Written by:

Dr Bonnie Ng

MBChB, BMedSci (Hons)

NIHR Academic Clinical Fellow in Obstetrics and Gynaecology ST3Southampton

Breech Babies – Your Choices and Options

In this article:

  • The different types of breech presentation
  • Why does a breech presentation happen?
  • Can the baby be turned before labour?
  • What are the options for birth if my baby remains breech or I do not want an ECV?
  • What does a breech baby mean for labour?
  • Who will decide how you give birth to a breech baby?
  • Main Points

Breech Babies – Your Choices and Options

Babies often twist and turn during pregnancy, but most will have moved to a head-down position (cephalic presentation) by 36-37 weeks, and often by the time labour begins. However, sometimes babies may be bottom or feet-first (breech presentation) or lying sideways (transverse).

Babies lying bottom or feet first in the womb, instead of the usual head first position, are called breech babies. It is common in early pregnancy, but only 3-4% of babies are breech at the end of pregnancy. If your baby is breech, you may feel discomfort under your ribs as your baby’s head presses up under your diaphragm. You may also feel sharp kicks to your bladder.

The different types of breech presentation

There are three main types of breech presentation.

Extended or frank breech: baby in bottom first, with the thighs against the chest and feet up to the ears. Most breech babies are in this position.

Flexed breech: baby is bottom first, with the thighs against the chest and the knees bent.

Footling breech: baby’s foot or feet are below the bottom.

Why does a breech presentation happen?

It may be pure chance that your baby has not turned to the head-first position and if your baby has not turned it does not usually mean that your baby will have any problems. There are, however, certain factors that make it more difficult for a baby to turn during pregnancy and therefore more likely to stay in the breech position.
Potential reasons for breech presentation include:

  • Low lying placenta
  • Too much or too little fluid around baby
  • More than one baby in the womb
  • First pregnancy
  • The shape of your womb or pelvis

Can the baby be turned before labour?

If your baby is in breech position at 36 weeks, you’ll usually be offered an external cephalic version (ECV). This is done by a healthcare professional, usually an obstetrician, who tries to turn your baby to the head down position. It is a safe procedure involving the application of gentle pressure to your tummy and although it should not be painful, it may be uncomfortable. About 30-50% of breech babies can be turned using ECV, allowing a normal vaginal birth. Successful ECV lowers your chances of a caesarean section and its associated risks.

What are the options for birth if my baby remains breech or I do not want an ECV?

There are two options: a planned caesarean section or a planned vaginal delivery.

Caesarean section birth
Research has shown that a planned caesarean birth is safer for your baby than a vaginal breech birth. If your baby is breech at the end of pregnancy and you are not in labour, you should be offered a caesarean birth. There are some risks associated with a caesarean birth; there is an increased risk of problems in future pregnancies, including problems with the way that your placenta implants in the womb, difficulty with subsequent caesareans and complications of a vaginal delivery when there is a scar on the womb.

If you have planned a caesarean birth, but you go in into labour with a breech baby before your operation date, a midwife or an obstetrician will examine you and assess the safest way to deliver your baby. In some cases, it may be safer to have a vaginal breech birth especially if your baby is close to being born.

Vaginal Breech Birth
Along with careful discussion with the obstetrician or midwife, you may opt for a vaginal breech birth if you and your baby are suitable. You should deliver on a labour ward where there are facilities to perform an emergency caesarean section if required (around 40% of women planning a vaginal breech birth will need a caesarean). If successful, a vaginal breech birth will usually mean that you will have a straightforward recovery.

A vaginal breech birth is not recommended if:

  • Your baby is ‘footling breech’, when the baby’s feet is below the bottom
  • Your baby is larger or smaller than average
  • You have a low lying placenta
  • You have pre-eclampsia or other pregnancy complications

What does a breech baby mean for labour?

Breech birth options for pain relief are the same as for delivery of a baby who is head first. Your baby’s heart rate will be monitored continuously. In some instances, if there are concerns with your baby’s heart rate or if your labour is not progressing, you may need a caesarean section in labour. You will be assessed appropriately to ensure that it is safe to proceed with the mode of delivery decided. A paediatrician (doctor specialising in the care of babies and children) will be present to ensure that your baby receives neonatal care and support if required.

Who will decide how you give birth to a breech baby?

You should discuss your options with the obstetrician and midwife who are looking after you. You may also want to talk through your options with your family and friends. You should never feel as though you are left on your own to make a decision.

It’s important to discuss your breech birth options with your obstetrician and midwife, and also with family and friends.

Main Points

  • Around 3 – 4 % of babies are in a breech presentation by the end of pregnancy.
  • Most babies are in a ‘head-down’ position (cephalic presentation) by weeks 36 – 37.
  • There are three main types of Breech presentation: Extended (or frank), flexed and footling.
  • Most breech babies will be in the extended breech position.
  • If your baby is in a breech position at 36 weeks you will be offered ECV (external cephalic version), a manual procedure to turn the baby in the womb.
  • Around 40% of women who plan a vaginal breech birth will go on to have a caesarean section.
  • A paediatrician will be present at a breech birth to provide appropriate care to the baby if required.