If your baby has its bottom or feet facing downwards in the womb this is called the breech position. Find out everything you need to know about ECVs and giving birth to a breech baby.
What does ‘breech’ mean?
When your baby is bottom or feet first in the womb, they are in a breech position. This is common in early pregnancy. The ideal position for birth is head-first.
Most babies that are breech will naturally turn by about 36 to 37 weeks so that their head is facing downwards in preparation for birth, but sometimes this does not happen. Around three to four babies in every 100 remain breech.
There are three main breech positions:
Complete or flexed breech describes a baby that is bottom first with their knees bent and their thighs against their tummy and chest.
Extended or frank breech is also a bottom-first position, but the baby’s knees are not bent. Instead, babies in this position will have their legs up and their feet by their ears.
Most babies who are breech will be in the extended or frank position.
Footling breech is when a baby is feet-first. Either one or both feet are below their bottom in this position.
Why is my baby breech?
Sometimes there is no clear reason why your baby is breech but there are some things that make it more likely, such as:
too little or too much fluid around your baby (oligohydramnios/polyhydramnios).
Is a breech birth more difficult?
Vaginal breech birth is more complicated because the largest part of the baby (the head) is delivered last. In some cases this may be difficult and a caesarean may be needed.
Some breech positions are “better” than others for a vaginal birth. The safest is frank breech or complete breech (see above). If you have a footling breech, labour is less likely to go smoothly and you may be advised to have a caesarean.
A vaginal breech birth is a choice for women and their partners and it will be respected by your healthcare professionals. However, it may not always be recommended as safe.
What happens if my baby is breech?
If your midwife or doctor thinks that your baby is still breech at 36 weeks pregnant then you should a have scan to confirm this.
A doctor can try to turn your baby into a head-first position using a procedure called an 'external cephalic version’ (ECV). During this, the obstetrician will put pressure on specific parts of your bump to encourage your baby to move round in the womb.
What is an external cephalic version (ECV)?
An ECV can be done from 36 weeks all the way up until early labour, as long as your waters have not yet broken. It is successful for around 50% of women. If successful, you will be less likely to need a caesarean section or other medical assistance during labour.
If you agree to an ECV, you will need to go into hospital to have it done.
‘I was absolutely petrified (crying before they'd even started) but the consultant and midwife were brill and turned her within a couple of minutes. She went on to be 1.5 weeks overdue and I had a completely natural birth at our midwife led unit.’ Emma
Is everyone offered an ECV?
Most women will be offered an ECV, however there are some reasons why it may not be safe for you to have one. These include:
Before the doctor starts, you will be scanned to make sure your baby is still breech. They will also check your blood pressure and heart rate.
You will be given an injection of a drug to relax your uterus (tocolytic), which should make turning your baby easier. It is safe for you and your baby but it may make you feel flushed and your heart might beat faster. These side effects should only last for a short time.
Your baby’s heart rate will also be checked before an ECV.
During an ECV
The procedure will last for a few minutes. The pressure is likely to feel uncomfortable but it should not hurt. If it causes you pain, tell the doctor and ask them to stop.
After an ECV
You will have another ultrasound scan to check if your baby has successfully turned head-first. Your blood pressure and heart rate will also be checked again, along with your baby’s. Call the hospital if you have any bleeding, abdominal pain, contractions or reduced movements after an ECV.
Watch this short video from the NHS about ECVs
Other ways to turn a breech baby
There are a couple of things you might like to try to help your baby turn:
Stretches and positions
Kneel on a mat with your head down to the floor and your bottom raised up for about 15-20mins each day. The aim is to get your baby out of your pelvis to give them more room to turn. There is no research to support this method, but some mums say it has worked for them.
If you feel any pain or dizziness then stop straight away.
Moxibustion seems unusual but a small number of clinical studies have shown that it has worked in 50-80% of cases. It involves gently burning a ‘moxa stick’ containing a soft woolly Chinese herb called ‘mugwort’.
It is either placed directly on the skin on your little toe or just above it to produce a warming sensation. The idea is that the heat permeates the skins and affects the flow of energy and blood in the area being treated.
Moxibustion should only be done under the direction of a trained healthcare professional. Many maternity units now run clinics offering this, so ask your midwife about it. You can also find someone on the British Acupuncture Council.
What are the risks of an ECV?
The risks associated with ECV are very small. As mentioned, an ECV isn’t always successful. You may be offered another one, depending on your circumstances.
Very rarely, the procedure may work but your baby may still turn back to the breech position.
the baby can become distressed
there may be bleeding from the placenta.
This happens in approximately one in 200 ECVs and if it does, your baby will be delivered by emergency caesarean section.
What happens if my baby doesn’t turn?
After an ECV (or if you choose not to have one), if your baby does not turn head-down you may be offered another ECV.
There are two other options for giving birth to your breech baby which your doctor and midwife will talk you through:
You might go into labour before your planned date. If this happens, a midwife or doctor will examine you to see if it is safe to give you an emergency caesarean. Sometimes, if your baby is nearly ready to be born they will advise you to give birth naturally.
Planned vaginal breech birth
If you decide you would like to have a vaginal breech birth, you will be looked after by a team who is experienced in looking after women during breech deliveries. This should be in a hospital where they will be able to give you a caesarean in case of an emergency.
You will be advised against a vaginal breech birth if:
RCOG, ‘Green-top Clinical Guidelines No.20a External Cephalic Version and Reducing Incidence of Term Breech Presentation’: www.rcog.org.uk/en/ guidelines-research-services/guidelines/gtg20a/ [accessed 23/03/2018]