Breech babies and birth
Most babies are usually lying head down by the end of pregnancy. This makes birth more straightforward, as the largest part of an unborn baby - its head - is born first. About 3% of babies are not head down at the end of pregnancy and remain in a ‘breech’ position. This article covers why some babies are breech; whether a breech baby can be turned before being born and giving birth to a breech baby.
When a baby is born ‘bottom first’ there is a greater chance of complications. This is partly because babies who are premature, or have some types of physical problem, are more likely to be born bottom first. But it’s also because a breech birth doesn’t always go as smoothly as a headfirst birth.
Are there ways to turn a breech baby?
Most babies who are in the breech position at 32 to 34 weeks turn themselves into a headfirst position. If your baby is still breech at 37 weeks, it may be possible for an obstetrician to turn your baby using a technique called external cephalic version (ECV).
External cephalic version (ECV)
Having an ECV shouldn’t be painful for you; although it can be uncomfortable. You may be offered a drug (tocolysis) to help your uterus stay relaxed. In order for a baby to be turned, its bottom needs to be pushed up out of your pelvis so that there’s space for them to move around. The doctor will then push quite firmly, holding the baby to prevent them returning to the breech position. Some babies resist being moved and some spontaneously move back to lying bottom first.
Just over half of all breech babies can be turned this way. Research has shown that the success rate of ECV depends partly on the experience of the obstetrician. Success is also greater in women who have had a baby before.
All hospitals should now offer women the chance to have an ECV if their baby is breech at 37 weeks. If your hospital doesn’t, you can ask to be referred to one that does. Women may not be offered this procedure if their waters have broken, if they are already in labour, if they have previously had a caesarean, or if they have experienced bleeding, or if it’s known the baby is small, ill or otherwise vulnerable.
What can I do to turn my breech baby?
There are some other techniques you could try yourself to encourage your baby to turn, but there is no robust evidence to show whether they make a difference.
You could try kneeling on your bed with your knees comfortably apart and your hip joints over your knees, rest your shoulders down on the pillow. Some midwives recommend that this ‘knee-chest’ position is adopted regularly towards the end of pregnancy, for about 15 minutes, two to three times a day.
Planning a breech birth
In the UK, about half of women who start off labour with a breech baby will end up having a caesarean. An international trial in 2000 showed that caesarean section appears to give a safer outcome with no longer term drawbacks. Since this research, most doctors have recommended that breech babies should be born by caesarean section. And almost everyone agrees that if labour doesn’t go smoothly, it’s safer to deliver a baby by caesarean.
More recently, a Cochrane review published in 2011 concluded that for single babies, a planned caeasarean section is safer for a breech birth. However, the review reported more short-term problems in women, compared with vaginal birth, and there was insufficient information about the consequences for future pregnancies.
Can I have a vaginal breech birth?
There are a few hospitals that continue to believe in the value of vaginal breech birth and offer this option, so it’s worth asking for your hospital’s policy, or the obstetrician’s view. Your decision may include a discussion about whether you have any other complications or risk factors, and specific factors will apply to twins and pre-term babies. Again, it’s best to discuss the options with your midwife or doctor.
A vaginal breech birth may be the right choice for you if:
- you want to avoid a caesarean section,
- your baby is in a good position and not expected to be too big and
- you can find a midwife or doctor willing and experienced in natural breech birth.
A vaginal breech birth need not be more difficult or painful than a headfirst birth. However, like headfirst births, breech births vary. Vaginal breech births are managed in different ways by healthcare professionals depending on their training and experience. Some births are ‘managed’ or ‘assisted’ with epidural anaesthesia, episiotomy (a cut to enlarge the vagina) and forceps. Others are ‘natural’ or ‘physiological’ in which a woman is free to move about and change position; neither an epidural or opiates are used; and the baby is born without intervention or assistance.
Some breech positions do allow for an easier vaginal birth. The safest positions are when the baby has their legs straight up, and feet by their ears (the ‘frank breech’) or legs crossed with feet higher than their bottom (the ‘complete breech’). If a baby’s feet or knees are coming first, labour is less likely to go smoothly and you may be advised to opt for a caesarean.
If the baby is particularly big, you will probably be advised to have a caesarean birth, but bear in mind that judgment about the size of the baby before birth can be inaccurate. If you have a clear preference for a vaginal birth you may want to discuss just how big the baby is expected to be and what additional risks the doctor thinks this poses, to help you decide.
The safety of a vaginal breech birth depends partly on the approach and experience of the midwife or doctor at the birth. As a caesarean has become usual for breech babies, trainee midwives and doctors have fewer opportunities to gain experience in vaginal breech births, and many will only be familiar with the managed approach. Your hospital may say that they don’t have any staff experienced in natural breech birth.
If a unit is unable to offer the choice of a vaginal breech birth, women who choose this option should be referred to a unit where this option is available. Some women labour too fast for a caesarean and occasionally a breech position is not diagnosed, so bottom-first births continue, despite hospital policies. You might want to consider enquiring about care from an independent midwife; they usually have experience of natural breech births, but you would have to pay for their services.
Page last updated March 2015
NCT's helpline offers practical and emotional support in all areas of pregnancy and early parenthood: 0300 330 0700. We also offer antenatal courses which are a great way to find out more about pregnancy, labour and life with a new baby.
NHS choices has information on breech babies 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.