If your baby is breech this means they are not positioned head-down. It means they are lying bottom-down in your uterus, with their head up under your ribs.
This position can be common before 35 weeks of pregnancy - however, most babies will then rotate before the last month of pregnancy.
During your pregnancy, your midwife or doctor will assess your babies’ position to see if they are in the right position for birth. If they suspect your baby is breech after 35 weeks, they will confirm this with an ultrasound and discuss what this might mean for your labour and birth.
There are several types of breech position:
- Frank Breech – (also called extended breech) where both your baby’s legs are extended up in front of their body
- Footling Breech – Where one of your baby’s feet are hanging down below their bottom
- Complete Breech – (also called flexed breech) where your baby is sitting with their legs crossed in front of them
Why isn’t my baby turning head-down?
There may be a reason your baby is not turning head-down, some of the common reasons include:
- A short umbilical cord
- Irregular shape of the uterus
- A low-lying placenta
- Twins or Triplets
- Uterine fibroids
Is there anything I can do to turn my baby?
There is still a possibility your baby may turn by themselves in the last month of pregnancy, although the chances of this happening become less and less over time.
If your baby has not rotated on their own by 36 weeks, your doctor or midwife might suggest a procedure called ‘External Cephalic Version’ or ECV. This procedure involves trying to externally manoeuvre the baby into a head-down position. ECV is a procedure that carries some risk, and it not suitable for all mothers and breech babies. For these reasons it is important to extensively discuss these options with your doctor or midwife before making a decision.
My baby is still breech, what does this mean for my delivery?
If your baby does not turn, the birth process can be more challenging. Vaginal breech delivery carries risks that cephalic (head-down) delivery does not. It is common for caesarean delivery to be recommended depending on the type of breech position your baby is in, your medical history and the experience of the healthcare providers looking after you.
Vaginal breech birth
Vaginal breech birth can be possible (although not recommended in cases of footling breech babies). Your midwife or doctor will firstly talk about the risks of vaginal breech birth. They will likely inform you that if your baby is born bottom first, this means the widest part to delver (their head) comes last. This can mean that your baby’s body can be delivered before your cervix is fully dilated at 10cm, and therefore trapping your baby’s upper body/head. This is rare in a controlled hospital environment with experienced clinicians – but it is an emergency and often results in serious complications.
It is important to note there are risks during any birth, vaginal delivery or caesarean. Risks with breech birth or cephalic (head down) birth. For these reasons it is important for you to have unbiased and open discussions with your midwife or doctor to be able to make an informed decision. The more questions you can ask during this process, the better!
Questions you will need to ask:
- Is a vaginal birth an option for my baby considering the breech position he/she is in?
- Does my doctor/hospital have the training, experience and skill required to assist me in delivering my breech baby safety?
- If not, what are my other options if I would like to try for a vaginal breech birth?
Written by Keryn Thompson RM & IBCLC (L-301766)
References
Berhan, Y., & Haileamlak, A. (2015). The risks of planned vaginal breech delivery versus planned caesarean section for term breech birth: a meta-analysis including observational studies. BJOG: An International Journal of Obstetrics & Gynaecology, 123(1), 49–57. https://doi.org/10.1111/1471-0528.13524
Cluver, C., Gyte, G. M., Sinclair, M., Dowswell, T., & Hofmeyr, G. J. (2015). Interventions for helping to turn term breech babies to head first presentation when using external cephalic version. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd000184.pub4
Hofmeyr, G. J., Hannah, M., & Lawrie, T. A. (2015). Planned caesarean section for term breech delivery. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd000166.pub2
Irion, O., Hirsbrunner Almagbaly, P., & Morabia, A. (1998). Planned vaginal delivery versus elective caesarean section: a study of 705 singleton term breech presentations. BJOG: An International Journal of Obstetrics and Gynaecology, 105(7), 710–717. https://doi.org/10.1111/j.1471-0528.1998.tb10200.x
Jensen, V. M., & Wüst, M. (2015). Can Caesarean section improve child and maternal health? The case of breech babies. Journal of Health Economics, 39, 289–302. https://doi.org/10.1016/j.jhealeco.2014.07.004
Management of Breech Presentation. (2017). BJOG: An International Journal of Obstetrics & Gynaecology, 124(7), Article e151-e177. https://doi.org/10.1111/1471-0528.14465
Petrovska, K., Watts, N. P., Catling, C., Bisits, A., & Homer, C. S. E. (2016). Supporting Women Planning a Vaginal Breech Birth: An International Survey. Birth, 43(4), 353–357. https://doi.org/10.1111/birt.12249
Petrovska, K., Watts, N. P., Catling, C., Bisits, A., & Homer, C. S. (2017). ‘Stress, anger, fear and injustice’: An international qualitative survey of women's experiences planning a vaginal breech birth. Midwifery, 44, 41–47. https://doi.org/10.1016/j.midw.2016.11.005
Reinhard, J., Sänger, N., Hanker, L., Reichenbach, L., Yuan, J., Herrmann, E., & Louwen, F. (2012). Delivery mode and neonatal outcome after a trial of external cephalic version (ECV): a prospective trial of vaginal breech versus cephalic delivery. Archives of Gynecology and Obstetrics, 287(4), 663–668. https://doi.org/10.1007/s00404-012-2639-1
Uotila, J., Tuimala, R., & Kirkinen, P. (2005). Good perinatal outcome in selective vaginal breech delivery at term. Acta Obstetricia et Gynecologica Scandinavica, 84(6), 578–583. https://doi.org/10.1111/j.0001-6349.2005.00248.x
Wängberg Nordborg, J., Svanberg, T., Strandell, A., & Carlsson, Y. (2022). Term breech presentation—Intended cesarean section versus intended vaginal delivery—A systematic review and meta‐analysis. Acta Obstetricia et Gynecologica Scandinavica, 101(6), 564–576. https://doi.org/10.1111/aogs.14333
