Breech Baby: What It Means and Your Options
Twin breech presentation. C.Monck, CC BY-SA 4.0, via Wikimedia Commons
Discovering that your baby is in a breech position can feel overwhelming, but it is 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 us 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 does not mean there is anything wrong with your baby or that you have done anything to cause this position. It is 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 is 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 will 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 is adequate amniotic fluid
- Some babies may turn back to breech position after a successful ECV
- You will 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 are 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 do not hesitate to seek a second opinion if you are unsure.
Hospital preparation
Ensure you know which hospital you will 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 are 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 do not delay seeking medical advice if you have concerns.
Frequently asked questions
A breech presentation means your baby's bottom or feet are positioned to come out first rather than their head. It is more common than many people realise, around 25% of babies are breech at 28 weeks, though most turn naturally as they grow. By term, only approximately 3–4% of babies remain breech. Having a breech baby does not mean anything is wrong with your baby or that you have done anything to cause it.
There are three main types. Frank breech (the most common, around 70%) is where the hips are flexed but knees are straight, with feet near the head. Complete breech (around 25%) is where the baby sits cross-legged with both hips and knees flexed. Footling or incomplete breech (around 5%) is where one or both feet are positioned to come out first. This is more common in premature births.
Often there is no identifiable cause. Contributing factors can include a first pregnancy with tighter uterine muscles, a multiple pregnancy where babies have less room to turn, abnormal amniotic fluid levels, placental position at the top of the uterus, or uterine factors such as fibroids or a previous caesarean section.
ECV is a procedure offered at 36–37 weeks where an obstetrician attempts to turn the baby manually by applying firm pressure to your abdomen. It is performed in hospital so the baby can be monitored throughout, and a muscle relaxant may be given to help. Success rates are approximately 60% for first pregnancies and 70% for subsequent ones. While generally safe, there is a small risk of changes to the baby's heart rate or premature rupture of membranes.
Most UK obstetricians recommend a planned caesarean section for breech babies, particularly for first-time mothers, as it reduces the risk of birth trauma and cord prolapse. A vaginal breech delivery may be an option in specific circumstances. The baby must be in a frank breech position, estimated to weigh between 2.5kg and 3.8kg, with the head well-flexed, and experienced staff must be available. Your healthcare team will discuss the most appropriate option for your situation.
You can expect continuous monitoring of your baby's heart rate throughout labour. An epidural is often recommended to manage pain and prevent premature pushing. An experienced obstetrician will be present for the birth itself, and a surgical team will be on standby in case an emergency caesarean becomes necessary.
Some women explore complementary approaches such as the knee-chest position, moxibustion (a traditional Chinese medicine technique using heat on acupuncture points), gentle swimming or movement, or playing music near the lower abdomen. Scientific evidence for these methods is limited, but they are generally considered harmless. Always discuss any complementary approaches with your healthcare provider before trying them.
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 is 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 are 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 am here to provide the expert care and support you need during this important time.