What happens if my baby is breech?

What does breech mean?

When a baby is upright, with their bottom or feet low down in the womb, they are in a breech position. This is common in early pregnancy.  

Most babies that are breech will turn themselves by about 36 to 37 weeks, so that they are head-down, ready for birth. This is the best position for a baby to be in near the end of pregnancy.

Sometimes, though, babies do not turn head-down. Around 3 to 4 babies in every 100 remain breech.

What are the different breech positions?

There are three main breech positions:

Extended or frank breech

Your baby is bottom first, with their thighs pressed against their tummy and chest, and 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 their knees bent, thighs against their chest, and their feet next to their bottom.

Why is my baby breech?

For some people having a breech is just down to chance. Certain factors do make it more likely, for example:

• it's your first pregnancy
• there is too little amniotic fluid (oligohydramnios) around your baby
• you are pregnant with more than one baby
• you have a a low lying placenta (placenta praevia).

Is a breech birth more difficult?

Vaginal breech birth can be complicated. That’s partly because the baby's head, which is the biggest part of their body, comes out last. This can lead to problems, such as them not getting enough oxygen during the birth.

But if your baby's bottom is coming first, rather than their foot or knee, vaginal birth is more likely to run smoothly. 

Being cared for in hospital, by a team experienced in breech vaginal birth, is the safest option for you and your baby. That’s why your midwife or doctor will talk to you about your birth options at 36 weeks of pregnancy if your baby is in a breech position.

There are benefits and risks with both caesarean section and vaginal breech birth, which they will discuss with you so that you can choose what is best for you and your baby.

What happens if my baby stays breech?

If a scan shows that your baby is still breech at 36 weeks your midwife or doctor will explain your options. These are:

• They can try to turn your baby around in your womb using a technique called external cephalic version (ECV).
• You can have a planned caesarean birth.
• You can have a planned vaginal breech birth.

What is an external cephalic version (ECV)?

An ECV involves a specially trained midwife or doctor pressing firmly but gently on your belly. The pressure may help your baby to turn to a head-down position. Your chances of having a vaginal birth are higher if your baby is head-down.

Your midwife or doctor will check your blood pressure before trying an ECV, as well as your baby's heart rate. If all is well they will give you an injection of medicine to relax your womb muscles. It may push your heart rate up for a short while and you may feel flushed.

An ECV only lasts a few minutes, but it can be uncomfortable. If you are in pain, tell the person carrying out the ECV, and they will stop.

ECV is safe for people who are having a straightforward pregnancy. It turns half of breech babies. You will have a scan after the ECV to see if it has worked for your baby.

If the ECV does not work the first time your midwife or doctor may offer to try again on a different day.

"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?

An ECV does not suit everyone. You will not be offered an ECV if:

• if you need a caesarean section for another reason, such as a low-lying placenta
• you have had recent vaginal bleeding
• there is concern about your baby’s heart rate
• your waters have broken
• you are pregnant with more than one baby.

Watch this short video from the NHS about ECVs

Is there anything I can try to help turn my baby?

There are a couple of other things you could try, but there’s no guarantee they will work.

Stretches and positions

There is no proof that getting into certain positions turns a breech baby, but some people say it worked for them.

As long as it is comfy for you, kneel on a mat with your head down to the floor and your bottom raised up, for about 15-20 minutes each day. The aim is to get your baby out of your pelvis to give them more room to turn. 

If you feel any pain, or start to get dizzy, stop straight away.

A simpler option could be lying on your side (lateral position). One small study suggests that lying on your right side several times a day if your baby's back is on the left side, or lying on your left side if your baby's back is on the right side, may help your baby to turn to a head-down position. 

Moxibustion

Moxibustion is an alternative therapy that uses Chinese herbal medicine and acupuncture points. A practitioner burns a stick of the dried herb mugwort (moxa) over certain acupuncture points on the body. There is no contact with the skin.  

The idea is that moxibustion at 33 to 35 weeks of pregnancy can stimulate hormones and womb muscles, and therefore encourage your baby to move.

There is some evidence that moxibustion works, but more proof is needed to be sure.

You can do moxibustion yourself once a trained, registered practitioner has shown you how to do it. Talk to your midwife or doctor before trying moxibustion or any other alternative therapy.  

Chiropractic

A chiropractic technique called the Webster method claims to help breech babies to turn. A chiropractor using this method, will aim to manually adjust certain parts of your lower body to realign your pelvis. The idea is that this helps your baby to get into the best position for birth. 

Some mums say the technique has helped them, but it is unproven. Research into its safety is limited, too. It’s best to talk to your midwife if this is something you’re tempted to try. 

How will I give birth to my breech baby?

Your midwife or doctor will explain your birth options if your baby stays breech towards the end of your pregnancy. They will talk you through the risks and benefits of a caesarean birth compared with a vaginal birth.

They should explain that, while a caesarean is safer for your baby, a vaginal birth may be safer for you. Each pregnancy is different. Your healthcare team should support you to make the decision that is best for you and your baby.

Planned caesarean section

Your healthcare professional will advise you to have a planned caesarean section if:

• your baby is footling breech (feet first)
• your baby is larger or smaller than average
• your baby's neck is in an awkward position, for example, tilted back
• you have a low-lying placenta
• you have other pregnancy complications, such as pre-eclampsia.

A planned caesarean means you will have a set day and time to arrive at the hospital to have your baby. 

" had an amazing birth experience and couldn't thank the midwives and surgical team enough for all the help and support."

Ruth. Read more about Ruth's breech birth story.

Some people go into labour before their planned caesarean date. If this happens to you, your midwife or doctor will ask to examine you, to see if it would be best for you to have an emergency caesarean. Sometimes, if your baby is nearly ready to be born, they will advise you to have a vaginal birth after all.

Planned vaginal breech birth

If you decide to have a vaginal breech birth, your midwife and doctor will explain how it may affect you and your baby, taking into account your pregnancy history. They will advise you to include the possibility of a caesarean in your birth plan.

It is helpful to think about this in advance. That’s because 4 in 10 people who choose a vaginal breech birth go on to have a caesarean.

When you go into labour, a breech birth team will care for you in a hospital maternity unit. The team will include midwives and doctors who have supported other people through vaginal breech births.

You will have the same pain relief options as someone giving birth to a head-down baby. That includes an epidural.

Although there may be more staff on hand to look after you, they should still create a calm, supportive space for you to labour and give birth.

Where can I find out more about breech births?

Download the Breech baby at the end of pregnancy leaflet from the Royal College of Obstetricians & Gynaecologists (RCOG).

Find out more about positions for birth.