What does ‘breech’ mean?

If your baby is lying bottom-down in your uterus (womb), this is called the breech position. It is common for a baby to be in a breech position before 35 to 36 weeks of pregnancy.

Most babies turn to a head-down position before the last month of pregnancy. About 3 in every 100 babies are lying in a breech position at the end of pregnancy.

How will I know if my baby is in the breech position?

During pregnancy check-ups in the second and third trimesters, your doctor or midwife will feel your abdomen to check your baby’s position.

When they feel your abdomen at 36 weeks, they will assess if your baby has settled into a head-down position in preparation for birth. If they suspect your baby might be in a breech position, they can confirm this with an ultrasound scan.

What does the breech position look like?

There are different types of breech position, including:

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

What does it mean for my baby?

The birth process is often more challenging if your baby is in a breech position at the start of labour. A vaginal birth can be more risky for your baby. Your doctor or midwife may advise you to have a caesarean birth, especially if your baby is in a footling breech position.

If your baby is born in a breech position, they have a higher risk of developmental dysplasia of the hip (DDH), when your baby’s hip doesn’t develop normally. They should have an ultrasound of their hips after six weeks of age to check for this.

Why might my baby remain in a breech position?

Often, it is unclear why a baby stays in a breech position. Some of the common causes include:

• too much or too little amniotic fluid around the baby
• a short umbilical cord
• a low-lying placenta
• many previous pregnancies, making the muscles of the uterus more floppy
• multiple pregnancy
• uterine fibroids
• an irregular size or shape of your uterus

Can my baby still turn after 36 weeks?

Some breech babies turn themselves naturally in the last month of pregnancy. The chance of this happening gets lower as time goes on.

If your baby is in a breech position at 36 weeks, your doctor or midwife might suggest you an ECV, or external cephalic version after 37 weeks. This procedure tries to turn breech babies to the head-down position, ready for a normal vaginal birth. However, ECV is not suitable for everyone, so it’s important to discuss this option with your doctor or midwife.

Is there anything else I can do to make my baby turn?

Some people think that you might be able to encourage your baby to turn by holding yourself in certain positions, such as kneeling with your bottom in the air and your head and shoulders flat to the ground. Other options you might hear include acupuncture, a Chinese herb called moxibustion and chiropractic treatment. There is no good evidence that these work.

Talk to your doctor or midwife before trying any techniques, to check if they might harm you or your baby.

What are my birth options if my baby is breech?

If your baby does not turn, you will have 2 options:

• planning an elective caesarean birth
• trying to have a vaginal breech birth

Most breech babies are born by caesarean. You may be able to have a vaginal birth with a breech baby, but you will need to go to a hospital that can offer you and your baby specialised care.

If your baby is breech, an elective (planned) caesarean is safer for your baby than a vaginal birth in the short term. However, in the longer term their health will be similar, on average, regardless of how they were born.

A vaginal birth is safer for you than an elective caesarean. However, about 4 in 10 people planning a vaginal breech birth end up needing an emergency caesarean. If this happens to you, your risk of complications will be higher.

Your obstetrician. or midwife can talk about your options with you. Whether it’s safe for you to try a vaginal birth will depend on many factors, such as how big your baby is, the exact position of your baby, where the placenta is, the structure of your pelvis and whether you’ve had a caesarean in the past.

What are the safety risks of a vaginal breech birth?

If your baby is being born bottom-first, their largest part — their head — is the last to come out. There is a chance that their head or arms may not follow easily once their body is born.

Risks to your baby can include:

• Erb’s palsy (damage the nerves in your baby’s shoulder and /or arm)
• fractures, dislocations or other injuries
• bleeding in your baby’s brain
• low Apgar scores
• their head getting stuck — this is an emergency

If your waters break when your baby is not head-first, there is a higher risk of cord prolapse. This is an emergency.

What is involved in a vaginal breech birth?

It is important that a midwife or obstetrician with skills and experience in vaginal breech births is with you to help you birth your baby.

Your baby’s heart rate should be monitored continuously with a cardiotocograph (CTG). You may want to ask your doctor or midwife if you can use a cordless, waterproof CTG so you can remain upright and mobile, and so you can use the bath or shower for pain management during labour.

You will be able to choose what pain relief you have.

Giving birth in an upright position is recommended with a breech baby, however you may need to give birth in a different position if your obstetrician or midwife has more experience with it.

Your obstetrician or midwife will be close by and can help guide your baby into the best position for birth if needed. If your progress during labour slows down, there are a number of techniques they can use to assist your baby to be born vaginally. However, sometimes it may be necessary to have an emergency caesarean section.

Can I have a vaginal breech birth at any hospital?

No. Not all hospitals have obstetricians and midwives on staff with the skills and experience in assisting with a vaginal breech birth. If it is important to you to have a vaginal breech birth and your doctor, midwife or hospital don’t offer this option, you can ask them to refer you to another health service.

What should I ask my doctor or midwife?

It is worth discussing whether you can have an ECV, because if this is successful, you can go on to try a vaginal birth that is safer and more straightforward.

You should also ask if:

• a vaginal birth is safe for the type of breech position your baby is in
• the health service you are planning to use can manage a vaginal breech birth
• your doctor or midwife has training and experience in managing a vaginal breech birth

What if I am planning a home birth and my baby is breech?

If you are planning a home birth, discuss options for your care with your midwife. A planned homebirth is only considered safe if your baby is head-first.

If your baby is breech when you go into labour, it is safest to give birth at a hospital with staff experienced in supporting vaginal breech births and facilities for an emergency caesarean.

Your midwife may be able to continue supporting you during your birth in hospital and after you go home. This will depend on the arrangement between your midwife and the hospital.