Birth Preparation

Breech Baby: What It Means and Your Options

Published today 9 min read

Discovering that your baby is in a breech position can feel overwhelming, but it's more common than you might think. Understanding breech presentation can help you make informed decisions about your birth plan and feel more confident about your options. Let's explore what it means to have a breech baby and the choices available to you.

What Is a Breech Presentation?

A breech presentation occurs when your baby's bottom or feet are positioned to come out first, rather than their head. This is the opposite of the normal "head-down" or vertex position that most babies adopt before birth.

Breech presentation is quite common earlier in pregnancy, with about 25% of babies in breech position at 28 weeks. However, most babies naturally turn head-down as they grow larger and have less room to move. By term (37-40 weeks), approximately 3-4% of babies remain in breech position.

Don't Panic: Having a breech baby doesn't mean there's anything wrong with your baby or that you've done anything to cause this position. It's simply one of the natural variations in how babies can present for birth.

Types of Breech Presentation

There are three main types of breech presentation, each with different characteristics and implications for delivery:

Frank Breech (Extended Breech)

This is the most common type, accounting for about 70% of breech presentations. In frank breech, your baby's hips are flexed but their knees are straight, so their bottom comes first with their legs extended upwards. This position is most common in first pregnancies.

Complete Breech (Flexed Breech)

Also known as "full breech," this occurs when both the hips and knees are flexed, so your baby is sitting cross-legged with their bottom presenting first. This accounts for about 25% of breech presentations.

Incomplete Breech (Footling Breech)

In this position, one or both feet present first, with the baby's hips and knees partially flexed. This is the least common type, representing about 5% of breech presentations, and typically occurs in premature babies or second pregnancies.

Why Do Some Babies Stay Breech?

There are several factors that might contribute to a baby remaining in breech position, though often there's no identifiable cause:

First pregnancy (primiparous), where the uterine muscles may be tighter
Multiple pregnancies (twins, triplets)
Too much or too little amniotic fluid (polyhydramnios or oligohydramnios)
Placental location, particularly if the placenta is positioned at the top of the uterus
Uterine abnormalities or fibroids
Previous caesarean section
Premature labour

External Cephalic Version (ECV)

If your baby is still breech after 36-37 weeks, you may be offered an external cephalic version (ECV). This is a procedure where an obstetrician tries to turn your baby into a head-down position by applying gentle but firm pressure to your abdomen.

How ECV Works

During an ECV, you'll lie on your back and the procedure will be performed in a hospital setting. The obstetrician will use their hands to encourage your baby to perform a forward or backward somersault to achieve a head-down position. You may be given medication to help relax your uterine muscles, making the procedure more comfortable and potentially more successful.

Success Rates and Considerations

Success rates are approximately 60% for first pregnancies and 70% for subsequent pregnancies
The procedure is more successful when there's adequate amniotic fluid
Some babies may turn back to breech position after a successful ECV
You'll be monitored before and after the procedure to ensure your baby's wellbeing
If you have a negative blood type, you may need an anti-D injection

ECV Considerations: ECV is generally safe, but like any medical procedure, it carries small risks. These include temporary changes in your baby's heart rate, premature rupture of membranes, or the rare need for immediate delivery. Your obstetrician will discuss these risks with you and ensure you're a suitable candidate for the procedure.

Your Delivery Options

If your baby remains in breech position, you have two main delivery options to discuss with your healthcare team:

Planned Caesarean Section

Most obstetricians in the UK recommend a planned caesarean section for breech babies, particularly first babies. This recommendation is based on research showing reduced risks of complications during delivery.

Benefits of planned caesarean for breech include:

Reduced risk of birth trauma to the baby
Lower chance of cord prolapse
Predictable timing and controlled environment
Reduced risk of emergency interventions during labour

Vaginal Breech Delivery

Some women may be suitable candidates for planned vaginal breech delivery, though this requires careful assessment and specific criteria to be met. Your obstetrician will consider factors such as:

Type of breech presentation (frank breech is most favourable)
Estimated baby's weight (typically between 2.5-3.8kg)
Your pelvis size and previous birth history
Baby's position and flexion of the head
Availability of experienced staff during labour

Preparing for Birth with a Breech Baby

Regardless of your chosen delivery method, there are several ways to prepare:

Birth Plan Discussions

Have detailed conversations with your midwife, GP, and obstetrician about your options. Ask questions about the risks and benefits of each approach, and don't hesitate to seek a second opinion if you're unsure.

Hospital Preparation

Ensure you know which hospital you'll be delivering at and familiarise yourself with their policies regarding breech delivery. Some hospitals may have specific protocols or may not offer vaginal breech delivery.

Support Network

Inform your birth partner and support network about your situation so they can provide appropriate emotional support and advocacy during labour.

What to Expect During Labour

If you're planning a vaginal breech delivery, labour is monitored more closely than with a head-down baby:

Continuous fetal monitoring to watch your baby's heart rate
An epidural may be recommended for pain relief and to prevent the urge to push too early
An episiotomy might be necessary to make more room for delivery
An experienced obstetrician will be present for the birth
Theatre facilities will be immediately available in case of emergency

Complementary Approaches

Some women try complementary methods to encourage their baby to turn, though scientific evidence for their effectiveness is limited:

Specific exercises and positions (such as the knee-chest position)
Swimming and other gentle activities
Acupuncture or moxibustion (a traditional Chinese medicine technique)
Playing music or talking to your baby at the bottom of your bump

Remember: While these methods are generally harmless, always discuss them with your healthcare provider before trying them, and don't delay seeking medical advice if you have concerns.

Final Thoughts

Having a breech baby requires careful consideration and planning, but with the right support and information, you can make decisions that feel right for you and your family. Every pregnancy is unique, and what's most important is ensuring the safest possible outcome for both you and your baby.

The key is to stay informed, ask questions, and work closely with your healthcare team to develop a birth plan that aligns with your circumstances and preferences. Remember that flexibility is important, as situations can change during pregnancy and labour.

If you're facing a breech presentation and would like personalised guidance to explore all your options thoroughly, including detailed discussions about ECV procedures or planning for the safest delivery approach for your specific situation, I'm here to provide the expert care and support you need during this important time.