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Breech Baby

Most babies lie in a head down position in the womb, but a minority lie in the breech position – referred to as bottom or feet first.

How common are breech babies?

As many as one in five babies will be in the breech position at around 28 weeks, but usually around 36 weeks most have turned into the head down position.

By this stage only about 3 per cent of babies are still breeches.

Are there different ways a baby can be breech?

A breech baby will always be the result of a baby lying in the womb feet first, but there are a few different ways they might position themselves in the position:

  • Complete or Flexed breech: Where your baby’s bottom comes first, with the knees bent up and the feet tucked in beside the buttocks and thighs against the chest.
  • Extended Breech: Your baby sits bottom first with thighs against the chest and feet up by the ears. This is the most common type of breech presentation.
  • Footling Breech: Your baby’s feet are below their bottom.

Why do babies get in the breech position?

It can be just down to chance, but sometimes there are more obvious reasons, including:

  • Too much or too little amniotic fluid – making it difficult for the baby to turn.
  • Low lying placenta
  • More than one baby in the womb

Why is the breech position a problem?

It can make labour more difficult for various reasons including:

  • The umbilical cord may slip down and become compressed, depriving your baby of oxygen
  • Your baby may suffer damage to her hip joints because of the pressure being exerted on her bottom half during labour
  • The delivery may be more complicated, as the largest part of your baby’s body ( the head,) will be delivered last and this may need an obstetrician skilled in these types of delivery, who may have to use forceps (see Assisted delivery)

Do babies turn on their own if you wait long enough?

If a baby hasn’t turned by 36 weeks it is unlikely to do so and you may be advised to have a procedure called External Cephalic Version.

How are breech babies turned?

The Royal College of Obstetricians and Gynaecologists (RCOG) recommends all women pregnant with breech babies at 36 weeks (apart from those with specific medical conditions) are offered a procedure called External Cephalic Version (ECV).

ECV is where an obstetrician or specially-trained midwife exerts gentle pressure on your tummy to encourage your baby to do a somersault and lie in the head down position.

How successful is ECV?

It has a 50 per cent success rate – some babies just won’t budge and there are others who do turn, but then turn back again.

What are the risks of ECV?

It’s a safe procedure, but there is a 0.5 per cent chance that your baby’s heart rate may drop so low that they have to be delivered immediately by caesarean. For this reason ECV should always be done in a hospital which has facilities to deal with emergencies.

Is ECV suitable for everyone?

No – not in the following situations:

  • You need a c-section for another reason
  • You’ve experienced vaginal bleeding in the previous week
  • Your womb is not the normal pear shaped
  • Your waters have been broken before you go into labour

Is there anything else I can do to get my breech baby to change position?

  • Experts say there’s no evidence that sitting or lying in a certain position will encourage your baby to change position – but some old wives’ tales recommend getting down on all fours or crawling as if scrubbing a floor.
  • Moxibustion: This is a Chinese medicine technique used to encourage babies to turn in the womb. It involves burning the dried leaves of an herb called Artemisi vulgaris, near the toe. It might sound a bit wacky, but some research has suggested it might work. Find a qualified acupuncturist if you want to give it a try.

What’s the best method of delivery if my baby still won’t turn after ECV?

Current advice from the RCOG says a c-section is the safest method of delivery for the baby around the time of birth; however they also acknowledge that a caesarean has slightly higher risks.

If your baby is coming prematurely (before 37 weeks) your obstetrician should discuss the specific risks vs. benefits of a c-section or vaginal delivery with you.

Is it still possible to have a vaginal delivery for a breech baby?

This is a choice – but isn’t a safe for all women. Your doctor or midwife will be able to help you decide if a vaginal delivery is something you can consider.

Any vaginal labour for a breech baby will need foetal monitoring and may need forceps to help deliver your baby’s head.

When is a vaginal breech delivery not recommended?

You may be advised against choosing a vaginal delivery if:

  • Your baby is in the footling breech position
  • Your baby is classed as big (300g or more) or small (less than 200g)
  • You have a narrow pelvis
  • You have a placenta previa
  • You have pre-eclampsia ( a pregnancy high blood pressure condition)

Breech Baby