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Key takeaways

• A breech baby is positioned bottom or feet first, not head first.
• Most babies turn head-down by 36-37 weeks of pregnancy.
• External cephalic version (ECV) can turn a breech baby in about 50% of cases.
• Birth options include a planned caesarean or a planned vaginal breech birth.

What is a breech presentation?

A breech position means your baby is lying bottom-down or feet-down in your womb. This is instead of the usual head-down position. This means your birth may need a bit more planning and support from your healthcare team.

Breech positions are common in early pregnancy. Most babies will turn themselves to a head-down position by about 36 to 37 weeks. This is the best position for birth.

However, around 3 to 4 in every 100 babies remain breech towards the end of pregnancy.

Types of breech positions

There are three main types of breech positions:

• Extended or frank breech – Your baby is bottom first with their feet up by their ears. Most breech babies are in this position.
• Footling breech – Your baby is feet first. Either one or both feet are below their bottom.
• Flexed breech – Your baby is bottom first with bent knees. Their feet are next to their bottom.

If your baby is still breech at around 36 weeks, your midwife or doctor will discuss your options with you.

Turning a breech baby before birth

If your baby is in a breech position, a doctor who specialises in pregnancy and birth (an obstetrician) may offer to try turning your baby. This can be done with a procedure called external cephalic version (ECV).

What is an ECV?

An ECV involves a specially trained midwife or doctor applying gentle but firm pressure to your tummy. This pressure helps your baby turn to a head-down position in your womb.

When is an ECV performed?

An ECV is usually performed after 36 or 37 weeks of pregnancy. It can be done right up until the early stages of labour. You will have an ultrasound scan beforehand to confirm your baby is breech.

The ECV procedure

Before the ECV, your blood pressure and your baby's heart rate will be checked. You will also be given an injection of medicine to relax your womb muscles. This medicine can make you feel flushed and your heart may beat faster for a short time.

During the ECV, your baby's heart rate will be monitored constantly. The procedure only lasts a few minutes.

It can be uncomfortable, and sometimes painful. If you feel pain, tell the person performing the ECV. They will stop.

After the ECV, another ultrasound scan will be done to see if your baby has turned. Your baby's heart rate will also be monitored again. If the first attempt is not successful, your healthcare professional may try again on another day with your consent.

Success rates and risks of ECV

An ECV is successful for about 50% of women. It is more likely to work if you have had a vaginal birth before. If successful, there is a small chance your baby will turn back to the breech position. This happens in less than 5% of successful ECVs.

ECV is generally safe with a very low complication rate. There does not appear to be an increased risk to your baby from having an ECV. However, there is a 1 in 200 chance of needing an emergency caesarean section immediately after an ECV. This could be due to bleeding or changes in your baby's heartbeat. This is why an ECV should be carried out in a hospital. This ensures you can have an emergency caesarean section if needed.

When ECV is not recommended

An ECV should not be carried out if:

• You need a caesarean section for other reasons, such as a low-lying placenta (placenta praevia).
• You have had recent vaginal bleeding.
• Your baby's heart rate tracing is showing some unexpected changes.
• Your waters have broken.
• You are pregnant with more than one baby.

Other techniques to help your baby turn

You may hear about other ways to encourage your baby to turn. It is important to discuss any alternative therapies with your midwife or doctor first.

• Stretches and positions – There is no scientific proof that certain positions can turn a breech baby. Some people try kneeling with their head down and bottom raised to give the baby more room.
• Moxibustion – Moxibustion is an alternative therapy using the Chinese herb mugwort, burned over specific acupuncture points. Moxibustion at 33-35 weeks may help your baby turn, according to some evidence. It should be performed under the direction of a registered healthcare practitioner.
• Chiropractic (Webster method) – The Webster method of chiropractic care aims to realign your pelvis to help your baby get into the best position. However, this method is unproven, and research into its safety is limited.

Birth options if your baby remains breech

If your baby remains breech towards the end of pregnancy, you have two main birth options. These are a planned caesarean section or a planned vaginal breech birth. Your healthcare professional will discuss the benefits and risks of each option with you. This will help you choose what is best for you and your baby.

Planned caesarean section

A planned caesarean section is recommended as being safer for your baby than a vaginal breech birth. This is according to both the Royal College of Obstetricians and Gynaecologists and the National Institute for Health and Care Excellence (NICE).

A caesarean section carries slightly more risk for you than a vaginal birth. It can also slightly increase the chance of certain complications in future pregnancies, such as issues with the placenta or with another caesarean birth. Your care team will talk you through all of this in detail.

Planned caesarean sections are usually performed from the 39th week of pregnancy. Your healthcare professional may advise a planned caesarean section if:

• Your baby is a footling breech (feet first).
• Your baby is larger or smaller than average.
• Your baby's neck is in an awkward position, such as tilted back.
• You have a low-lying placenta (placenta praevia).
• You have other pregnancy complications, like a condition that causes high blood pressure (pre-eclampsia).

Planned vaginal breech birth

If you choose a planned vaginal breech birth, you will need to be cared for by a team trained in this type of delivery. A hospital birth is recommended, as 4 in 10 women planning a vaginal breech birth need an emergency caesarean section. Induction of labour is not usually recommended.

A successful vaginal birth carries the least risks for you. However, it's important to know that a vaginal breech birth carries a small increase in the risk of serious complications for the baby.

This is when compared to a planned caesarean. Your care team will explain this to you in detail.

There is also a higher chance that your baby may need some extra care from the hospital team for a short while after they are born. These complications do not seem to have any long-term effects on your baby.