbilicus in breech presentation. [ 1 ]

Tenderness under one or other costal margin as a result of pressure by the harder fetal head.

Pain due to fetal kicks in the maternal pelvis or bladder.

breech position

Visualizes the fetus and reveals its position.

Used to confirm a clinically suspected breech presentation. [ 28 ]

Should be performed by practitioners with appropriate skills in obstetric ultrasound.

Establishes the type of breech presentation by imaging the fetal femurs and their relationship to the distal bones.

Differentiating Signs/Symptoms

Fetus lies horizontally across the uterus with the shoulder as the presenting part.

Similar predisposing factors such as placenta previa, abnormal amniotic fluid volume, and uterine anomalies, although more common in multiparity. [ 1 ] [ 2 ] [ 29 ]

Differentiating Tests

Clinical examination and fetal auscultation may be indicative.

Ultrasound confirms presentation.

Treatment Approach

Breech presentation <37 weeks' gestation.

The UK Royal College of Obstetricians and Gynaecologists (RCOG) recommends that corticosteroids should be offered to women between 24 and 34+6 weeks' gestation, in whom imminent preterm birth is anticipated. Corticosteroids should only be considered after discussion of risks/benefits at 35 to 36+6 weeks. Given within 7 days of preterm birth, corticosteroids may reduce perinatal and neonatal death and respiratory distress syndrome. [ 32 ] The American College of Obstetricians and Gynecologists (ACOG) recommends a single course of corticosteroids for pregnant women between 24 and 33+6 weeks' gestation who are at risk of preterm delivery within 7 days, including those with ruptured membranes and multiple gestations. It may also be considered for pregnant women starting at 23 weeks' gestation who are at risk of preterm delivery within 7 days. A single course of betamethasone is recommended for pregnant women between 34 and 36+6 weeks' gestation at risk of preterm birth within 7 days, and who have not received a previous course of prenatal corticosteroids. Regularly scheduled repeat courses or serial courses (more than two) are not currently recommended. A single repeat course of prenatal corticosteroids should be considered in women who are less than 34 weeks' gestation, who are at risk of preterm delivery within 7 days, and whose prior course of prenatal corticosteroids was administered more than 14 days previously. Rescue course corticosteroids could be provided as early as 7 days from the prior dose, if indicated by the clinical scenario. [ 33 ]

Magnesium sulfate given before anticipated early preterm birth reduces the risk of cerebral palsy in surviving infants. Physicians electing to use magnesium sulfate for fetal neuroprotection should develop specific guidelines regarding inclusion criteria, treatment regimens, and concurrent tocolysis. [ 34 ]

Breech presentation from 37 weeks' gestation, before labor

ECV is the initial treatment for a breech presentation at term when the patient is not in labor. It involves turning a fetus presenting by the breech to a cephalic (head-down) presentation to increase the likelihood of vaginal birth. [ 35 ] [ 36 ] Where available, it should be offered to all women in late pregnancy, by an experienced clinician, in hospitals with facilities for emergency delivery, and no contraindications to the procedure. [ 35 ] There is no upper time limit on the appropriate gestation for ECV, with success reported at 42 weeks.

There is no general consensus on contraindications to ECV. Contraindications include multiple pregnancy (except after delivery of a first twin), ruptured membranes, current or recent (<1 week) vaginal bleeding, rhesus isoimmunization, other indications for cesarean section (e.g., placenta previa or uterine malformation), or abnormal electronic fetal monitoring. [ 35 ] One systematic review of relative contraindications for ECV highlighted that most contraindications do not have clear empirical evidence. Exceptions include placental abruption, severe preeclampsia/HELLP syndrome, or signs of fetal distress (abnormal cardiotocography and/or Doppler flow). [ 36 ]

The procedure involves applying external pressure and firmly pushing or palpating the mother's abdomen to coerce the fetus to somersault (either forward or backward) into a cephalic position. [ 37 ]

The overall ECV success rate varies but, in a large series, 47% of women following an ECV attempt had a cephalic presentation at birth. [ 35 ] [ 38 ]  Various factors influence the success rate. One systematic review found ECV success rates to be 68% overall, with the rate significantly higher for women from African countries (89%) compared with women from non-African countries (62%), and higher among multiparous (78%) than nulliparous women (48%). [ 39 ] Overall, the ECV success rates for nulliparous and multiparous non-African women were 43% and 73%, respectively, while for nulliparous and multiparous African women rates were 79% and 91%, respectively. Another study reported no difference in success rate or rate of cesarean section among women with previous cesarean section undergoing ECV compared with women with previous vaginal birth. However, numbers were small and further studies in this regard are required. [ 40 ]

Women's preference for vaginal delivery is a major contributing factor in their decision for ECV. However, studies suggest women with a breech presentation at term may not receive complete and/or evidence-based information about the benefits and risks of ECV. [ 41 ] [ 42 ] Although up to 60% of women reported ECV to be painful, the majority highlighted the benefits outweigh the risks (71%) and would recommend ECV to their friends or be willing to repeat for themselves (84%). [ 41 ] [ 42 ]

Cardiotocography and ultrasound should be performed before and after the procedure. Tocolysis should be used to facilitate the maneuver, and Rho(D) immune globulin should be administered to women who are Rhesus negative. [ 35 ] Tocolytic agents include adrenergic beta-2 receptor stimulants such as albuterol, terbutaline, or ritodrine (widely used with ECV in some countries, but not yet available in the US). One Cochrane review of tocolytic beta stimulants demonstrates that these are less likely to be associated with failed ECV, and are effective in increasing cephalic presentation and reducing cesarean section. [ 43 ] There is no current evidence to recommend one beta-2 adrenergic receptor agonist over another. Until these data are available, adherence to a local protocol for tocolysis is recommended. The Food and Drug Administration has issued a warning against using injectable terbutaline beyond 48 to 72 hours, or acute or prolonged treatment with oral terbutaline, in pregnant women for the prevention or prolonged treatment of preterm labor, due to potential serious maternal cardiac adverse effects and death. [ 44 ] Whether this warning applies to the subcutaneous administration of terbutaline in ECV is still unclear; however, studies currently support this use. The European Medicines Agency (EMA) recommends that injectable beta agonists should be used for up to 48 hours between the 22nd and 37th week of pregnancy only. They should be used under specialist supervision with continuous monitoring of the mother and unborn baby owing to the risk of adverse cardiovascular effects in both the mother and baby. The EMA no longer recommends oral or rectal formulations for obstetric indications. [ 45 ]

If ECV is successful, pregnancy care should continue as usual for any cephalic presentation. One systematic review assessing the mode of delivery after a successful ECV found that these women were at increased risk for cesarean section and instrumental vaginal delivery compared with women with spontaneous cephalic pregnancies. However, they still had a lower rate of cesarean section following ECV (i.e., 47%) compared with the cesarean section rate for those with a persisting breech (i.e., 85%). With a number needed to treat of three, ECV is still considered to be an effective means of preventing the need for cesarean section. [ 46 ]

Planned cesarean section should be offered as the safest mode of delivery for the baby, even though it carries a small increase in serious immediate maternal complications compared with vaginal birth. [ 24 ] [ 25 ] [ 31 ] In the US, most unsuccessful ECV with persistent breech will be delivered via cesarean section.

A vaginal mode of delivery may be considered by some clinicians as an option, particularly when maternal request is provided, senior and experienced staff are available, there is no absolute contraindication to vaginal birth (e.g., placenta previa, compromised fetal condition), and with optimal fetal growth (estimated weight above the tenth centile and up to 3800 g). Other factors that make planned vaginal birth higher risk include hyperextended neck on ultrasound and footling presentation. [ 24 ]

Breech presentation from 37 weeks' gestation, during labor

The first option should be a planned cesarean section.

There is a small increase in the risk of serious immediate maternal complications compared with vaginal birth (RR 1.29, 95% CI 1.03 to 1.61), including pulmonary embolism, infection, bleeding, damage to the bladder and bowel, slower recovery from the delivery, longer hospitalization, and delayed bonding and breast-feeding. [ 23 ] [ 31 ] [ 47 ] [ 48 ] [ 49 ] [ 50 ] [ 51 ] [ 52 ] [ 53 ] [ 54 ] [ 55 ] [ 56 ] [ 57 ] [ 58 ] Consider using antimicrobial triclosan-coated sutures for wound closure to reduce the risk of surgical site infection. [ 59 ]

The long-term risks include potential compromise of future obstetric performance, increased risk of repeat cesarean section, infertility, uterine rupture, placenta accreta, placental abruption, and emergency hysterectomy. [ 60 ] [ 61 ] [ 62 ] [ 63 ]

Planned cesarean section is safer for babies, but is associated with increased neonatal respiratory distress. The risk is reduced when the section is performed at 39 weeks' gestation. [ 64 ] [ 65 ] [ 66 ] For women undergoing a planned cesarean section, RCOG recommends an informed discussion about the potential risks and benefits of a course of prenatal corticosteroids between 37 and 38+6 weeks' gestation. Although prenatal corticosteroids may reduce admission to the neonatal unit for respiratory morbidity, it is uncertain if there is any reduction in respiratory distress syndrome, transient tachypnea of the newborn, or neonatal unit admission overall. In addition, prenatal corticosteroids may result in harm to the neonate, including hypoglycemia and potential developmental delay. [ 32 ] ACOG does not recommend corticosteroids in women >37 weeks' gestation. [ 33 ]

Undiagnosed breech in labor generally results in cesarean section after the onset of labor, higher rates of emergency cesarean section associated with the least favorable maternal outcomes, a greater likelihood of cord prolapse, and other poor infant outcomes. [ 23 ] [ 67 ] [ 49 ] [ 68 ] [ 69 ] [ 70 ] [ 71 ]

This mode of delivery may be considered by some clinicians as an option for women who are in labor, particularly when delivery is imminent. Vaginal breech delivery may also be considered, where suitable, when delivery is not imminent, maternal request is provided, senior and experienced staff are available, there is no absolute contraindication to vaginal birth (e.g., placenta previa, compromised fetal condition), and with optimal fetal growth (estimated weight above the tenth centile and up to 3800 g). Other factors that make planned vaginal birth higher risk include hyperextended neck on ultrasound and footling presentation. [ 24 ]

Findings from one systematic review of 27 observational studies revealed that the absolute risks of perinatal mortality, fetal neurologic morbidity, birth trauma, 5-minute Apgar score <7, and neonatal asphyxia in the planned vaginal delivery group were low at 0.3%, 0.7%, 0.7%, 2.4%, and 3.3%, respectively. However, the relative risks of perinatal mortality and morbidity were 2- to 5-fold higher in the planned vaginal than in the planned cesarean delivery group. Authors recommend ongoing judicious decision-making for vaginal breech delivery for selected singleton, term breech babies. [ 72 ]

ECV may also be considered an option for women with breech presentation in early labor, when delivery is not imminent, provided that the membranes are intact.

A woman presenting with a breech presentation <37 weeks is an area of clinical controversy. Optimal mode of delivery for preterm breech has not been fully evaluated in clinical trials, and the relative risks for the preterm infant and mother remain unclear. In the absence of good evidence, if diagnosis of breech presentation prior to 37 weeks' gestation is made, prematurity and clinical circumstances should determine management and mode of delivery.

Primary Options

12 mg intramuscularly every 24 hours for 2 doses

6 mg intramuscularly every 12 hours for 4 doses

The UK Royal College of Obstetricians and Gynaecologists recommends that corticosteroids should be offered to women between 24 and 34+6 weeks' gestation, in whom imminent preterm birth is anticipated. Corticosteroids should only be considered after discussion of risks/benefits at 35 to 36+6 weeks. Given within 7 days of preterm birth, corticosteroids may reduce perinatal and neonatal death and respiratory distress syndrome. [ 32 ]

The American College of Obstetricians and Gynecologists recommends a single course of corticosteroids for pregnant women between 24 and 33+6 weeks' gestation who are at risk of preterm delivery within 7 days, including those with ruptured membranes and multiple gestations. It may also be considered for pregnant women starting at 23 weeks' gestation who are at risk of preterm delivery within 7 days. A single course of betamethasone is recommended for pregnant women between 34 and 36+6 weeks' gestation at risk of preterm birth within 7 days, and who have not received a previous course of prenatal corticosteroids. Regularly scheduled repeat courses or serial courses (more than two) are not currently recommended. A single repeat course of prenatal corticosteroids should be considered in women who are less than 34 weeks' gestation, who are at risk of preterm delivery within 7 days, and whose prior course of prenatal corticosteroids was administered more than 14 days previously. Rescue course corticosteroids could be provided as early as 7 days from the prior dose, if indicated by the clinical scenario. [ 33 ]

consult specialist for guidance on dose

external cephalic version (ECV)

There is no upper time limit on the appropriate gestation for ECV; it should be offered to all women in late pregnancy by an experienced clinician in hospitals with facilities for emergency delivery and no contraindications to the procedure. [ 35 ] [ 36 ]

ECV involves applying external pressure and firmly pushing or palpating the mother's abdomen to coerce the fetus to somersault (either forward or backward) into a cephalic position. [ 37 ]

There is no general consensus on contraindications to ECV. Contraindications include multiple pregnancy (except after delivery of a first twin), ruptured membranes, current or recent (<1 week) vaginal bleeding, rhesus isoimmunization, other indications for cesarean section (e.g., placenta previa or uterine malformation), or abnormal electronic fetal monitoring. [ 35 ]  One systematic review of relative contraindications for ECV highlighted that most contraindications do not have clear empirical evidence. Exceptions include placental abruption, severe preeclampsia/HELLP syndrome, or signs of fetal distress (abnormal cardiotocography and/or Doppler flow). [ 36 ]

Cardiotocography and ultrasound should be performed before and after the procedure.

If ECV is successful, pregnancy care should continue as usual for any cephalic presentation. A systematic review assessing the mode of delivery after a successful ECV found that these women were at increased risk for cesarean section and instrumental vaginal delivery compared with women with spontaneous cephalic pregnancies. However, they still had a lower rate of cesarean section following ECV (i.e., 47%) compared with the cesarean section rate for those with a persisting breech (i.e., 85%). With a number needed to treat of 3, ECV is still considered to be an effective means of preventing the need for cesarean section. [ 46 ]

tocolytic agents

see local specialist protocol for dosing guidelines

Tocolytic agents include adrenergic beta-2 receptor stimulants such as albuterol, terbutaline, or ritodrine (widely used with external cephalic version [ECV] in some countries, but not yet available in the US). They are used to delay or inhibit labor and increase the success rate of ECV. There is no current evidence to recommend one beta-2 adrenergic receptor agonist over another. Until these data are available, adherence to a local protocol for tocolysis is recommended.

The Food and Drug Administration has issued a warning against using injectable terbutaline beyond 48-72 hours, or acute or prolonged treatment with oral terbutaline, in pregnant women for the prevention or prolonged treatment of preterm labor, due to potential serious maternal cardiac adverse effects and death. [ 44 ] Whether this warning applies to the subcutaneous administration of terbutaline in ECV is still unclear; however, studies currently support this use. The European Medicines Agency (EMA) recommends that injectable beta agonists should be used for up to 48 hours between the 22nd and 37th week of pregnancy only. They should be used under specialist supervision with continuous monitoring of the mother and unborn baby owing to the risk of adverse cardiovascular effects in both the mother and baby. The EMA no longer recommends oral or rectal formulations for obstetric indications. [ 45 ]

A systematic review found there was no evidence to support the use of nifedipine for tocolysis. [ 73 ]

There is insufficient evidence to evaluate other interventions to help ECV, such as fetal acoustic stimulation in midline fetal spine positions, or epidural or spinal analgesia. [ 43 ]

Rho(D) immune globulin

300 micrograms intramuscularly as a single dose

Nonsensitized Rh-negative women should receive Rho(D) immune globulin. [ 35 ]

The indication for its administration is to prevent rhesus isoimmunization, which may affect subsequent pregnancy outcomes.

Rho(D) immune globulin needs to be given at the time of external cephalic version and should be given again postpartum to those women who give birth to an Rh-positive baby. [ 74 ]

It is best administered as soon as possible after the procedure, usually within 72 hours.

Dose depends on brand used. Dose given below pertains to most commonly used brands. Consult specialist for further guidance on dose.

elective cesarean section/vaginal breech delivery

Mode of delivery (cesarean section or vaginal breech delivery) should be based on the experience of the attending clinician, hospital policies, maternal request, and the presence or absence of complicating factors. In the US, most unsuccessful external cephalic version (ECV) with persistent breech will be delivered via cesarean section.

Cesarean section, at 39 weeks or greater, has been shown to significantly reduce perinatal mortality and neonatal morbidity compared with vaginal breech delivery (RR 0.33, 95% CI 0.19 to 0.56). [ 31 ] Although safer for these babies, there is a small increase in serious immediate maternal complications compared with vaginal birth (RR 1.29, 95% CI 1.03 to 1.61), as well as long-term risks for future pregnancies, including pulmonary embolism, bleeding, infection, damage to the bladder and bowel, slower recovery from the delivery, longer hospitalization, and delayed bonding and breast-feeding. [ 23 ] [ 31 ] [ 47 ] [ 48 ] [ 49 ] [ 50 ] [ 51 ] [ 52 ] [ 53 ] [ 54 ] [ 55 ] [ 56 ] [ 57 ] [ 58 ] Consider using antimicrobial triclosan-coated sutures for wound closure to reduce the risk of surgical site infection. [ 59 ]

Vaginal delivery may be considered by some clinicians as an option, particularly when maternal request is provided, when senior and experienced staff are available, when there is no absolute contraindication to vaginal birth (e.g., placenta previa, compromised fetal condition), and with optimal fetal growth (estimated weight above the tenth centile and up to 3800 g). Other factors that make planned vaginal birth higher risk include hyperextended neck on ultrasound and footling presentation. [ 24 ]

For women undergoing a planned cesarean section, the UK Royal College of Obstetricians and Gynaecologists recommends an informed discussion about the potential risks and benefits of a course of prenatal corticosteroids between 37 and 38+6 weeks' gestation. Although prenatal corticosteroids may reduce admission to the neonatal unit for respiratory morbidity, it is uncertain if there is any reduction in respiratory distress syndrome, transient tachypnea of the newborn, or neonatal unit admission overall. In addition, prenatal corticosteroids may result in harm to the neonate, including hypoglycemia and potential developmental delay. [ 32 ] The American College of Obstetricians and Gynecologists does not recommend corticosteroids in women >37 weeks' gestation. [ 33 ]

It is best administered as soon as possible after delivery, usually within 72 hours.

Administration of postpartum Rho (D) immune globulin should not be affected by previous routine prenatal prophylaxis or previous administration for a potentially sensitizing event. [ 74 ]

≥37 weeks' gestation in labor: no imminent delivery

planned cesarean section

For women with breech presentation in labor, planned cesarean section at 39 weeks or greater has been shown to significantly reduce perinatal mortality and neonatal morbidity compared with vaginal breech delivery (RR 0.33, 95% CI 0.19 to 0.56). [ 31 ]

Although safer for these babies, there is a small increase in serious immediate maternal complications compared with vaginal birth (RR 1.29, 95% CI 1.03 to 1.61), as well as long-term risks for future pregnancies, including pulmonary embolism, infection, bleeding, damage to the bladder and bowel, slower recovery from the delivery, longer hospitalization, and delayed bonding and breast-feeding. [ 23 ] [ 31 ] [ 47 ] [ 48 ] [ 49 ] [ 50 ] [ 51 ] [ 52 ] [ 53 ] [ 54 ] [ 55 ] [ 56 ] [ 57 ] [ 58 ]  Consider using antimicrobial triclosan-coated sutures for wound closure to reduce the risk of surgical site infection. [ 59 ]

Continuous cardiotocography monitoring should continue until delivery. [ 24 ] [ 25 ]

vaginal breech delivery

Mode of delivery (cesarean section or vaginal breech delivery) should be based on the experience of the attending clinician, hospital policies, maternal request, and the presence or absence of complicating factors.

This mode of delivery may be considered by some clinicians as an option, particularly when maternal request is provided, when senior and experienced staff are available, when there is no absolute contraindication to vaginal birth (e.g., placenta previa, compromised fetal condition), and with optimal fetal growth (estimated weight above the tenth centile and up to 3800 g). Other factors that make planned vaginal birth higher risk include hyperextended neck on ultrasound and footling presentation. [ 24 ]

For women with persisting breech presentation, planned cesarean section has, however, been shown to significantly reduce perinatal mortality and neonatal morbidity compared with vaginal breech delivery (RR 0.33, 95% CI 0.19 to 0.56). [ 31 ]

ECV may also be considered an option for women with breech presentation in early labor, provided that the membranes are intact.

There is no upper time limit on the appropriate gestation for ECV. [ 35 ]

Involves applying external pressure and firmly pushing or palpating the mother's abdomen to coerce the fetus to somersault (either forward or backward) into a cephalic position. [ 37 ]

Relative contraindications include placental abruption, severe preeclampsia/HELLP syndrome, and signs of fetal distress (abnormal cardiotocography and/or abnormal Doppler flow). [ 35 ] [ 36 ]

Rho(D) immune globulin needs to be given at the time of ECV and should be given again postpartum to those women who give birth to an Rh-positive baby. [ 74 ]

≥37 weeks' gestation in labor: imminent delivery

cesarean section

For women with persistent breech presentation, planned cesarean section has been shown to significantly reduce perinatal mortality and neonatal morbidity compared with vaginal breech delivery (RR 0.33, 95% CI 0.19 to 0.56). [ 31 ] Although safer for these babies, there is a small increase in serious immediate maternal complications compared with vaginal birth (RR 1.29, 95% CI 1.03 to 1.61), as well as long-term risks for future pregnancies, including pulmonary embolism, infection, bleeding, damage to the bladder and bowel, slower recovery from the delivery, longer hospitalization, and delayed bonding and breast-feeding. [ 23 ] [ 31 ] [ 47 ] [ 48 ] [ 49 ] [ 50 ] [ 51 ] [ 52 ] [ 53 ] [ 54 ] [ 55 ] [ 56 ] [ 57 ] [ 58 ]  Consider using antimicrobial triclosan-coated sutures for wound closure to reduce the risk of surgical site infection. [ 59 ]

This mode of delivery may be considered by some clinicians as an option, particularly when delivery is imminent, maternal request is provided, when senior and experienced staff are available, when there is no absolute contraindication to vaginal birth (e.g., placenta previa, compromised fetal condition), and with optimal fetal growth (estimated weight above the tenth centile and up to 3800 g). Other factors that make planned vaginal birth higher risk include hyperextended neck on ultrasound and footling presentation. [ 24 ]

It is best administered as soon as possible after the delivery, usually within 72 hours.

External cephalic version before term

Moxibustion, postural management, follow-up overview, perinatal complications.

Compared with cephalic presentation, persistent breech presentation has increased frequency of cord prolapse, abruptio placentae, prelabor rupture of membranes, perinatal mortality, fetal distress (heart rate <100 bpm), preterm delivery, lower fetal weight. [ 10 ] [ 11 ] [ 67 ]

complications of cesarean section

There is a small increase in the risk of serious immediate maternal complications compared with vaginal birth (RR 1.29, 95% CI 1.03 to 1.61), including pulmonary embolism, infection, bleeding, damage to the bladder and bowel, slower recovery from the delivery, longer hospitalization, and delayed bonding and breast-feeding. [ 23 ] [ 31 ] [ 47 ] [ 48 ] [ 49 ] [ 50 ] [ 51 ] [ 52 ] [ 53 ] [ 54 ] [ 55 ] [ 56 ] [ 57 ] [ 58 ]

The long-term risks include potential compromise of future obstetric performance, increased risk of repeat cesarean section, infertility, uterine rupture, placenta accreta, placental abruption, and emergency hysterectomy. [ 60 ] [ 61 ] [ 62 ] [ 63 ] The evidence suggests that using sutures, rather than staples, for wound closure after cesarean section reduces the incidence of wound dehiscence. [ 59 ]

Emergency cesarean section, compared with planned cesarean section, has demonstrated a higher risk of severe obstetric morbidity, intra-operative complications, postoperative complications, infection, blood loss >1500 mL, fever, pain, tiredness, and breast-feeding problems. [ 23 ] [ 48 ] [ 50 ] [ 70 ] [ 81 ]

Key Articles

Impey LWM, Murphy DJ, Griffiths M, et al; Royal College of Obstetricians and Gynaecologists. Management of breech presentation: green-top guideline no. 20b. BJOG. 2017 Jun;124(7):e151-77. [Full Text]

Hofmeyr GJ, Hannah M, Lawrie TA. Planned caesarean section for term breech delivery. Cochrane Database Syst Rev. 2015 Jul 21;(7):CD000166. [Abstract] [Full Text]

Royal College of Obstetricians and Gynaecologists. External cephalic version and reducing the incidence of term breech presentation. March 2017 [internet publication]. [Full Text]

Cluver C, Gyte GM, Sinclair M, et al. Interventions for helping to turn term breech babies to head first presentation when using external cephalic version. Cochrane Database Syst Rev. 2015 Feb 9;(2):CD000184. [Abstract] [Full Text]

de Hundt M, Velzel J, de Groot CJ, et al. Mode of delivery after successful external cephalic version: a systematic review and meta-analysis. Obstet Gynecol. 2014 Jun;123(6):1327-34. [Abstract]

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74. Qureshi H, Massey E, Kirwan D, et al. BCSH guideline for the use of anti-D immunoglobulin for the prevention of haemolytic disease of the fetus and newborn. Transfus Med. 2014 Feb;24(1):8-20. [Abstract] [Full Text]

75. Hutton EK, Hofmeyr GJ, Dowswell T. External cephalic version for breech presentation before term. Cochrane Database Syst Rev. 2015 Jul 29;(7):CD000084. [Abstract] [Full Text]

76. Coyle ME, Smith CA, Peat B. Cephalic version by moxibustion for breech presentation. Cochrane Database Syst Rev. 2012 May 16;(5):CD003928. [Abstract] [Full Text]

77. Hofmeyr GJ, Kulier R. Cephalic version by postural management for breech presentation. Cochrane Database Syst Rev. 2012 Oct 17;(10):CD000051. [Abstract] [Full Text]

78. Hannah ME, Whyte H, Hannah WJ, et al. Maternal outcomes at 2 years after planned cesarean section versus planned vaginal birth for breech presentation at term: the International Randomized Term Breech Trial. Am J Obstet Gynecol. 2004 Sep;191(3):917-27. [Abstract]

79. Eide MG, Oyen N, Skjaerven R, et al. Breech delivery and Intelligence: a population-based study of 8,738 breech infants. Obstet Gynecol. 2005 Jan;105(1):4-11. [Abstract]

80. Whyte H, Hannah ME, Saigal S, et al. Outcomes of children at 2 years after planned cesarean birth versus planned vaginal birth for breech presentation at term: the International Randomized Term Breech Trial. Am J Obstet Gynecol. 2004 Sep;191(3):864-71. [Abstract]

81. Brown S, Lumley J. Maternal health after childbirth: results of an Australian population based survey. Br J Obstet Gynaecol. 1998 Feb;105(2):156-61. [Abstract]

Published by

American College of Obstetricians and Gynecologists

2016 (reaffirmed 2022)

Royal College of Obstetricians and Gynaecologists (UK)

National Institute for Health and Care Excellence (UK)

Topic last updated: 2024-03-05

Natasha Nassar , PhD

Christine L. Roberts , MBBS, FAFPHM, DrPH

Jonathan Morris , MBChB, FRANZCOG, PhD

Peer Reviewers

John W. Bachman , MD

Rhona Hughes , MBChB

Brian Peat , MD

Women's and Children's Hospital

Lelia Duley , MBChB

Justus Hofmeyr , MD

6.1 Breech presentation

Presentation of the feet or buttocks of the foetus.

6.1.1 The different breech presentations

• In a complete breech presentation, the legs are tucked, and the foetus is in a crouching position (Figure 6.1a).
• In a frank breech presentation, the legs are extended, raised in front of the torso, with the feet near the head (Figure 6.1b).
• In a footling breech presentation (rare), one or both feet present first, with the buttocks higher up and the lower limbs extended or half-bent (Figure 6.1c).

6.1.2 Diagnosis

• The cephalic pole is palpable in the uterine fundus; round, hard, and mobile; the indentation of the neck can be felt.
• The inferior pole is voluminous, irregular, less hard, and less mobile than the head.
• During labour, vaginal examination reveals a “soft mass” divided by the cleft between the buttocks, with a hard projection at end of the cleft (the coccyx and sacrum).
• After rupture of the membranes: the anus can be felt in the middle of the cleft; a foot may also be felt.
• The clinical diagnosis may be difficult: a hand may be mistaken for a foot, a face for a breech.

6.1.3 Management

Route of delivery.

Before labour, external version (Chapter 7, Section 7.7 ) may be attempted to avoid breech delivery.

If external version is contra-indicated or unsuccessful, the breech position alone – in the absence of any other anomaly – is not, strictly speaking, a dystocic presentation, and does not automatically require a caesarean section. Deliver vaginally, if possible – even if the woman is primiparous.

Breech deliveries must be done in a CEmONC facility, especially for primiparous women.

Favourable factors for vaginal delivery are:

• Frank breech presentation;
• A history of vaginal delivery (whatever the presentation);
• Normally progressing dilation during labour.

The footling breech presentation is a very unfavourable position for vaginal delivery (risk of foot or cord prolapse). In this situation, the route of delivery depends on the number of previous births, the state of the membranes and how far advanced the labour is.

During labour

• Monitor dilation every 2 to 4 hours. 
• If contractions are of good quality, dilation is progressing, and the foetal heart rate is regular, an expectant approach is best. Do not rupture the membranes unless dilation stops.
• If the uterine contractions are inadequate, labour can be actively managed with oxytocin.

Note : if the dilation stales, transfer the mother to a CEmONC facility unless already done, to ensure access to surgical facility for potential caesarean section.

At delivery

• Insert an IV line before expulsion starts.
• Consider episiotomy at expulsion. Episiotomy is performed when the perineum is sufficiently distended by the foetus's buttocks.
• Presence of meconium or meconium-stained amniotic fluid is common during breech delivery and is not necessarily a sign of foetal distress.
• The infant delivers unaided , as a result of the mother's pushing, simply supported by the birth attendant who gently holds the infant by the bony parts (hips and sacrum), with no traction. Do not pull on the legs.

Once the umbilicus is out, the rest of the delivery must be completed within 3 minutes, otherwise compression of the cord will deprive the infant of oxygen. Do not touch the infant until the shoulder blades appear to avoid triggering the respiratory reflex before the head is delivered.

• Monitor the position of the infant's back; impede rotation into posterior position.

Figures 6.2 - Breech delivery

6.1.4 Breech delivery problems

Posterior orientation.

If the infant’s back is posterior during expulsion, take hold of the hips and turn into an anterior position (this is a rare occurrence).

Obstructed shoulders

The shoulders can become stuck and hold back the infant's upper chest and head. This can occur when the arms are raised as the shoulders pass through the mother's pelvis. There are 2 methods for lowering the arms so that the shoulders can descend:

1 - Lovset's manoeuvre

• With thumbs on the infant's sacrum, take hold of the hips and pelvis with the other fingers.
• Turn the infant 90° (back to the left or to the right), to bring the anterior shoulder underneath the symphysis and engage the arm. Deliver the anterior arm.
• Then do a 180° counter-rotation (back to the right or to the left); this engages the posterior arm, which is then delivered.

Figures 6.3 - Lovset's manoeuvre

6.3c  - Delivering the anterior arm and shoulder

2 - Suzor’s manoeuvre

In case the previous method fails:

• Turn the infant 90° (its back to the right or to the left).
• Pull the infant downward: insert one hand along the back to look for the anterior arm. With the operator thumb in the infant armpit and middle finger along the arm, bring down the arm (Figure 6.4a).
• Lift infant upward by the feet in order to deliver the posterior shoulder (Figure 6.4b).

Figures 6.4 - Suzor's manoeuvre

6.4b  - Delivering the posterior shoulder

Head entrapment

The infant's head is bulkier than the body, and can get trapped in the mother's pelvis or soft tissue.

There are various manoeuvres for delivering the head by flexing it, so that it descends properly, and then pivoting it up and around the mother's symphysis. These manoeuvres must be done without delay, since the infant must be allowed to breathe as soon as possible. All these manoeuvres must be performed smoothly, without traction on the infant.

1 - Bracht's manoeuvre

• After the arms are delivered, the infant is grasped by the hips and lifted with two hands toward the mother's stomach, without any traction, the neck pivoting around the symphysis.
• Having an assistant apply suprapubic pressure facilitates delivery of the aftercoming head.

2 - Modified Mauriceau manoeuvre

• Infant's head occiput anterior.
• Kneel to get a good traction angle: 45° downward.
• Support the infant on the hand and forearm, then insert the index and middle fingers, placing them on the infant’s maxilla. Placing the index and middle fingers into the infant’s mouth is not recommended, as this can fracture the mandible.
• Place the index and middle fingers of the other hand on either side of the infant's neck and lower the infant's head to bring the sub-occiput under the symphysis (Figure 6.6a).
• Tip the infant’s head and with a sweeping motion bring the back up toward the mother's abdomen, pivoting the occiput around her symphysis pubis (Figure 6.6b).
• Suprapubic pressure on the infant's head along the pelvic axis helps delivery of the head.
• As a last resort, symphysiotomy (Chapter 5, Section 5.7 ) can be combined with this manoeuvre.

Figures 6.6 - Modified Mauriceau manoeuvre

6.6a - Step 1 Infant straddles the birth attendant's forearm; the head, occiput anterior, is lowered to bring the occiput in contact with the symphysis.

6.6b  - Step 2 The infant's back is tipped up toward the mother's abdomen.

3 - Forceps on aftercoming head 

This procedure can only be performed by an operator experienced in using forceps.

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Breech - series—Types of breech presentation

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There are three types of breech presentation: complete, incomplete, and frank.

Complete breech is when both of the baby's knees are bent and his feet and bottom are closest to the birth canal.

Incomplete breech is when one of the baby's knees is bent and his foot and bottom are closest to the birth canal.

Frank breech is when the baby's legs are folded flat up against his head and his bottom is closest to the birth canal.

There is also footling breech where one or both feet are presenting.

Review Date 11/21/2022

Updated by: LaQuita Martinez, MD, Department of Obstetrics and Gynecology, Emory Johns Creek Hospital, Alpharetta, GA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Related MedlinePlus Health Topics

• Childbirth Problems

Breech Presentation

Objectives:

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

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

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

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

• Mullerian anomalies: Septate uterus, bicornuate uterus, and didelphys uterus 
• Congenital anomalies:  Fetal sacrococcygeal teratoma, fetal thyroid goiter

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

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

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

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

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

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

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

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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.

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.

Was this article helpful?

What to know if your baby is breech

What's a sunny-side up baby?

What happens to your baby right after birth

How your twins’ fetal positions affect labor and delivery

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

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

Breech presentation, which occurs in approximately 3 percent of fetuses at term, describes the fetus whose presenting part is the buttocks and/or feet. Although most breech fetuses have normal anatomy, this presentation is associated with an increased risk for congenital malformations and mild deformations, torticollis, and developmental ...

A breech baby (breech birth or breech presentation) is when a baby's feet or buttocks are positioned to come out of your vagina first. This means its head is up toward your chest and its lower body is closest to your vagina. Ideally, your baby is in a head down, or vertex presentation, at delivery. While most babies do eventually turn into this ...

Overview. Breech presentation is defined as a fetus in a longitudinal lie with the buttocks or feet closest to the cervix. This occurs in 3-4% of all deliveries. The percentage of breech deliveries decreases with advancing gestational age from 22-25% of births prior to 28 weeks' gestation to 7-15% of births at 32 weeks' gestation to 3-4% of ...

Breech presentation is a type of malpresentation and occurs when the fetal head lies over the uterine fundus and fetal buttocks or feet present over the maternal pelvis (instead of cephalic/head presentation). The incidence in the United Kingdom of breech presentation is 3-4% of all fetuses. 1.

Summary. Breech presentation refers to the baby presenting for delivery with the buttocks or feet first rather than head. Associated with increased morbidity and mortality for the mother in terms of emergency cesarean section and placenta previa; and for the baby in terms of preterm birth, small fetal size, congenital anomalies, and perinatal ...

Breech presentation: clinical practice guideline from the French College of Gynaecologists and Obstetricians [2020] ... The lack of a standard definition of a footling breech is problematic because the term is open to interpretation and will invariably lead to a higher rate of C/S for breech in this setting, further limiting birth mode options ...

At full term, around 3%-4% of births are breech. The different types of breech presentations include: Complete: The fetus's knees are bent, and the buttocks are presenting first. Frank: The fetus's legs are stretched upward toward the head, and the buttocks are presenting first. Footling: The fetus's foot is showing first.

Women with a breech presentation at term should be offered external cephalic version (ECV) unless there is an absolute contraindication. ... The strict criteria included 'normal' (definition unstated) radiological pelvimetry which was performed in 82.5% of planned vaginal births, continuous EFM and routine ultrasound.

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

The most widely quoted study regarding the management of breech presentation at term is the 'Term Breech Trial'. Published in 2000, this large, international multicenter randomised clinical trial compared a policy of planned vaginal delivery with planned caesarean section for selected breech presentations.

Definition. Breech presentation in pregnancy occurs when a baby presents with the buttocks or feet rather than the head first (cephalic presentation) and is associated with increased morbidity and mortality for both the mother and the baby. ... Breech presentation is a normal finding in preterm pregnancies, when the fetus is more mobile, and ...

What Causes Breech Presentation? - Only about 15% of breech presentations have an identifiable etiology.5 - Established risks for breech presentation are: Previous breech presentation pregnancy,5,6,7,8 Late or lack of antenatal care,8,9 Prematurity (<37 weeks gestation),6,7,8 Comparatively lower birth weight,8,9 and Congenital anomalies.8,9,10

Presentation of the feet or buttocks of the foetus. 6.1.1 The different breech presentations. In a complete breech presentation, the legs are tucked, and the foetus is in a crouching position (Figure 6.1a).; In a frank breech presentation, the legs are extended, raised in front of the torso, with the feet near the head (Figure 6.1b).; In a footling breech presentation (rare), one or both feet ...

Definition. Most babies move into a head-down position in the uterus before labor. The baby is in a breech position when its buttocks or feet are in place to come out first. There are three types: Frank breech—the baby's buttocks are down and the legs extend straight up in front of the body with the feet up near the head. Complete breech ...

Overview. There are three types of breech presentation: complete, incomplete, and frank. Complete breech is when both of the baby's knees are bent and his feet and bottom are closest to the birth canal. Incomplete breech is when one of the baby's knees is bent and his foot and bottom are closest to the birth canal.

Breech presentation refers to the fetus in the longitudinal lie with the buttocks or lower extremity entering the pelvis first. The three types of breech presentation include frank breech, complete breech, and incomplete breech. In a frank breech, the fetus has flexion of both hips, and the legs are straight with the feet near the fetal face ...

presence of a breech presentation because they may disguise fetopelvic disproportion. Oxytocin, however, may be used for the delivery of the aftercoming head. 9. If the presentation is breech and delivery is imminent preterm, consideration may be given to a vaginal delivery in the absence of intrapartum complications. 10.

Breech presentation is a form of mal-presentation in which the fetal buttocks or lower extremities occupy or is in direct relationship with the maternal pelvic

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).

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Drei Jahre unterwegs. Tausende Kilometer entfernt von Zuhause, ganz auf sich allein gestellt. 2018 beendete Radu Paltineanu das größte Abenteuer seines Lebens. Er fuhr die längste Straße der Welt, die Panamericana von Alaska bis nach Feuerland - mit dem Fahrrad! 

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• Märkte Händler zufrieden mit OutDoor by ISPO: „Hochgesteckte Anforderungen übertroffen“
• Alles über OutDoor by ISPO 2019

Als erster Rumäne absolvierte Radu Paltineanu die Tour, die ihn über insgesamt 34.554 km von Alaska nach Feuerland führte. Drei Jahre, zwei Monate und 18 Tage dauerte dieses Abenteuer auf der Panamericana, der längsten Straße der Welt. 

Ursprünglich hatte er für die Tour lediglich neun Monate veranschlagt. Auf seinem Weg passierte er mehr als ein Dutzend Staatsgrenzen, bewältigte mehrere tausend Höhenmeter und querte nahezu alle Klimazonen der Erde, ehe er am 22. Oktober 2018 endlich das Ziel Ushuaia auf der Insel Feuerland erreichte.

Von Alaska nach Patagonien auf dem Bike

Der selbsternannte Ciclotrotter Paltineanu war zuvor bereits alleine Langstrecken-Touren in Osteuropa, Skandinavien und Zentralasien gefahren. Alles kein Vergleich zur Panamericana. So vieles hätte schiefgehen können. Doch Radu Paltineanu hat sein ganz persönliches Abenteuer mit seinem unbändigen Optimismus gemeistert. Am Ende zahlte sich seine Beharrlichkeit aus. 

View this post on Instagram A post shared by Radu Păltineanu (@radu.paltineanu)

• Lesen Sie hier: Bikepacking - Das perfekte Rad-Abenteuer fürs Wochenende

Auf der OutDoor by ISPO als „Abenteurer des Jahres“ ausgezeichnet

Für diesen beispiellosen Trip erhielt Radu Paltineanu heute auf der OutDoor by ISPO die Auszeichnung als „ Abenteurer des Jahres “ . Paltineanu war persönlich nach München gekommen und nahm den Preis im Adventure Tourism & Travel Hub in Halle B6 von Matthias Aßmann, Owner Mandel/Adventure Academy entgegen. 

Gefragt, welches Abenteuer er als nächstes vorhabe, hatte der frisch gekürte Preisträger keine Antwort parat. Aber möglicherweise werde er als nächstes Grönland auf Skiern durchqueren. Wenn’s weiter nichts ist.

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The Ultimate Guide To Driving The Pan-American Highway

The scenic Pan-American Highway is the longest road in the world stretching around 15,000 miles from Alaska in North America all the way down to Argentina in South America.

When we finally ditched our comfortable lives in LA and set out on a journey of a lifetime to travel across the Pan-American Highway for 15 months, we had no idea what to expect.

We learned so much along the way about things that can help make this trip easy ( and things that can go horribly wrong ).

Our Pan American Highway guide is here to help you plan an epic road trip and answer any questions you may have – from our personal experience!

If you are thinking about driving the famous Pan-American Highway, here are some tips and things that you should know before heading out on the Pan-American road trip:

Pan-American Route & Map

How long does it take, how much does it cost, crossing the darien gap, best vehicle for pan-american, do you need a 4×4, highlights of the trip, pan-american dangers, what to bring, car insurance, currency & credit cards, must-have phone apps, cell service, traveling with pets, other pan american highway tips.

The Pan-American route is a network of roads that start in Prudhoe Bay, Alaska, and from there travel south through both North America and South America until its ending point in Ushuaia, Argentina. It’s known as the longest road in the world because it connects two continents north to south.

The Pan-American Highway is approximately 15,000 miles long and passes through 14 countries along the way.

In North America, the Pan-American Highway passes through : the US , Canada , Mexico , Guatemala , El Salvador , Honduras , Nicaragua , Costa Rica , and Panama .

In South America, the Pan-American Highway passes through: Colombia , Ecuador , Peru , Chile, and Argentina .

Although the actual Pan-American route mapped out is around 15,000 miles long, nobody does the exact route without venturing into many detours and side roads. On average, most people end up driving around 30,000 miles during their Pan-American road trip.

In fact, during our trip across the Americas, we spent very little time driving the actual Pan-American Highway because most of the time we were crisscrossing into various attractions along the way. Some of those side destinations often include Belize in Central America and Bolivia in South America.

While some people try to start off their Pan-American road trip in Alaska, it’s so remote and far out of the way that most people start their trip in Canada or the US .

When we set out to venture down the Pan-American highway, we started off in California. We had already spent considerable time exploring Canada and US and we wanted to venture into some new countries starting with Mexico.

A trip across the Pan-American highway can really take as long as you have time ( or money ) for it. Most people that we met traveling along the Pan-American highway do it anywhere from 9 months to 2 years. We ended up spending 15 months on the road traveling from California to Southern Argentina.

If you are short on time , it’s best to plan the route ahead of time and focus on seeing the main highlights. On the other hand, if you have all the time in the world, you’ll probably find yourself venturing into lesser-known areas and going more “off the beaten path”.

We tried to take it slow and see everything under the sun during the first 9 months of our trip but traveling in this style started wearing on us after a while . We felt like we spent more time “living” in these countries and trying to stretch every last penny than seeing all of the best highlights and enjoying the destinations like we would have if we were on a vacation.

When we got to South America, we switched up our approach and only traveled to the main highlights. It worked better for us since we spent less time exhausting ourselves driving to random little towns and we spent more time exploring the top locations.

Again, this just depends on your travel style . We just wanted to see all the top highlights and sooner than later return back home to our old lives in the US.

The cost of driving the Pan-American Highway is highly dependent on your comfort level while traveling. While we try to travel pretty cheaply, we always leave a little room and budget to splurge on things that we love ( like cheese and wine ).

On average, we spent around $2200 in travel expenses per month between the both of us. The biggest expense for us is typically food followed closely by gas.

We cook most of the meals in our campervan and seldom splurge on restaurants but we also don’t eat ramen noodles like college kids. Eating healthy and yummy food to us is a priority but that often comes with a steep price.

Since we travel in a van we rarely pay for campsites or hotels , only on special occasions when we feel like taking a break from van life or when our families come to visit.

The biggest one-off expense of the Pan-American highway for us was shipping our van across the Darien Gap which cost us $1100.

The most expensive single activity of this entire trip was visiting Machu Picchu in Peru. The cost to visit the Machu Picchu ruins is around $250 per person covering a train ticket, a bus ticket, and an entry ticket to get into the ruins. The good news is that we found a cheap workaround from a back entrance that can save you a lot of money. To read more on that check out our Machu Picchu Travel Guide here .

Read Next: VAN LIFE – How Much Does It Really Cost?

Although the Pan-American highway is known as the longest road in the world, there is a section between Panama and Colombia that is not drivable . This section is called The Darien Gap .

For environmental and political reasons, visitors are not allowed to travel into this section. The only way to get your car across the Darien Gap is on a ship. This ship typically takes a few days to get your car across from Panama into Colombia ( or vice versa ) and costs anywhere from $1000 to a few thousand depending on your car size.

There are a few ways to ship a car across the Darien Gap: RORO (roll on/roll off), container, and LOLO (lift on/lift off).

We chose to go with a container because it’s the most secure way to ship. We heard a lot of theft happens during the RORO shipping since you have to give your keys to the port staff and the cars are left unattended.

When you choose container shipping, you drive your own car into a container that gets sealed before getting loaded on a ship. You get to keep the keys and the car is completely locked up until you go to pick it up on the arriving side.

If you decide to ship in a container, first you will need to find a shipping partner to share a container with in order to split the cost in half. We used the Pan-American Travelers Association Facebook group and Container Buddies to see if anyone was shipping at the same time as us. We ended up shipping in a 40 ft High Cube container with another car and paid around $1100 each.

Once you find a shipping partner you will need to arrange a shipping agent who will coordinate everything for you . We shipped our van from Panama City to Cartagena and the two main agents for this route are Boris Jaramillo and Tea Kalalback.

We had originally contacted Tea and everything seemed ready to go when last minute she emailed us saying that we did NOT have a spot on the ship and we ended up losing the non-refundable flights that we had booked from Panama to Colombia.

We then contacted Boris with Ever Logistics and he was super helpful and got us a spot on the next outgoing boat a few days later. His contact email is [email protected].

Passengers are not allowed on this ship so you will need to arrange a flight into Colombia and a hotel while your car ships across. Once your car arrives in Cartagena, you will need to go down to the dock in Cartagena and get it out. This requires 2 days of running around Cartagena to pay various fees and get paperwork signed. 

You don’t need an agent on the Colombia side, just a lot of patience while you run around the city getting paperwork done.

You May Also Like: 50 Van Life Tips For Living On The Road

During our trip along the Pan-American Highway, we met people traveling in all types of vehicles – small sedans, SUVs, motorcycles, vans, trucks with pop-up tents, huge motorhomes, bikes, Unimogs, old and new, you name it . There really is no best vehicle and it really just depends on your travel style and personal comfort level .

We had originally planned to do this trip in our Honda Element SUV. We even converted our Honda Element by adding a bed, solar shower, fan, and fridge. But after a trial month of traveling through the US and Canada, we realized that it was just too tight and crammed for us to enjoy a long-term trip.

Instead, we got a Promaster van and spent 3 months converting it into a campervan . It has made our traveling so much more comfortable and we rarely splurge on hostels or Airbnb’s, saving us a ton of money.

Having a midsize van on this trip also helps us stealth camp just about anywhere. It’s especially helpful in cities where the cops are a little stricter about camping on the streets. Most people just think we’re a working van.

Many people choose to go with smaller vehicles that may be more nimble or get better fuel mileage, but you’re likely to end up spending just as much in monthly expenses since you will need to pay for campsites, hostels, hotels, and Airbnb’s more often.

If you’re worried about having car issues and not finding parts, you might want to look for cars that are sold throughout Latin America . These would include any car or SUV sold by Kia or Hyundai, Ford Explorer, Mercedes Sprinter, Suzuki Grand Vitara, Toyota 4Runner, or Jeep Wrangler.

There are many others sold in North America that are also sold in Latin America, like Toyota Land Cruiser, Ram Promaster (Fiat Ducato/Citroen Relay/Peugeot Boxer/Renault Master), Land Rover Discovery, and Mitsubishi Montero, to name a few, but all of these are sold in North America with gasoline engines whereas in Latin America they are only sold with diesel engines. If something goes wrong and you have to find parts for the engine/tranny of these cars, you’re probably going to have to ship the parts in from another country ( speaking from our personal experience ).

If you have a right-hand drive vehicle, note that you may have some difficulty traveling through Central America, especially in Costa Rica. It is illegal to drive RHD vehicles in Costa Rica so many people end up shipping their vans from Guatemala into Colombia, skipping most of Central America for this reason.

A lot of people think that you need a 4×4 van to do this trip. Although there are roads along the Pan-American highway where having a 4×4 is helpful, it is not a necessity .

Our Promaster van is a front-wheel drive. We have driven across some of the most rugged roads in Guatemala and through the sketchiest mountain passes in Peru with no issues.

We did get stuck in a swamp once and had to get pulled out… but that was 100% our own fault .

Instead, what’s really essential in choosing the right vehicle for the Pan-American Highway is getting one that has high clearance, weighs as little as possible, has a good set of all-terrain tires, and isn’t oversized . This combination will get you to 90-95% of the places you want to go.

We’ve seen some really cool 4x4s that can’t go off the paved roads because they’re so overloaded and top-heavy. We’ve also seen many Unimogs that can’t go off the main highways because they don’t fit in any of the side roads or campgrounds, so having a 4×4 doesn’t always help.

Personally, we find it almost impossible to provide one single answer when someone asks us what our favorite country or place has been on this trip. However, there certainly are some places that stand out more than others. Here are some of our top highlights from 15 months of traveling along the Pan-American highway .

We started our trip in Mexico and our plan was to spend 2 months there, at the most. After realizing how much cool stuff there is to see and do, we threw that plan out the window and we ended up spending 5 months traveling through all of Mexico.

We swam in turquoise waterfalls in La Huasteca Potosina , snorkeled in underground cenotes in the Yucatan Peninsula , and drove through remote mountain roads to get to some unreal hillside thermal pools , all for only a few bucks each at the most. Thinking of countries that left a lasting impression on us, Mexico is definitely on top of that list.

Central America

After leaving Mexico we ventured into Belize which offers some of the best snorkeling in the world. Although Belize technically is not part of the Pan-American Highway, we just had to visit it.   

Our main mission in Belize was to find the top snorkeling sites. While Caye Caulker is the “go to” fun party island that offers tours to some really amazing snorkeling sites ( and unlimited rum after ), our personal favorite was Silk Caye, a tiny island off the southern coast in Belize. Here we swam with sharks, eagle rays, octopus, and other incredible sea creatures for half the price and half the crowds.

We continued along into Guatemala , one of Joel’s favorite locations. Guatemala is one of the least developed countries in Central America which means rugged jungle adventures, erupting volcanoes, and remote pyramids along with some of the friendliest people we’ve met on this journey. Guatemala is also known for beautiful markets filled with colorful textiles.   We have 5 blankets to prove it.

Another one of our favorites was Costa Rica . Costa Rica is known for its beaches, surfing and some unreal wildlife that looks like a scene from The Jungle Book come alive. While we certainly enjoyed searching for waterfalls in the jungle, our favorite part was seeing all the monkeys, sloths, and macaw birds along the trails.

Overall we loved Central America , but at the same time, the heat and humidity were making sleeping and cooking in our van almost impossible. In our opinion, this is a region that’s best explored in short traditional vacations while going on adventures during the day and recharging at a hotel pool or room at night.  

South America

After crossing into South America, we didn’t really know what to expect of Colombia (it probably didn’t help that we just finished watching Narcos).

Colombia turned out to be one of the most diverse South American destinations with colorful colonial towns, lots of history, culture, amazing coffee, and unique adventures. After spending 2 months traveling through Colombia, here are 15 of our top Colombia destinations that we highly recommend for Overlanding .

One of my personal favorites of our time in South America was Peru ( okay, so maybe I DO have a favorite after all ). Besides visiting the world-famous Machu Picchu ruins , Peru is home to one of the tallest waterfalls in the world, incredible mountain hikes, and a cool oasis city Huacachina hidden between giant sand dunes in the Peruvian desert.

Last ( but not least ) there is the Carretera Austral Highway in Chile , the southern region of the continent. Known for turquoise blue lakes, unique caves, and endless glaciers I couldn’t think of a better way to finish up a trip through the Americas .

We could really go on forever sharing all about our favorite Pan-American destinations, but if you want to read more about our trip highlights, check out our Destinations page here .

This is one of the topics that we get asked about the most and something that our friends and family were really concerned about when we started the trip.

And I’m not gonna lie… we were pretty nervous too .

While I can’t speak for everyone because sometimes unfortunate things happen, during our 15 months of traveling the Pan-American highway we had no major issues and we felt relatively safe.

One of the worst things that happened to us was getting my backpack stolen in Colombia at a Starbucks ( from all places ) while I was working on my laptop and not paying attention.

There are some areas, however, that are known to be more prone to crime along the Pan-American highway and travelers should use more caution while driving through:

• Chiapas, Mexico . We always hear about the crime issues in Mexico due to the drug cartels, but neither we nor any of the hundreds of people we know who went through Mexico ever encountered an issue with cartel violence. Instead, it’s Chiapas, the southernmost state in Mexico, where people have the most issues. This region has long been anti-government, anti-establishment, very poor, and many of the villages thrive on violently extorting money from anybody who passes through. We were held up by angry mobs demanding money for driving on the roads and asked for a “security payment” by an armed “neighborhood watch”. Our friends had their tires slashed and chased by locals demanding money at the threat of violence, and another overlander was attacked with wooden boards with nails. And the saddest of all, two European bikers were found dead with their belongings missing while passing through this region. The cops and military don’t really go into this area so it’s sort of the Wild West down there.
• Peru Coast . We heard there are a lot of car break-ins, armed robberies, and well-organized scams along the Peruvian coast. It’s also one of the poorest areas that we saw along this trip so people are a bit more desperate. While traveling along the Peruvian coast we watched for any warnings left on the iOverlander app and we never left the van completely unattended. We personally had no issues but unfortunately, our friends were not so lucky and had a break into their van and had all of their electronics stolen.
• Costa Rica . This one was really surprising since Costa Rica is basically the 51 st state of the US these days, but Costa Rica is currently a hot spot for thieves and car break-ins. There are thousands of American tourists around every corner, and locals know that tourists carry nice, often expensive things in their cars as they move around the country. Many of the people we know had their cars broken into in Costa Rica, but they weren’t always necessarily only after nice things – our friend’s well-used swimming shorts were stolen right off his side mirror as he made dinner just a few feet away.
• Northern South America . From Colombia through the northern metros of Argentina and Chile, pickpocketing and petty theft are very common in cities. This is why you’ll see many people walking with their backpacks worn on their chest, and sitting at coffee shops with their bags held under their arms. While traveling in this area, just try not to walk on empty streets at night and never put anything into pockets that can’t be zipped or closed somehow. Since we spent very little time in the cities of South America and opted instead for the mountains and more remote areas, we mostly avoided these issues.

Most people who start the Pan-American road trip will pack their cars to the max with emergency and “just in case” items but in reality, you don’t need that much .

Personally, we don’t have a whole lot of stuff to begin with and we also like to keep our living space uncluttered. We decided to only bring the bare necessities which helped us keep the van light for better gas mileage.

Along with everyday necessities like clothing and kitchen utensils, here are some things that you should bring along on the Pan-American road trip :

• Two water tanks . We keep one water tank for filtered drinking water and one for everything else like doing dishes and brushing our teeth that we fill up at gas stations. You could use filtered water for everything but it would be quite costly.
• One spare tire . We actually didn’t even use our spare tire once during our 15 months of driving down the PanAm road so you don’t need more than one.
• Basic tools . Flat/Phillips screwdrivers , an adjustable wrench , duct tape , a flashlight , and pliers – the bare minimum in case you break down in the middle of nowhere. Otherwise, mechanics are everywhere and other overlanders usually carry a ton of tools in case you need to borrow one.
• Fire extinguisher . If you have a stove in your vehicle, you’ll be cooking in small quarters or outside and things can easily tip over and catch on fire. Our friends’ stove actually caught on fire but they were able to safely toss it out and put the fire out before it did any damage. Better to be prepared and keep a small fire extinguisher at hand reach.
• Tow strap . In case you push the limits of your car like we constantly do and need someone to pull you out. They’re super cheap and don’t take up much room.
• Headlamp . 95% of the time, we’re sleeping in places that don’t have much light. Look for one that is dimmable and preferably one that has a red light setting, which helps keep your night vision and doesn’t travel as far so you can be more incognito.

Read More: 85 Van Life Essentials That You Should Be Packing

There are a few countries along the Pan-American highway that require vehicle insurance for international drivers.

In North America, the countries requiring car insurance are: Canada, the US, Mexico, Costa Rica, and Panama .

US and Canada have reciprocal car insurance laws so if you have insurance in either country, you can use it in the other as well.

In South America, the countries requiring car insurance are: Colombia, Peru, Chile, and Argentina .

In the US, Mexico, and Chile we purchased our vehicle insurance online, but most of the time you can purchase car insurance right at the border. Peru was the only country where we had to cross the border and drive into the next town to purchase it.

Related Post: DIY Promaster Campervan Conversion Guide

Most of the small businesses in Central and South America operate on a cash basis so for this trip, it’s very important to have a good debit card that won’t charge you crazy ATM fees . We love the Schwab Debit Card because it is free, charges no overseas withdrawal fees, and refunds any ATM fees that we were charged by other banks at the end of the month.

The Schwab Debit card comes with the Schwab Bank High Yield Investor Checking Account – you can read more about it on the Schwab website.

At some ATMs we have been charged up to a $10 fee to take out the money in a single transaction. Getting this money back at the end of the month has been pretty sweet.

For this trip, you will also need a VISA credit card. Most businesses in Central & South America only accept VISA or Mastercard , but some countries like Peru only accept VISA (when they accept credit cards at all).

We really couldn’t have done this trip without our favorite phone app iOverlander . For us, this app was a total lifesaver.

The iOverlander app was created by other Pan-American overlanders as a place to note all the best campsites, attractions, gas stations, laundry spots, and other useful places while traveling. Over the years it has grown extremely popular and is based solely on reviews left by other travelers. iOverlander is our go-to source to find cheap (or free) camping spots and anything else we may need along the way.

There are also a couple of map apps that can make life on the road so much easier. Google Maps is great because the roads are pretty up-to-date, it gives you accurate driving time estimates, and you can download the map sections ahead of time to use when you’re offline. We also like using the Maps. me app which is amazing for finding hiking trails and figuring out their distance and elevation but is not so great for driving because it likes to give extremely optimistic time estimates and can sometimes lead you down dirt roads that shouldn’t even be on the map.

We also recently found out about the app WiFi Map . WiFi Map lists tons of open WiFi networks in the surrounding areas and for someone like me who works a lot online, this app is super helpful.

A few years ago I signed up for Google’s Project Fi cell phone service and it has been a total game changer for traveling. Instead of purchasing local cell phone chips in each new country, Google Fi automatically connects your cell phone to the local cell providers so you never lose reception while traveling, all at full LTE when available.

We pay around $80 per month for Google Fi service that includes “unlimited” data up to 15 GB for the two of us. The data is still unlimited after 15 GB but it’s much slower.

We use just about all of 15 GB of available data every month. But we also work online, stream shows and slightly obsess over Instagram so most people tend to use a lot less than that. It actually says on their website that less than 1% of users use all 15 GB of the available data so THAT makes me sort of question my life choices.

If you have a pet, you may be wondering if it’s possible to do this trip with your furry little friend.

During our trip along the Pan-American highway, we brought along our indoor cat Minka. We made some special arrangements for her in the van but overall we found that traveling with a pet through Central and South America is very easy .

It took her a couple of months to get used to being in new environments every day but now she absolutely loves it. As soon as we stop she hops out of the van, runs around a bit, eats some grass, and looks at the farm animals from the distance but mostly just naps. She has traveled through 15 countries in our van and every new place is like a new adventure for her.

Many of the people we’ve met during our Pan-American road trip travel with pets – mostly dogs, some cats, and even a couple of guinea pigs – and everyone manages just fine. There are some restrictions on dogs in many of the national parks of South America so it does limit you a tiny bit, but overall it’s not that difficult.

While most countries don’t really care that we have a cat at the border crossings, some countries are tougher than others. The hardest countries for crossing with pets are Belize, Panama, Colombia, and Chile, where they want some kind of paperwork to be done before entering and/or charge a fee for entering with a pet.

Before crossing any borders check iOverlander for any requirements. All of the information in iOverlander gets constantly updated by other travelers so this has been our best resource for border crossings with pets.

I also joined a Facebook group called Animal Travelers specifically created for people who travel with pets. It’s a great place to ask questions about traveling with pets, especially for flying and specific border crossings.

Read Next: 10 Tips & Tricks To Get Ready For Van Life With A Cat

Here are a few tips that we learned ( sometimes the hard way ) that can really help make life easier on this trip:

• Make copies of car registration, passports, driver’s licenses , and any other important documents before tucking them away somewhere safe. Also, make sure to scan and keep a backup online like on Google Drive.
• Apply for an extra license before leaving . This was a big one for us that we easily overlooked. After my wallet was stolen in Colombia and Joel lost his wallet in Ecuador, we were stuck without driver’s licenses which we needed to drive, pay for groceries, and cross borders. We didn’t have any extras so we ended up making laminated copies out of the scans that we had backed up. Thankfully they’ve worked so far at every border and checkpoint!
• Join the Pan-American Travelers Association Facebook Group . This is a public group with thousands of members who are traveling the Pan-American highway, have done it in the past, or plan to do it. If we have any concerns or questions that we can’t find answers to anywhere else, a lot of times we find them by searching this group or by posting a question in it.

The idea of traveling in a car through 14+ foreign countries can seem pretty intimidating ( at least it did for us ), but during our trip, we met so many amazing travelers and overlanders who helped us out with questions and tips along the way.

We hope this guide can do the same for you but if we didn’t cover something fully or if you still have any questions on traveling the Pan-American highway, don’t hesitate to ask us in the comments below!  

Looking for more van life inspiration? Here are a few other helpful resources and blog posts that you may like:

• 16 Best Sprinter Conversions For Van Life
• 30 Must-Have Campervan Accessories For Van Life
• 10 Amazing Ford Transit Conversions For Inspiration
• How To Make Money While Living In A Van
• The Ultimate Solo Female Van Life Guide

This post is written by Laura Sausina. Hi, I’m the founder of the Fun Life Crisis travel blog and I’ve been traveling full-time for the past 7 years. Here I share my experiences and tips to help 100,000 people a month plan their adventures around the world! Read more about me here .

Some of the links used in this blog may be affiliate links. At no extra cost to you, I may earn a small commission when you book through these links which helps support this blog! Thank you!

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134 thoughts on “The Ultimate Guide To Driving The Pan-American Highway”

Very helpful, thank you. I’m a 58 year old (spiritually about 28!) Brit going to do the journey. No mention of buying US 3rd party insurance here though, any ideas? Thanks Andy

Personally, we have not used travel insurance and have gotten pretty lucky with never having any issues on our travels so far. But it is something that I am looking info for future travels and I have heard that the World Nomad insurance is a pretty popular choice. Here is a link to their UK website: https://www.worldnomads.co.uk/

Cheers, Laura & Joel

3rd party insurance is compulsory in US and most South American countries, I believe, isn’t it ?

Hey Andy, sorry I misread your comment. I thought you were asking about travel health insurance.

In US it’s easy to get car insurance as long as the car is registered in the US. There are tons of companies offering car insurance online such as Geiko, AAA, Progressive, State Farm, All State, Liberty Mutual etc.

In North America, the countries requiring car insurance are: Canada, US, Mexico, Costa Rica, and Panama. In South America, the countries requiring car insurance are: Colombia, Peru, Chile, and Argentina.

In the US, Mexico, and Chile we purchased our vehicle insurance online, but most of the time you can purchase the car insurance right at the border. Peru was the only country where we had to cross the border and drive into the next town to purchase it.

Hope this helps clarify things.

Hello! First of all, thanks a lot for this great info! It’s truly appreciated and useful. I’m a 30-year-old Argentine national but have lived in Florida for 19 years. I’m planning to tackle this road next year. I have the following questions, any info would be greatly appreciated!

1. Do you think is doable in 3-4 months starting from Florida? I have time constraints due to work/studies.

2. How much did it cost to ship the car from Ushuaia back home? (or perhaps from Buenos Aires or Valparaiso?)

3. Approximately how much did you spend in gas? food? paperwork/documentation?

4. How was your experience during border crossings? Was it expensive?

Thanks a lot in advance! I truly appreciate it.

1. I really don’t think you can do it in that short of time. In 3-4 months you could do the US through Panama, or part of South America, but I don’t think shipping the car to South America and back would be worth the hassle for that short of a trip. There are many overlanders selling their cars in South America for cheap after they finish their trip, maybe buying one of those and doing a few months in SA would be a good idea. 2. It all depends on the size, but from Valparaiso or BA/Montevideo to the US/Mexico, you’re looking at $2k-5k and takes a few weeks to coordinate. There are no shipping options south of that. 3. Our costs were about $1200 (Mexico) to $2500 (South America) per month for two people. This is highly dependent on where you stay, what you eat, and your fuel efficiency. We very rarely paid for places to sleep, cooked 95% of our own meals, and drove a van that got 16 mpg on average. 4. Border crossings are all over the place but usually not bad. Nicaragua was the worst by far because they were so slow, unorganized, and inspected everything, but the other ones were quick and we rarely got inspected or questioned. Usually, borders take 1-2 hours but some were as quick as 20 minutes. Having pets is probably the biggest hurdle because sometimes they want extra paperwork. Entering Mexico is the most expensive at around $100, the rest are usually free or a couple of dollars.

Hope that helps!

Nicolas have you considered shipping to Ushuania and driving back? I am from the UK and looking at riding a vespa scooter the whole route from south to north in early 2022.

There is no place to ship a vehicle south of Santiago, Chile or Buenos Aires, Argentina

Hi! Is shipping your van back to the states from Argentina best or is it easy to sell your van at the end of the trip? Thanks!!

It really depends on the vehicle, timing, and a bit of luck. For us, we tried to sell the van at a huge discount down in Argentina but couldn’t find the right buyer since it’s all about timing. I’ve heard of some people that sell their vehicles for next to nothing to avoid the shipping costs, and have known some people that paid a huge premium to get an expedition ready vehicle that was at the right place at the right time. In general, I noticed that vans were in high demand but only on the very low end of pricing, like under $5k.

Thanks for your response! Thought – what if we started in Patagonia/Argentina and tried to find a van down there to drive back north? Might be luck/timing but maybe could find someone selling in advance…? Not sure how popular the van life culture is down there / enough supply and demand. Mil gracias!

It’s pretty rare for people to sell their vehicles in Patagonia since it’s so far south and there’s so little transportation from down there. Most people sell around Santiago, Chile or Buenos Aires, Argentina since that’s where most international flights land and leave from. Buying a local vehicle with Chile or Argentina plates is super expensive because of their crazy import tax laws, so the best bet is to find another overlander who’s done with their trip.

This is what Ewan McGregor and Charlie Boorman did for Long Way Up. You should be able to ship a scooter or motorcycle (motorbike) in the cargo hold of an airplane.

Awee , I lived in Florida , was going through the whole process of traveling on the pan America highway , We shipped our Toyota truck in our country in Guyana and we went through Guyana interior , throughout to lethem into Brazil, , into Venezuela Columbia Ecuador Peru Chile Argentina and Brazil back into my country Guyana,Took us three months of nonstop driving, except in the night, We slept in a our truck. every night it was just me and my husband, that’for me was a life time adventure I will never forgot , the sceneries was breathtaking, there is so much to see, but we had to come back because we had four kids so so a good vehicle , know language,, and I have all your documents insurance and everything passport everything in order before traveling,,you would love the trip enjoy , it cost us around 12thousand dollars , and the year 1996 , the road driving is unbelievable ?????

Found your site and have enjoyed our reading so far. We are leaving after next year for 12-15 months like you to go to South America. Our big thing is we will have our two dogs (lab & husky) and the gap is our biggest concern right now. Can we go on any boat with our van? Flying with dogs is not an option (unless emergency). It does not have to be comfortable and we would pay extra for this want but seek beta from those who potentially have made the journey. Thoughts? Thanks for sharing

The only way to ship the car is on a cargo ship but they don’t allow passengers since they’re only for cargo. To get across the Darien Gap, you can either fly or take a sail boat that goes through the San Blas islands. We’ve heard numerous people go on those sail boats with animals, you just have to find the right captain that allows pets. What most people with pets do is get an ESA letter and fly with your pets onboard instead of in a kennel in the storage area. That’s what we did and it was really easy, you just need any ESA letter, a vet letter, and a pet document from Panama – the details of how to get that document is on iOverlander.

great article. I plan to make the drive from Costa Rica to the states. I have a vw wagon which I converted into a camper…I am not into outdoor life, however, I would like to do some sightseeing and take my time…I am retired and time is on my side. I was wondering if I can sleep in my wagon and relax….

That sounds like a very relaxing trip! We spent quite a bit of time in Central America and there is just so much to see and do. Hope you have a great time on your trip!

Always dreamed of driving through the Pan American Highway (Mexico to Argentina and then circle back from Brazil to French Guiana (Circle around the entire continent of South America). I now live in Europe, so I’m not sure when I’d be able to do it. Though I’ve already been to Peru, many other countries all over Latin America have intrigued me (Costa Rica, Panama, Belize, Colombia, Ecuador, Uruguay, Chile, Argentina, Brazil). Hopefully, I’ll be able to fulfill the dream soon, but I prefer to see countries by seeing them one at a time.

hi, am looking to start this journey soon…will be travelling south to north (peru to canada/alaska) any links for insurance please?

Insurance is usually bought on-site at or near the borders at every border you’ll be crossing. The only exception is Mexico through Canada where it’s done online. For Mexico, try Baja Bound insurance. I don’t know about US & CA insurance since we’re from the US and never had to deal with that part

What kind of insurance is he talking about? Car insurance? Health insurance? I never considered insurance…

Car insurance is mandatory in many countries, most can be bought at the borders but some you need to buy online. In some countries they won’t give you a car permit at the border without it, and in some they set up police checkpoints where they check your insurance. It sounds more complicated than it is, you figure it out pretty quickly once you hit the road get a few border crossings under your belt.

Your blog is great! My boyfriend and I are saving to drive from Canada to Argentina, your posts are so helpful! Thanks

Hi Marsha Do share your experience; I am in Toronto and planning to do an Arctic to Argentina trip myself. Thanks,,, Max

Thank you so much for the information. We are saving money for this trip and we want to go when we have enough money. But because of the wet season we don’t know when it is the best time to go. How did you plan that part?

We just went whenever our van was ready. Mexico is nice in October-March, central is good in December-July, the northern part of SA is good in May-September, and the southern part of SA is good in November-March. So it depends on how long you want to go but if you want to do it in about 15 months you could start in Mexico in the fall and hit every place in their ideal time. As for the rainy season, we kept hearing about the rain in Central America but we thought it was blown way out of proportion. CA did not have a bad rainy season since it’s always hot and humid anyway. The rainy season you should really watch out for is in the northern part of SA (Colombia-Peru) where you really can’t do anything between October-April. Many roads are impassable and most hikes are closed or impossible to do.

Hi there. We have been traveling back and forth from Mexico to Canada and have made three trips. We have a 29′ RV (I want to downsize) something missing in your posts was getting an import permit for any foreign vehicles traveling into Mexico. With the RV we could get a 6 month or a 10 year permit. If you are caught without a permit they will impound your vehicle. We paid around 450 pesos for a 10 year permit. The Permits are available at most border crossings in a separate building than Customs. We are enjoying the information you have shared here. Thank you and take care.

Thank you for this bit of info but I wonder if you could clarify what a foreign vehicle really means: one registered in another country (US/CAD) I presume? Also, wouldn’t customs inform people of this import permit? From what you say, it sounds as though it’s not nearly as obvious as it should be. True?

What Peter is trying to say is that Mexico’s border is pretty relaxed and for the most part, they just let you in without really stopping you. They do this because so many people cross the border daily that they can’t stop everybody and check for vehicle permits, it’s up to the driver to stop and get the appropriate vehicle permit to drive in the country. Also, you’re allowed to drive a foreign vehicle without a permit as long as you stay within 26 km of the border. If you just cross without stopping to get the permit, then later on you’ll get to a checkpoint where they’ll ask for your vehicle permit and you’ll have to drive back to the border to get the permit. This is very different from any country south of Mexico where they don’t have these agreements in place to let people roam freely, and in those borders they make you get all the appropriate permits before crossing.

I want to travel via sub or truck from Texas to Costa Rica. Any advice is cc’d welcome and appreciated.

Do you have to go both ways, can you sell your vehicle at the south end of the trip and fly back? If people are selling their vehicle at the south end, is it possible to buy it and drive back north? thanks

Hey Cornelius,

Most people go one way and either ship or sell their vehicles at the end of the trip. We drove from the US to Chile and shipped our van back to the US when we reached the end of the Pan-American Highway.

A lot of people do end up selling their vehicles at the south end because shipping them back costs around $3000-$5000. For that you can check out the PanAmerican Travelers Association Facebook group . A lot of people post their cars for sale on there.

Cheers, Laura

I have a house in Panama and I’m planning on driving down this time what does it cost and what kind of paperwork do you need to cross ryukahr does it need to be translated in Spanish

Hey Steven,

Are you referring to the Darien Gap? It costs around $1000 to ship a van across the Darien Gap. You will need the vehicle title to arrange shipping through an agent on the Panama side.

I’ve seen a lot of mention shipping one’s vehicle FROM Darien Gap but what about in reverse? Is it the same process? And is it possible to catch a sailboat with one’s dogs (flying isn’t an option) to get back to Panama? Also, no one’s mentioned how people get around once their vehicle’s been freighted. Is it easy to rent a car for a day or so?

Yes, plenty of people do it in reverse and it’s the same process. I’ve heard of people going on sailboats with their dogs to do the Panama-Colombia crossing which would be cool since they go through the San Blas islands. We originally wanted to do this but it takes a lot of planning to coordinate the crossings just right. We did the ESA thing for our cat, nobody hassled us and pets fly free in the cabin if they’re an ESA. Cartagena is really easy to get around in a taxis, Panama is a little more difficult because things are more spread out so a rental car would help there.

How much do you have to pay at each countries border crossing to get your car across and does the paperwork needs to be translated from English to Spanish notarized

Usually, you don’t have to pay for border crossings. When you do, it’s only a couple of dollars. You can check the iOverlander app where people leave notes for each border crossing.

The paperwork can be in English, it doesn’t have to be translated into Spanish.

This is Harold and Eva 66 and 67. If we ever would travel S.America, we would like to do this with some other party with similar interests. Anyone out there ?? Greetings, Harold

Yes. We are interested Brian & Shelly [email protected]

Great post. Love the fact you stated all the important details. Thanks

Your trip struck me as “the trip of a lifetime.” Hey, I get lost in my backyard, would my car navigation work out there in the towns and main highways. You guys are fantastic inspirations. Rick

Take a look at Itchyboots’ YouTube channel. She uses a nav system everywhere (South America, Africa, the Middle East) on her motorcycle. Very inspirational!

This post is so inspiring and informative!! Thank you so much!! I’m looking forward to taking more road trips after the pandemic and would love to convert a van.

That is very good.

Thanks for your post. My wife and I are considering driving from Florida to Panama City in a 4X4 pickup with my motorcycle in the bed. Looking to be expats moving to Panama. Will we incur any problems with this? Luggage will be minimal.

In some countries you’re only allowed one vehicle per person so make sure you have the vehicles titled to both names, that way if they say anything you can just do the paperwork under the other person’s name.

Advice: If you’re traveling on a right hand drive vehicle, note that in 2018 Guatemala passed a law that made right hand drive vehicles illegal (as in Costa Rica). Should you get caught driving on the right you could get fined and your car can even be consigned by law enforcment so don’t take that chance.

I’m putting together my 1949 F1 ,with a 2003 Lincoln avaitor drivetrain, what kind of documentation is needed for the vehicle to ship to Colombia, I’m in the US right now.

You just need the car title and registration along with a driver’s license and passport. They’ll ask for Colombian car insurance but you can easily get it in Cartagena if that’s where you’re shipping to.

Hi Laura and Joel I enjoyed reading about your trans-American Highway adventure. It is so informative and current. Thank you very much. I am planning to do this big driving trip. As I am not handy with car repairs, could I ask if the car does break down esp. in SA, are there mechanics available to help with repairs? Once again, thanks Peter

There are plenty of mechanics everywhere but the big problems with breakdowns are finding parts and getting towed anywhere. Unless you drive one of the few vehicles that are sold unchanged throughout the world, you’ll likely have to ship in parts if something goes wrong. Also, our overlanding rigs are usually too big to get towed since they’re used to dealing with much smaller cars in Latin America. Lastly, if you’re in a small town or in the middle of nowhere, there’s pretty much 0% chance you’ll find either of those two things without getting to a major city first. Best thing I can say is if you’re not very familiar with your vehicle and know how to fix things, buy the newest car you can afford for the trip since that’ll give you the best chance of making it without a breakdown

I saw a reference to RHD vehicles in both the article as well as the comments. Am I missing something?

Many people drive Delicas and other cool imported 4x4s that are perfect for a trip like this and are mostly found as RHD. Many people who do the trip also come from RHD countries.

Did you carry much cash or use it in transactions. How is the gas quality?

We hid some cash in our van’s walls in case we needed it but never did. Other than that, we carried very little cash on hand and used our Schwab account to take out money from ATMs anywhere for free. We never had issues with gas quality but we have a gasoline engine, those with modern diesel engines could have issues since they don’t sell ULSD between Mexico and Chile.

2 Questions… Did your van get searched at border crossings and can you carry a weapon for protection?

Our van got searched a few times (maybe 5) but usually not very thoroughly. We did not have weapons other than knives and wouldn’t risk bringing a firearm along as it’s illegal to cross borders with them and they’re illegal in many countries.

Great story and comments! Very intrigued by the prospect of doing this trip as we’re approaching retirement and would like to do it before we’re too old. I noticed that you made no comment as to currency types used. Was the US Dollar good everywhere? Or were you making currency changes in each country you passed through. Thanks in advance for the info and safe travels in the future!

We used our credit card almost everywhere since CCs actually give you pretty good conversion rates. We just made sure to use CCs that don’t have foreign transaction fees. When we needed cash, we took out local currency from the ATMs using our Schwab account which gives us free ATM withdrawals anywhere in the world and refunds us any fees the ATM charges. We never used USD except for El Salvador, Panama, and Ecuador where the dollar is used as their national currency.

I love this! It’s a perfect starting point to plan a trip

I’m hoping to start a big South American road trip in about a year if covid has finally settled down

Any advice on buying a car when you get to SA rather than shipping one? I’m trying to decide between buying a car in the Southern US and shipping it across the Darién gap when I get there or just backpacking Mexico/Central America and then buying a car in Colombia to drive South with.

I speak Spanish reasonably well and have a few close Colombian friends in Bogota and Medellin which should help with the paper work I think.

Buying a car in South America is a great way to do it because most people finish their trip down there and don’t want to deal with the expense or hassle of shipping their vehicle back home. The problem is you have to be pretty flexible as far as timing and what kind of vehicle you buy, but if you’re flexible, you can get some great deals. For instance, we were willing to sell our van for $10k less when it was down there but we didn’t find the right buyer at the right time. There are a few facebook groups dedicated to buying/selling overland vehicles in South America, check those out as they’re the best resources. The best place to find American titled vehicles is around Santiago and Buenos Aires as most people end their trips there and there are people that will title your car in Washington without being there.

I had heard that you can’t have any liens on your vehicle before entering mexico. ie fully own it with no payments.

Is that true?

I’m not sure about Mexico, plenty of people take new cars down there and I doubt they all own their vehicles outright. I know a lot of people take their cars to Mexico with just a registration so I don’t think Mexico cares about ownership. Once you keep going south, many of the other countries ask for the title but let’s just say they don’t know what a US car title looks like or have any way of verifying whether it’s real

Hello, I am Brazilian and I am currently in the USA, I want to drive from Las Vegas to Brazil, my question is regarding the documents to cross the borders, I have a car, insurance and driver license here from the USA all in my name, but my passport is from Brazil. do you believe this is a problem?

No, won’t be a problem anywhere except for maybe in Brazil. A lot of people drive cars titled in countries other than where they’re from.

Do you have to have a drivers license in all of the countries you travel through?

For clarification, I am an US citizen. I have a Utah drivers license. Will I need to get a new license in Mexico, Peru, etc. to drive in those countries?

No, any license will work

If you’re driving then yes you’ll need a license in case you get pulled over and to get the car permit at the borders

Do you have any interest in selling your van to us for the trip?

Hey Matthew,

Yes, we are looking to sell it soon. You can email us at [email protected] to chat more.

I just wanted to thank you for sharing your grand adventure, and all the most valuable information on traveling “do’s and don’ts”.

Thank you, Mike! We’re glad that our post was helpful : )

Hi , thanks for taking all the time to share your fantastic experiences. I’m from Australia. I would start the journey in the US. can I buy a car in the US as a tourist – or do I need a residential address in my name? I encountered this in Holland : There-was-no-way I could register a car in my name unless I was properly registered in a town’s citizens register, for which I needed proof of registered house ownership or … proof of registered house rental for which the waiting lists are so long one just as well books a burial lot.

You need some kind of address to write on the registration papers and get the registration and title sent to, but don’t necessarily have to prove residency. It also depends on the state, I know many foreigners go to the state of Washington since their rules are much more relaxed whereas in Oregon they wanted me to have an Oregon driver’s license to register a car. There are people who offer a service on the panamerican travel association group on facebook where for a small fee they’ll take care of everything and you don’t even have to be there. Otherwise, you can rent a virtual mailbox in a state to use as your home address and register the vehicle there then cancel the service once you get the registration and title delivered.

I’m really interested in knowing how you handled the problem in Chiapas and the right-hand drive issue at the Costa Rica border. Thanks

Chiapas has a deep history of anti-government activities and issues, and as a result it can be kind of lawless at times. Looking back at it now, the best outcome would be to approach that area with caution, stay and park only in secure areas, and be prepared to pay the locals when they violently demand money for no reason. Travel in groups when possible and don’t let your guard down. As for Costa Rica, we don’t have right-hand drive but the common things people do to get through if you do have right-hand drive is to either 1) stop in Nicaragua and head back to ship south from Guatemala or Mexico, or 2) cross the border at night, hide the wheel with stuff, and create a dummy steering wheel on the left side, or 3) pay someone a lot of money to tow your vehicle through the entire country. In my opinion, option 1 is best because once you’ve seen the jungles of southern Mexico through Nicaragua, there’s not much else to see in Costa Rica and Panama and you’ll save yourself from the torture of the never ending heat of Central America.

Holà, looking at driving home to Canada from Costa Rica, the winds seems favourable. This plan is in its early stages so I might add that I am not rushed at all, and that I’m very much looking into networking, forums, and tips that could help over the next months. I am planning the purchase of the vehicle in Costa Rica but so far my biggest barrier in preliminary research is the Insurance situation from Mexico-North…Tips, forum links, experienced persons would be hugely appreciated. Another import question I have is: tent & bnbs, or camper? Is camping more liberating than a well planned route with safe campsites/bnbs?

(i’ve emailed you as well btw)just in case

The best forum for information and questions is the Facebook group “Panamerican Travelers Association”. Most people who are traveling the panam are part of that group so it’s a great place to get updates on traveling conditions or to just connect with others who are also on the trip. The sleeping situation is probably one of the most varied in everyone’s approach. It’s hard to reliably find places to tent camp so that would be hard to do. It’s also hard to consistently find good hotels/hostels/whatever. The more set up your are to sleep in your own vehicle comfortably with some amenities, the easier the journey without having a need to constantly plan ahead or spend half the day looking for a hotel or campsite every time you move.

Hi there, Enjoyed everything you guys posted. One thing nobody bothered to ask was since your trip was going over 12 months how did you get your renewal tags for the following year since you were out of the country? Did you have a friend with access to your mailbox which then mailed them to your current location?

Thank you for your response!

We have permanent plates from Oregon but if we didn’t then I probably would have registered the vehicle as non-operational during the entire trip. That way you don’t have to keep paying for US insurance and the DMV won’t ask for smog checks. As far as the actual paperwork and mail, we had that delivered to our parents while we were gone. And as far as tags go, nobody outside the US knows what kind of tags your plates are supposed to have so nobody will ever notice or care that your tags are expired.

Hi Joel, Thanks for responding. Is there a difference between Oregon and California (This is where my car is registered) when it comes to plate assignment? So none of the countries you guys drove in bothered you guys at all if the car was current or not on its registration? And what I mean by that when you guys crossed the border, if you were pulled over or not by the police, or especially, when you shipped you van from Panama to Colombia? Because that’s kind of risky. I know for a fact in Chile and Argentina they will expect your car to be up to date on its registration year because that comes up when you need to obtain an car insurance policy in either of those counties. If you guys made it all the way down there without a hiccup you guys were incredibly lucky. But then again you guys had backup because your tags were mailed to your parents house so in the event that something were to happen they can easily fed-ex it to you guys.

Once you venture below the US you realize that for the most part, laws are at most a guideline that very few follow. Nobody ever bothered to look closely at any documents, even Chile and Argentina. In Chile their main concern at the border is pets and food, and Argentina didn’t really care about anything including so called mandatory insurance which most overlanders buy from some guy through Whatsapp and is probably fake. The brand Ram and the vehicle Promaster don’t exist south of the US and not a single country cared, they just marked us down as a Dodge Ram pickup truck which is close enough. It’s intimidating at first when planning ahead but once you hit the road and cross a few borders it all becomes much easier.

Hi there, Three of us are thinking of taking our Sprinter Vans along the Pan-American Hwy with our motorcycles on the back to get to those out of the way places our vans won’t go. Do you know if it is impossible to ‘import’ the 2nd vehicle (motorcycle) into some countries as they only allow one vehicle per person?

Like you said, some countries only allow one vehicle per person so it would probably be doable if there were two people per van and each person had their name on at least one of the titles. The other thing would be that you’ll have to do all the paperwork twice, get double the insurances, and in some countries pay fees for each (although it’s never much). What I would probably do is take something that doesn’t fit their bill of what a “vehicle” is and it wouldn’t trigger a need for an import permit. I’m thinking moped, electric bike, pocket bike, maybe even a Honda Ruckus with the plates removed… anything that doesn’t fit their idea of what a motorcycle should look like.

Hi there. Thanks for the info. I am wondering if there are people who want to make the trip south but don’t really want to turn around and do the trip north. Is there any group…. where I might be able to find a vehicle that wants to come back north?

I’ve never heard of anyone that has done the trip both ways. Most people start at the north, head south to the end, then travel back up to Buenos Aires or Santiago and ship their car back home from there. Europeans do it in reverse order quite often, shipping to Buenos Aires, heading south, then north to Canada before shipping back to Europe. Many people decide to sell their vehicles after doing the trip one way and is a great way to get into a vehicle that’s been prepared for overlanding but are typically in immediate need of maintenance.

Don’t you need a permit to take your car into each country? For example, I know when driving to Mexico you pay a fee and then it’s refunded (partially refunded) once you return. Any insight on this? I don’t plan on returning to the US though; I’m moving to Ecaudor.

Yes, you get a permit in each country as you enter, usually called a TIP. Mexico is the only one that actually charges you, the rest are free except for some spare change to make photocopies of documents. When you leave each country, the TIP is cancelled.

How did you get the van back from Argentina!!

We shipped our van from Buenos Aires to Houston via RORO ship (roll-on, roll-off)

can make this trip with a motorhome? (Buss). because of the roads

Absolutely, lots of people do the trip in Class A RVs, converted school busses, and Unimogs. The bigger the vehicle the more restricted you are in cities and remote locations but your comfort level increases drastically. We found that a van was probably the sweet spot between between comfort and access, with anything too much bigger or smaller requiring a lot more planning ahead for sleeping arrangements or road access.

me and my girlfriend were looking to drive the South America portion of the trip with our two cats. What did you guys do with your cat if you wanted to go off for the day exploring? Did you do any hiking in Patagonia?

we’re trying to be as realistic as possible.

The cat was perfectly fine throughout the trip, in fact she actually liked it more than being at a home. At home she just hides all the time, during the trip we was always trying to explore outside the van every time we stopped and wasn’t scared at all. We always made sure we left the exhaust fan on and a window cracked if we left her. We did a lot of hiking in Patagonia and would leave her in the van with extra food and water, she was always fine. Central America was actually the toughest region for her (and us) because it’s so hot and wet so there’s little you can do to cool the car down. All of South America, outside of the northern coast, had pretty cool weather so it was easy to leave her in the car.

Hey Joel, Laura Thank you for this blog! It is very well written and touches all the necessary aspects of Pan American travel. I am thinking of making this trip from Canada to Argentina solo in a 2-DR Jeep Wrangler. Good idea? Bad Idea? How long will it take (3-6 months?) and how much will it cost in total (USD 20,000?) I was wondering if I can may be get in touch with you at a regular basis for some guidance? Max

You can do it in any vehicle including the 2-door Jeep Wrangler but it’ll be a little harder with that car because you can’t sleep in it. It’s a decent choice, it’ll just take a little more planning because every day you’ll have to plan on where you’ll pitch a tent or rent a room to sleep in. If you can afford a roof top tent and have a way of putting it on, that would be a pretty ideal setup. The fastest we heard of people doing it and still having time to see things was about 8-9 months, anything less and you’re really having to skip too many things and spending most of your days driving. If you get a roof top tent, you should be able to do it quickly and cheaply since you can go faster without spending too much time trying to find the right sleeping place and you’ll rarely have to pay for campgrounds so it would very quickly pay for itself. Email us anytime for more

Hi, one of my fantasies has been doing this trip from US all the way until Chile. Every once in a while I do a search on how to do so and today I found your article and got me exited about trying to make it happen. One question, and of course safety is one of my biggest fears for doing the trip, but how you handled Chiapas people trying to bribe you?

Safety’s a big concern for everybody on the trip but once you get going you learn how to stay alert and avoid bad situations, for the most part. Out of all the people we met, we rarely heard of anybody getting into big trouble other than the occasional small theft. As for Chiapas, it’s pretty well known that certain areas are unstable and should be avoided so most people take a different route to avoid that bad area. When we couldn’t avoid it, it sucked paying an angry mob demanding money but there’s little we could do so we just bargained for the three vans we were traveling with and paid.

Hi, I’m curious how you paid the angry mobs when they demanded money. You mentioned you had cash hidden in the van’s walls, but that you never needed to use it. How then did you pay the angry mobs and how much did they demand vs. how much you actually had to pay? Thanks!

They usually had roadblocks set up and you couldn’t get through unless you paid. Every roadblock was different, some wanted $5, others $20. Sometimes we passed through multiple ones on the same day. I don’t know if the situation is still the same there.

Thanks for the info. We are planning Colombia to Argentina in Jan. Just a small point – in some of these countries you legally have to carry a kit in the car, for example in Colombia you must carry a fire extinguisher that is in date, and various tools.

Did you obtain visiting visa for each country you entered prior to your trip or the visas were obtained on arrival at the borders? (Not sure, to enter some of the latin American countries you don’t visas if you have USA passport).

If you are American, you don’t need a visa to enter most countries in Central and South America. The only country that might require a visa is Brazil (or at least they used to, not sure about it now) which is why we skipped it.

I am starting our trip very soon and I live in Colombia. I am a teacher and also plan on continuing teaching on the road through online classes. How reliable is the internet signal with the Google Fi service in countries like Peru and Bolivia?

Having Google Fi service was definitely the easiest option vs buying a SIM card in every new country like many of our friends did. Internet in bigger cities is pretty decent and you can also find a lot of coffee shops and cafes that offer internet. In smaller towns, it’s a bit more challenging so it just depends where you’re planning on traveling to.

Can you bring weapons for just incase purposes?

We personally did not. Every country has different rules and your van gets searched a lot, especially at the borders, so we didn’t risk it by bringing any weapons.

Did the national parks offer cabins as well as campsites?

It depends on each country and National Park. We visited several on our trip and some offered rustic accommodations, others campsites. Which park are you interested in?

Hi guys! I’ve been reading this article over an over. I’m hoping to do it soon. So, here is my thing. I’m living in the US, and anytime soon i want to go back home in Argentina. I have a dog, and a car so I thought driving back would be a great experience. I’m just interested in going back, so if we don’t do anything just driving and sleeping (on what would cost money), and some food and water, how much would you think it gonna cost? Do you pay a fee in every border you cross or some? I have an Argentinian passport so latin america should be easy to navigate. I have a regular suv car, so not like a ban or big car, will it cost about 1000$ to ship it to colombia? (From panama) -approximately- What expenses did you face only from easy food, gas and some campsites to sleep? Thank you!

How much you spend really depends on you. Our average was $2200 per month for two people but it’s hard to say what you would spend. Some quick math: Assuming you drive straight there without too many side trips, it’s about 20,000 miles. Most SUV’s get around 15 miles per gallon, so that would be 1,333 gallons of fuel, and at $5USD per gallon, that’s $6,700USD on fuel total. You could do that trip as fast as 3 months if you didn’t stop much, so $10 a day on food/water/basic necessities would be $900USD. Add in $2000 to ship your car plus flights, plus an extra $1000 for random expenses or emergencies. Add it all together and with minimal stops, driving fairly straight, not accounting for any entertainment or restaurant meals, and assuming you sleep in your car at free spots every night (easy to do 95% of the time), you’re looking at $10,600.

Do you have route coordinates you could share or a resource to pop into mapping software like GAIAGPS?

100% awesome usual information. Gracias! I’m planning to travel in my electric vehicle. I’ve done a lot of research and have discovered that there are more chargers than people might think. But I’ll also carry a range of adapter so I can plug into anything from a regular outlet (SLOW charging) to dryer, welder, and other outlets. Let me know if you know of any resources about EV traveling on the Pan American.

Thanks for your post and the pictures look incredible. Just added this to my bucket list. I do have some questions: 1. Did you have any issues with fuel? I have had issues using mexican gas back in the ’90’s. 2. Could a car be rented at each country to avoid all wear and tear on personal vehicles? 3. Can this be extended by driving back up on the east side of south america?

1. No issues with fuel since we used a gasoline engine, modern diesel engines that use DEF need some modifications to work with the dirty diesel 2. Probably not, the borders aren’t always by big cities so not sure how you’d get into a rental after crossing and how you would turn it in before crossing unless you took a taxi from the nearest city 3. Most people stick to the west side on the way down. You have to go back north because there aren’t any ports to ship from down south, so some people go on the east side on the way up. We did this to save time but the east was very boring, just long stretches on grasslands with very little to see. The northeastern countries are a bit tough to travel though, both physically and politically, so most people stop in Buenos Aires on the East.

How was the gas situation? Were there areas were it was difficult to find fuel?

We brought a 5-gallon gas can and didn’t use it once along our entire trip. It’s good to have as an emergency but the reality is that there’s gas everywhere. I’ve heard sometimes certain places like Patagonia’s route 40 will run out of fuel but we never experienced this. It could also be that we did the trip in a vehicle that can go 350+ miles on a single tank so maybe if you were going to do it in an older vehicle that doesn’t have a good range, then maybe you’d actually put the 5-gallon jerry can to use.

Wow, alot of great information. I’m retiring and hitting the road to live the nomad life.

I have considered travel outside if the states and the Pan American by highway trip interests me. Googling the trip your site came up. I am so glad to find it. Your article lets me I’m know that its not only possible but doable.

Hi, that’s really an amazing article and your effort and time to write it and post it is much appreciated. My wife and I are planning to do half of the trip. Would love to know your thoughts bout it. Planing to ship a 4×4 or a van from Florida to Columbia Cartagena and drive all the way down to Ushuaia Argentina and then Buenos Aries and ship it back (passing by Peru Chile etc.). or we can ship it to Uruguay, then go Buenos Aries, Ushuaia, and then all the way to Columbia and then ship it back to Florida. which one would you recommend? Second, how much would you think it takes to do the trip starting from Columbia or Argentina, the Southern part only and what would be the best time to do it? Countries we are planning to visit ( Columbia, Ecuador, Peru, Bolivia, Chile, Argentina, and maybe Uruguay to Sao Paolo) Thanks again and happy new year .

Hi Sam, the order you do it in is more dependent on when you do the trip. Ideally, you’d like to time it so you end up in Patagonia in their summer (December-February) and northern South America during the dry season (May-September). North Americans tend to go Colombia>Patagonia>BA since they come from the north, whereas many Europeans go BA>Patagonia>Colombia since they ship to BA. We know people that did all of South America in 3 months and others that took a year or more, it just depends on how many stops you make and how much you want to drive each day. I would plan for at least 6 months if you have the time and no faster than 3 months if you stick to only the highlights.

Thank You Joel & Laura Is it possible to make the trip without being fluent in spanish?

Hi Michael,

While Joel does speak fluent Spanish and it did help us a lot during the trip, there are plenty of people traveling the Pan-American Highway that don’t speak Spanish. I do recommend learning a few basics so you can purchase food at markets, buy entrance tickets and arrange campsites along the way. There are a lot of great free apps like Duolingo that make learning Spanish fun and easy! Cheers, Laura

Hi there I’m looking for a partner to make this adventure trip, by Chrisler Pacifica or eventually by motorcycle, Super Tenere 1250. [email protected]

This post is so helpful! Thank you! Not sure if you are still monitoring comments – but I just wondered what month you left in? We are trying to plan when to leave for a 12-14 Month trip and will be starting in Vancouver driving straight to Mexico (so leaving out alaska part and quickly through US)

Its hard trying to work a time so that we get to avoid rainy season in Central, but still get the Salt Flats drive in Bolivia – and Patagonia in Summer!

Hey Melissa! We started our trip in Mexico in December where we spent 6 months. Then we crossed into Central America for 4 months and then spent 5 months in South America. If I remember correctly, we finished the trip in March around 15 months later.

HI! First of all thanks for publishing this article. I’m an american living in Argentina looking to make the trip between Ushuaia and Alaska through December 2024 and Febuary 2025. My friends and I will be 21 during this timeframe and are concerned with the cost of insurance due to our age. Do you have any suggestions regarding this issue? Furthermore, we will drive one way and fly back the other, where would you recommend we start? Lastly, is there any page where we could contact other Overlanders looking to sell an American vehicle in Argentina or sell an argentine vehicle in the US or Canada? Kind regards, Dante

Hi Dante, if you’re talking about car insurance, it depends on each country but overall it was really cheap. We didn’t get medical insurance but that’s a bit of a gamble and completely up to you. Most people start in Canada or US but it’s cheaper to start in South America because a lot of people make it down there and sell their overlanding vehicles cheap which are already prepared for the drive. There is a facebook group called Overlanding Buy & Sell – Americas which will be your best bet for buying something, while the group Panamerican Travelers Association is a great place to get info and connect with others doing the drive. Good luck!

Thank you for this article! I’m in a corporate job i’m sick of & would like to quit and do some traveling before my next chapter in life.

1. I’m wondering how much money did you guys have saved up before leaving on this adventure? I have about $25k USD saved right now but not sure how long I can realistically make it. I live in Colorado & think I would go up to Canada first and adventure around there to get used to life on the road and avoid some culture shock as it would just be me.

2. Did you come across very many people doing this solo?

3. Ideally it would be great to document my trip on the various social media platforms and gain a following. I followed your IG and saw you have a pretty large following. Did you guys have that before your trip?

I may have more questions but that’s all i can think of for now. Just concerned doing it solo & how much i need to be able to do this.

1. We had saved up a good amount before traveling the PanAmerican Highway. We averaged $2200 in monthly costs for two people over the course of 15 months. This came out to around $33K for the entire trip. Canada is very expensive for traveling, but Mexico and south of US is much cheaper. 2. We came across solo travelers, couples, people with kids, retired people…it’s really a mix. There are people traveling the PanAmerican solo although they do it in much shorter trips. 3. We had a social media following before the trip but my blog is where I spend my focus on. If you want to grow an IG following for income reasons, making money on the road with brands through IG is nearly impossible as there is nowhere to send products to. Many people start YouTube channels documenting their trips and growing a following on there to make money from video ads.

Hope this helps! Good luck!

Hi, I am wondering if I would need a title for my vehicle to do all the border crossings. I am financing my van so I don’t have it. Is it possible to do a trip like yours without a title?

Hey Dustin! We replied to your email as well. In case anyone has a similar question, legally you’re supposed to have the title to your name or a title that’s not in your name with something called a “poder” which is a notarized letter from the owner saying that they grant you permission to travel with the vehicle outside the country. I don’t think a bank will want to give you this so it’s tough to do the trip with a financed car if you’re doing it the “right” way. I would advise you to get a cheaper vehicle that you can travel with than a nicer vehicle you can’t legally travel with.

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• Pan-American Highway
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South America ca. 17 weeks Central America ca. 5 weeks Mexico ca. 4 weeks

Our trip starts in the vibrant capital of Argentina. Buenos Aires has a very special and international atmosphere: the colorful wooden houses in La Boca, the elegant Recoleta, the main plaza with its government buildings and the Obelisk on the Avenida 9 de Julio (which locals claim is the world's widest road). At the end of our stay, we will enjoy an exciting tango performance by highly skilled dancers. We then head south and leave the big city behind us.

The Atlantic coast is an animal lover's paradise. You will encounter guanacos, Magellan penguins, sea lions, sea elephants and many more. With a bit of luck, you may be able to watch right whales close by the boat. Several days will be spent driving through the endless expanse of the Pampas until we finally reach the Strait of Magellan, where we will be ferried across to Tierra del Fuego.

You will reach the southernmost city in the world, Ushuaia. Your location is 54 degrees southern latitude: from here, the Antarctic is less then 1000km away! Time to explore the Tierra del Fuego National Park, where a sign marks the official beginning of the Pan-American Highway. The Torres del Paine National Park awaits you with its shimmering glacier lakes, thunderous waterfalls, diverse flora and fauna and unsurpassed rock formations. Icebergs float year around on the waters of Grey Lake. Patagonia unveils its natural beauty as all this stunning scenery surrounds our campground.

The Patagonian glaciers are part of one of the biggest extensions of continental ice, and listening to the sound of ice breaking off the front wall of the glaciers is an unforgettable and sobering experience. We reach the mountain range of Fitz Roy and Cerro Torre, a dream destination for any hiker. On a clear morning, the sunrise lights up the mountain peaks of Patagonia with every shade red imaginable. This is truly a magical place.

The famous gravel road "Ruta 40" takes us through vast and flat grassland where our only encounters will be with guanacos, ostriches and armadillos. We spend the night on Estancias, where you will get a taste of local farm life. From the shore of South America's second largest lake, you will continue your trip to Chile. The views are spectacular! The main attraction at the General Carrera Lake are the enthralling marble caves, and the famous Carretera Austral takes us through dense, cold rainforest along the Last HopeSound.

Further north, we will reach the ‘Switzerland of South America,’ Bariloche, rife with enchanting scenery. The campground here is ideally located at the shore of the Nahuel Huapi lake. After a well-deserved break, we continue our trip to Chile's Lake District and explore its beautiful snowcapped volcanoes.

This week, you will see Laja Falls, is the highest waterfall in Chile, as well as explore Santiago, the Chilean modern capital, by foot. You will also take a cable car to the San Cristobal summit for a beautiful overview of the city. A spectacular Andean crossing takes you to the highest mountain outside of the Himalayas, Cerro Aconcagua (6.962m). Finally, Mendoza is Argentinean wine capital, so of course we will visit a winery and indulge in a fine wine tasting while here!

The Moon Valley is a bizarre landscape with peculiar rock formations. Regardless of whether you are a museum fanatic or not, the open air Pachamama Museum is well worth a visit! The town of Salta is also known as La Linda, or “the beautiful,” in Spanish. Palm and orange trees surround the Plaza, and the churches that dot the town are picturesque enough to be in a fairy tale.

Your second Andean crossing will be a breathtaking experience. Flamingos and the timid vicuñas life here in the solitude. We won't miss seeing the Atacama, the world's driest desert. Leaving San Pedro de Atacama in off-road jeeps, we will have the opportunity to get deep into Bolivian territory and explore some of its extraordinary attractions: colorful lagoons almost 5000m above sea level and Salar de Uyuni, the world's biggest salt flat. Returning to our motorhomes, we will reach the Pacific coast in the northern reaches of Chile.

Back to the Andes! Snow-capped volcanoes are ubiquitous in this region and it’s best to keep an eye on your meals, as plenty of vicuñas are looking for food. At the border to Bolivia lies one of the world’s highest lakes, with the majestic Parinacota volcano acting as its backdrop. Only a few hours later, we reach La Paz, one of the craziest cities in the world: the height difference inside the city is more than 1.000m! Strolling through the witchcraft market, we guarantee you will find many bizarre items. Our next destination is Lake Titicaca, the highest navigable lake in the world. An adventurous ferry ride will take us over the Strait of Tiquina as we finally enter Peru. On a boat trip, we will observe and learn about the floating islands of the Uros.

Cusco is the former capital of the Inca Empire and without a doubt, one of the most beautiful cities in South America. The most impressive Inca site is by far the lost city of Machu Picchu. The mystic atmosphere that enshrouds this ancient region is absolutely incredible.

After spending some time in the altitude of the Peruvian Andes, we will come down and return to the ocean, not far one of the world's last mysteries is located, the famous Nasca lines of southern Peru. These giant drawings on the earth can only be seen properly from the air, so you may choose to take a scenic flight over the ancient geoglyphs. In the middle of the desert lie the huge and impressive sand dunes of Huacachina. Afterwards we will reach Lima, the capital of Peru.

Visiting the Museum of the Royal tombs of Sipan we will learn more about the ancient Peruvian culture. Reaching the border to Ecuador, you will leave the dry desert behind. The landscape changes completely and becomes lush and verdant. In the beautiful colonial city of Cuenca the famous Panama Hat is produced. You will then get to Baños, at the foot of the active volcano Tungurahua. Many eateries sell the local delicacy – grilled guinea pig.

Following the Avenue of the Volcanoes will take us to Quito, Ecuador's capital city, which is divided into old and new halves. During a city tour, you will learn quite a bit about the colonial history of this area. The official Equator monument is only a short drive away: here you can jump between the Southern and the Northern Hemisphere! On our way to Colombia, you will spent a night at an idyllic crater lake.

Colombia! This relatively unknown country will surprise you with its fascinating scenery and a unique hospitality. Spending several nights on the grounds of a coffee farm, you will learn the process of coffee making. We also explore Cartagena, a popular destination for cruise ships and surely one of the most beautiful cities in South America.

16th & 17th week

Due to the break in the Pan-American Highway at the Darien Gap, this is time when we will wait for our motorhomes to be shipped. It is the ideal location to take a break and recharge your batteries for the next part of the trip. A several day stay gives us enough time to organize everything concerning the shipping to Central America. Our vehicles will board a cargo ship, whereas we will take the plane. As a result, both in Cartagena and Panama City we will spent some nights in hotels.

We fly to Panama and return to our motorhomes; from here, the Pan-American Highway guides us through Central America. After visiting the colonial part of Panama City, we will see the world-famous Panama Canal and learn about its fascinating history and technical intricacies. Costa Rica's capital city, San José, is an ideal base from which to explore the surroundings. You will have the option to visit the top of Poás volcano and have a look into the steaming crater lake or wander around and enjoy the waterfalls, orchids and hummingbirds in the area.

There is a part of Costa Rica which could easily be mistaken for the middle of Switzerland! That is exactly what the owner of a chalet-style hotel thought, where we will stop to enjoy Swiss specialties like cheese fondue. With a little bit of luck, we may spot lava running down the Arenal volcano. During a boat trip, we will keep an eye out for monkeys and colorful birds and in Nicaragua, we will have a unique opportunity to drive our motorhomes right up to a smoking crater. Nearby is Granada, one of the oldest cities in Latin America and located on the shore of Managua Lake. A romantic carriage ride will take us through the town center.

In Honduras, you will see the first Mayan site and spend a night close to the highest waterfall in the country. We will drive along the beautiful Yojoa Lake until we reach the country of El Salvador. Here we will get a chance to relax at the beach. A boat trip takes us deep into an entangled forest of mangroves to a small inhabited island, and modern civilization will seem incredibly far away.

Guatemala is another highlight you can look forward to! Antigua is a world heritage site and wandering around, you will feel as though you are in a fairy tale. It is impossible not to fall in love with this beautiful city. We will spend some nights right on the shore of the Atitlan Lake, surrounded by several volcanoes. From here, you can visit a typical indigenous market and try the local produce.

Tikal itself is well worth the trip to Guatemala. It is an attraction for both its cultural importance and its location in the middle of lush and dense tropical vegetation. Of course, we won't miss Latin America’s only English-speaking country, the small and likeable Belize. There are several attractions aside from the laid-back Belize City, such as dripstone caves and hidden lakes in which you can bathe.

It’s time for Mexico! We can assure you that this huge country has more to offer than simply tacos and tequila. Its beautiful Caribbean beaches, colonial cities, vivid markets and fascinating Mayan sites all make it a wonderful destination. We will start our visit on the Yucatán Peninsula, where we will be able to relax at the beach before moving on to the must-see Mayan site of Chichén Itzá. At the Gulf of Mexico we will visit Campeche, where you can appreciate how it has preserved its Spanish heritage.

In the mighty jungle of Chiapas, you will discover the Mayan site Palenque. Don't miss the colossal stone heads at the Olmeke Museum in Villahermosa! After a stop-over in Puebla, we will dive into one of the largest cities in the world. Mexico City is a diverse and sprawling metropolis that we will explore by tour bus, and we will be sure to stop by the Anthropological Museum to learn more about its history.

On the way to Guadalajara, you are welcome to visit the archeological ruins of Tula, and San Miguel de Allende is truly a colonial treasure worth seeing. We then leave the Mexican highland and reach the Pacific Ocean, where we will spend some time in Mazatlán and San Blas, right by the sea.

After Guaymas, we leave the coast and eventually cross the border into the USA. After touring 180 days through Latin America, this one-of-a-kind tour ends in Tombstone, Texas. We will celebrate the end of our trip in a historic old western saloon drinking whisky, sharing the many stories, memories and mementos we have collected along our journey! From here, everyone is welcome to continue the tour on their own.

You can either continue your trip right away or put your motorhome in storage and fly back home, returning several weeks later to continue your journey. It is completely up to you whether you choose to explore the other end of the Pan-American Highway, all the way to Alaska, or to simply drive to the east coast.

During our trip there is a slight chance that changes in itinerary and program might occur, but these usually do not affect the overall length of the tour.

While it is uncommon, please note that if shipping delays cause scheduling changes, we reserve the right to shorten the trip in the end.

[Contact us] for a free „Tourbook“ with more details about itinerary, services and more.

Von Alaska nach Feuerland

mit dem Fahrrad entlang der Panamericana / Carretera Panamericana

• Rad und Ausrüstung
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Donnerstag, 28. Februar 2013

Reisevorträge.

Sonntag, 4. November 2012

Greffen, kleinet duorp in’t mönsterland.

Samstag, 20. Oktober 2012

54° 48′ s, 68° 18′ w.

Donnerstag, 11. Oktober 2012

I did it my way.

Samstag, 6. Oktober 2012

Auf nach tierra del fuego – feuerland.

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• Regent Seven Seas Cruises

Best of Moscow by high speed train

By shuguley , February 15, 2014 in Regent Seven Seas Cruises

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Sure would appreciate someone who has taken "Best of Moscow by high speed train" from St. Petersburg could please share their impressions of this shore excursion. From the description this sounds like a very long day.

Wondering how the 4 hour train trip was in terms of accommodations, etc. Also what time did you leave the ship and what time at night did you return? Were both legs of the trip on the high speed rail (I read that slower trains also travel the same tracks)?

My wife and I are considering this excursion. We thought that if we are making all the effort to go to Russia then how could we pass up going to Moscow, walking in Red Square, seeing St. Basil, etc.

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If you are considering this on the 2015 June Baltic cruise on Voyager; my suggestion is don't. There is so much to do in St. Petersburg and although a train is one of my favorite ways to travel the time would be far better spent in St. P.

Thanks for the advice. Yes, this would be on the Voyager during the 2015 season but not yet sure exactly which cruise.

We did the Moscow excursion "on a different luxury line", but from your brief description it sounds very much like the same trip, so I will operate on that assumption. It is a VERY long day! We left the ship at 5:30 AM and returned at 12:30 AM. The highspeed train trip is comfortable, and while they call it "Business Class" it does not compare well to the equivalent class on say Rail Europe. When we did it in 2011, we did have highspeed both ways, and the trip back seemed much longer as the adrenaline and excitement had worn off!:D

Moscow itself is not that terribly different from any other big city in the world, but this Cold War kid never thought he would ever stand in Red Square, never mind walk the grounds of The Kremlin, or tour The Kremlin Palace, or see (but not visit) Lenin's Tomb, or visit The Armoury. But he did, and he loved every minute of it! Yes, it is a long day, and you barely scratch a scratch on the surface, but it is worth it. There is a tremendous amount to see in St. Petersburg, but every Baltic cruise goes to St. Petersburg, so you can go back if you choose to. Not every cruiseline offers you the chance to see Moscow.

I have not personally done this tour, but our last time in St Petersburg, the private guide that we hired for a day was leading the regent tour to Moscow on the high speed train the next day. He said it was way better than the previous alternative, which was flying to Moscow and back. He said that you actually got to Moscow faster because you didn't have to deal with airline checkin etc. it did seem like a very long day to me, and there is so much to see and do in st. Petersburg that I didn't consider doing it.

countflorida

We toured to Moscow from St. Petersburg via the hi-speed SAPSAN train last September, from a Baltic cruise on the Oceania Marina. You need to have a two-night, three day port call in St. Petersburg to take this tour because the tour typically leaves the ship around 5:00 - 5:30 AM and doesn't return until after midnight the next day. We didn't take the ship's tour; we made private arrangements with TravelAllRussia for three days of touring, the first and third days in St. Petersburg and the second day the tour to Moscow by train. Our cost for the private tour for three days was about the same as what the ship charged for the excursion to Moscow alone. There are a number of private tour agencies that operate in St. Petersburg and offer the Moscow train tours; we would strongly recommend them over the ship's tours.

All three days had private guides with car and driver. The second day, the driver picked us up at the ship and took us to the train, but we were alone on the train, and met in Moscow by the guide on the station platform. After our tour and dinner, we were brought back to the train and after the return train trip met by the driver and taken back to the ship. Because you are alone on the train you must have your own Russian visas.

If this is your first visit to St. Petersburg, I would agree there is much more to see there. We found Moscow somewhat a disappointment, particularly Red Square. The Kremlin and the cathedral in Red Square were also worth seeing. But the best thing we saw was the Moscow subway! I worked for the Washington Metro system back in the 1980s as it grew from 40 to 80 miles and although I was in the computer area, I learned a lot about the challenges of running a subway system. We used the Moscow system to get across the city from where we had dinner to the train station, and I was amazed at the cleanliness', speed of operation, the short headways maintained, and the courtesy of everyone involved. A very impressive experience!

We had been to St. Petersburg before, and so had the time to take a day and go to Moscow. Also, I really like trains, and the SAPSAN is a German train set running on Russian rails. Seats are like first class domestic air, spacious but not too plush or comfortable, but with enough room. Not too much recline, and almost 8 hours on the train in two shots is a lot for an old man. They come through and sell drinks, candy, etc. but the sellers don't speak English and no one around us helped, so we had just poor coffee once coming, and brought stuff with us for the trip back. Not too much to see from the train either, particularly on the return when it is night the whole way.

If you decide to go, take a private tour and avoid the overly expensive ship's tour. I'm glad we did it, but wouldn't bother to repeat the tour; we've seen Moscow.

Thanks so much to all of you for the thorough and thought insight. Yhe information you have provided is most helpful.

countflorida: Your detailed post is very helpful. We are not quite ready for a Baltic cruise but should do so within a year. Time enough to do our pre travel research, bookings and visa gathering.:) Thank you!

Emperor Norton

Sure would appreciate someone who has taken "Best of Moscow by high speed train" from St. Petersburg could please share their impressions of this shore excursion. From the description this sounds like a very long day.   Wondering how the 4 hour train trip was in terms of accommodations, etc. Also what time did you leave the ship and what time at night did you return? Were both legs of the trip on the high speed rail (I read that slower trains also travel the same tracks)?   My wife and I are considering this excursion. We thought that if we are making all the effort to go to Russia then how could we pass up going to Moscow, walking in Red Square, seeing St. Basil, etc.

I did this on Seabourn. IMO DONT. Take Aeroflop (er Aeroflot). The train has non folding seats where you are literally knee to knee with your fellow passenger (facing each other). Further they don't believe in air conditioning. It's also the worlds slowed bullet train. I think I would have found more enjoyment wandering around the St. Petersburg and Moscow airports.

Countflorida,

This is a little off topic,, however we had planned a river cruise in Russia but decided we would rather stay on land and have booked about two weeks with Travel-All-Russia using the private guide and driver. I'm curious as to how you found them as a tour company.

The guides they provided were fine. We had a different guide each of the days in St. Petersburg, but both were flexible, pleasant, knowledgeable and spoke English very well, as did the guide in Moscow, incidentally. She was a bit aloof, distant, not too friendly, but otherwise fine. In fact, she was the one who suggested taking the Metro, which unexpectedly became one of the highlights of the Moscow excursion. If I have a complaint with AllTravelRussia, it is with their plan and its execution (more later).

I had requested emphasis on World War II (in Russia, the Great Patriotic War) sites and info. In scheduling us, they weren't careful about dates and a couple of the sites we wanted to see were scheduled on the third day, after we'd been to Moscow. But both sites were closed that day of the week, and that info was readily available, right on web sites describing them. Also, the included meals (lunches in St. Pete, dinner in Moscow) were not what we asked for: light meals with some choices, so we could avoid things we didn't like and choose things we did like. My request was ignored; we were given full Russian meals with a fixed menu, no choice. On the first day, a fish dish was the entre, but I am allergic to fish. Fortunately, I had the e-mail I'd sent with me and showed it to the guide, and she was able to change my entre to chicken, which was very good actually. But we didn't want a 3-4 course lunches or dinner (in Moscow). We had the guide drop the lunch the third day, although we never got any credit or refund. But, particularly in contrast to the ship's tours, the prices were so reasonable we didn't worry too much about it.

The people who were on the ship's tour to Moscow saw us boarding the same train for which they were forced to queue up and wait on the way back, and asked us what we had done. I was candid and open so they were not happy when I explained what we had arranged and particularly what it had cost. Also, when we returned to the ship, we found they had laid on a late supper for those who had gone to Moscow, so up we went and had something. Well, it turns out the late supper was supposed to be just for those on the ship's tour, but we and others on 'independent' tours, there were a dozen or more of us, crashed the party, actually got there first, and they didn't realize it until the larger group arrived and there weren't enough tables/places set. By that time, the 'independents' had all gotten served and were eating; what could they do?

A couple from the larger group sat down with us and asked us about our tour, and they were the ones I told about our arrangement and its cost. They turned to others who’d been with them and announced the details, loudly enough so the whole room heard, which started a lot of bitching and complaining. I gathered they weren't very happy with the ship's tour to begin with, and this was the straw that broke the camel's back. We finished up and beat it out of there, but overheard later that one of the excursion staff came to check on something and ran into a real mess. I caught a cold on the trip, which forced me to bed the second day following in Tallinn, so by the time we reappeared we heard about the contretemps' but apparently no one recalled who started it, thankfully.

Because of what happened to us, I would probably not use AllTravelRussia if I were to go again, or if I did, I would be sure to get confirmation of every detail of the tour. They do have good reviews generally, and we were certainly helped by their visa department and liked the guides and drivers. Their weakness, I say now with full 20:20 hindsight, is that once the sales person who plans the tour, sells it to you and collects your money, he (or she) transfers the plan to their Russia office for implementation; there is no follow-up to make sure it gets done right. And that is where our problems arose; we paid for a custom tour but got a standard package with a few destinations switched, and no one checked them out, even to see when they were open the day we were scheduled to go. If you check every detail that’s important to you, it should be OK, but that’s a hell of a way to have to do business, in my opinion.

Thank you for the 20/20 hindsight observation on your Russian tour operator, and better priced than the ship's excursion cost.

Thanks very much for the feedback.

We had the same experience as you so far as price. We originally booked a Viking Cruise but, hearing some things about the river cruises that made us unhappy, looked into other options. T-A-R cost the same or less than a cruise and had us in hotels for 11 days. We opted for the private tour. They have three tour levels, based on hotels. We originally opted for the four star as it did not cost much more than the three star hotels. Finally we decided to throw it all in and upgraded to five star. In Moscow we will be at the newly opened Kempinsky which is two blocks from Red Square. In St. Petersburg it is the Grand Hotel Europe, one of the most vaunted luxury hotels in Russia. Location is important for us as the tours use up only part of the day so being in the center of everything for our independent touring is important. As with many other cities, the less you pay, the farther out of the center of town you are.

We have been working with our salesman in D.C. and he seems to get back to us with the changes we want. He recently returned from Russia so is up on everything. When I asked they said they paid the full TA commission if I wanted so I got my usual TA on board so he is watching our back and giving us that extra level of comfort. He also set up our air, which I know pays him little or nothing, and got us business class for much less than T-A-R wanted for economy, though it took working for a while with a consolidator. He's happy to get his 10 percent on this trip without having booked it. He also took care of the trip insurance. We've been doing a lot of research on the CC sister site Trip Advisor and will write a report there. We will, I guess, become a source of info for CC members after having spent 5 days in Moscow and 6 in SP.

• 4 months later...

scubacruiserx2

Anybody considering a day trip to Moscow from St. Petersburg on the Sapsan may want to look at our travelogue filled with pictures.

http://boards.cruisecritic.com/showthread.php?t=1927687

Very informative. Thanks dor sharing. Jeff

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