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 is it?
As many as one in five babies lie in the breech position 28 weeks, but by late pregnancy (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 types of breech presentation?
- 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 babies turned?
The Royal College of Obstetricians and Gynaecologists (RCOG) recommend all women pregnant with breech babies at 36 weeks apart from those with specific medical conditions see below When is ECV not recommended) 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. It may feel uncomfortable (stop your obstetrician or midwife if you are in pain though and they can change 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 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 a 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 caesarean 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 for you.
If your baby is coming prematurely (before 37 weeks) your obstetrician should discuss the specific risks v benefits of a caesarean vaginal delivery with you.
Is it still possible to have a vaginal delivery for a breech baby?
The RCOG says this is a choice – but isn’t safe for all women and only supports vaginal deliveries of breech babies if the obstetrician is trained in them, there are emergency C-section facilities available and no high risks in your pregnancy.
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?
Obstetricians may strongly recommend against 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 low lying placenta
- You have pre-eclampsia ( a pregnancy high blood pressure condition)
A mums says..
‘Florence was breech until 36 weeks when I had an ECV in hospital. It was a bit uncomfortable - lots of pushing my tummy around - and I was anxious about her heart rate - but thankfully it worked a treat and Florence was born vaginally.’
Sarah Baldwin, mum to Florence two months.