Breech babies

Although most babies turn head down towards the end of pregnancy, about three to four per cent of babies will be breech at full term. This means the baby’s head stays uppermost in the uterus with his bottom or feet positioned to come out first. This article covers why some babies are breech; whether a breech baby can be turned before birth and giving birth to a breech baby.

Why are some babies breech?

Premature babies are often breech and in about 40 per cent of twin pregnancies, one baby is in the breech position. Possible conditions that make it difficult for the baby to settle head down include:

• A uterus that has a divider, or ‘septum’, running down the middle.
• A tumour or fibroid low in the pelvis.
• Placenta praevia or low-lying placenta (a placenta in the lower half of the uterus, instead of the upper).
• Too much amniotic fluid.

However most babies are breech for no obvious reason.

Can a breech baby be turned?

If your baby is breech before 34 weeks into your pregnancy, it’s quite likely that he will turn head down by himself.

If he’s still breech after 34 weeks, you can encourage him to turn by using ‘bottom-in-the-air’ positions. Either kneel with your forearms on the floor, your head down, and your bottom up, or lie on your back with your feet on the floor, your knees bent up, and three or four pillows under your bottom, for 10-15 minutes two or three times a day. There is currently insufficient evidence, however, to say how effective these positions are.

If your baby is still breech at 37 weeks and your pregnancy is otherwise straightforward, your midwife or doctor should offer you the opportunity to have external cephalic version – a process by which the midwife or doctor places their hands on the your abdomen and turns the baby into the right position.

Giving birth to a breech baby

Results of an international trial of over 2,000 women around the world giving birth to babies in breech positions were published in 2000. The study concluded that it is best for a breech baby to be born by caesarean section, as the risk to the baby was higher with a vaginal birth. However, the trial methodology has been criticised. The balance of benefits and risks is uncertain, particularly for women who may have another pregnancy. There are, for example, more obstetric complications in future pregnancies following surgery, and a small increased risk of reduced fertility and stillbirth.

Since this research, most doctors have recommended that breech babies should be born by caesarean section. But there are a few hospitals that continue to believe in the value of vaginal breech birth and offer this option, so it is worth asking for your hospital’s policy. There is no clear-cut answer about which mode of birth is safest overall. On balance, a caesarean may be beneficial if the pregnancy is more complex, but if there are no significant additional risk factors, a vaginal birth may be a good option. 

It’s perfectly possible for a breech baby to be born naturally, although a head first position makes the birth easier. Mothers who plan to have a vaginal breech delivery will need to make sure they receive care from a midwife experienced in natural breech births. Ask to talk to the consultant midwife or a supervisor of midwives at your local hospital or discuss it with an independent midwife.

See our leaflet on breech birth for more discussion of the risks and beneftis of vaginal versus caesarean breech birth.

Further information

NCT's helpline offers practical and emotional support in all areas of pregnancy, birth and early parenthood: 0300 330 0700. We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.

NHS choices has information on breech birth and external cephalic version.

The Royal College of Obstetricians and Gynaecologists (RCOG) offers a leaflet on what happens if your baby is breech at the end of pregnancy.