Breech pregnancy

A breech position is when your baby is lying with their bottom or feet facing your cervix (entrance of the womb). It is common and normal for a baby to be in a breech position until about 35 to 36 weeks of pregnancy.

Most babies turn to a head-down (cephalic) position before the last month of pregnancy. About 3 in every 100 babies are still lying in a breech position at the end of pregnancy.

Your doctor or midwife will feel your abdomen (tummy) at around 36 weeks of pregnancy to check your baby's position.

If your doctor or midwife suspects that your baby might be in breech position, they may refer you for an ultrasound scan to confirm.

There are a few different types of breech positions:

• 'Footling breech' — when one or both of your baby's feet are hanging below their bottom. Their foot or feet are their closest body part to your cervix.
• 'Complete' or 'flexed' breech — when your baby is sitting with their bottom towards your cervix. Their legs are crossed in front of their body and their feet are near their bottom.
• 'Frank' or 'extended' breech — when your baby is sitting with their bottom towards your cervix, with their legs are straight up in front of their body and their feet up near their face.

Most babies lie in a breech position until late pregnancy. If you have an uncomplicated pregnancy, no extra care will be needed for a baby in a breech position until you reach about 37 weeks gestation.

If your baby is in a breech position at the start of labour, a vaginal birth can more challenging and risky. There is a higher chance that labour won't progress as expected and that you will need a caesarean section. There's also a chance that your baby's head will get stuck in the birth canal after their body is born — a medical emergency that needs urgent treatment.

If your baby is born from a breech position, they have a higher risk of developmental dysplasia of the hip (DDH). They will usually be referred for an ultrasound of their hips to check for this condition after 6 weeks of age.

If there are no complications, a vaginal breech birth does not affect usually your baby's long-term health.

Your baby may stay in a breech position because:

• there is too much or too little amniotic fluid around your baby
• you have a short umbilical cord
• you have a low-lying placenta (placenta praevia)
• the muscles of your uterus are weak, sometimes because you have been pregnant many times
• you are carrying a multiple pregnancy
• you may have uterine fibroids
• your uterus is an irregular size or shape

Your doctor or midwife may consider why your baby is in breech position. There isn't always a clear reason.

Most babies in breech position naturally turn themselves into a head down position by the last month of pregnancy. As your pregnancy progresses, the likelihood of this happening decreases.

If your baby is in breech position, your doctor or midwife might suggest an external cephalic version (ECV) after 37 weeks.

An ECV is a procedure in which a specialist doctor tries to turn your baby to a head-down position. An ECV is not suitable for everybody. There is no guarantee that it will work. There is also a small chance your baby will turn back to a breech position after a successful ECV.

It is a good idea to discuss together with your doctor or midwife the benefits and risks involved in an ECV and if it is right for you.

Alternative therapies such as doing exercises in certain positions, chiropractic treatments and moxibustion (a form of Chinese medicine) are sometimes used to turn babies. However, there is no scientific evidence to prove that these methods are effective.

If your baby does not turn, you will have 2 options:

1. Plan an elective caesarean birth.
2. Try to have a vaginal breech birth.

An elective (planned) caesarean is safer for your baby than a vaginal birth in the short term. In the longer term their health will be similar with either one of these methods.

If you decide you want to try a vaginal breech birth, your healthcare team will discuss your options with you. Around 4 in 10 people planning a vaginal breech birth end up needing an emergency caesarean. If this happens to you, your risk of complications will be higher than if you had an elective caesarean.

Some medical factors that influence if you can safely have a vaginal birth if your baby is in breech position are:

• how big your baby is
• the exact position of your baby
• the position of your placenta
• the structure of your pelvis
• your medical and obstetric history

It's important that you discuss your options with your obstetrician or midwife.

If you are planning a vaginal breech birth, because of the higher risks involved for your baby, your midwife or doctor will make sure that:

• your baby will be continuously monitored with a foetal heart rate monitorf
• a qualified midwife or obstetrician with skills and experience to assist with a vaginal breech birth is present
• there are facilities and anaesthetists available in case you need an emergency caesarean
• a paediatrician is available, if there are any complications

You may want to find out whether the hospital has cordless, waterproof monitoring equipment, as this will help you remain more upright and mobile during labour. Waterproof monitoring equipment also means that you use the bath or shower for pain management during labour, even with continuous monitoring.

Your options for pain relief during labour will usually be the same as with a non-breech birth.

In some situations, your health team may recommend that you give birth while lying on your back for a vaginal breech birth. Your obstetrician or midwife may ask you to birth in a different position, if they are more comfortable helping you in certain positions.

It's important that your obstetrician or midwife is close by in case you need help during the birth. If your progress during labour slows down, your doctor or midwife has techniques to help your baby to be born vaginally. Sometimes an emergency caesarean section is the safest option for you and your baby.

Read more about making a birth plan.

Hospitals offering vaginal breech birth need doctors and midwives on staff with the skills and experience to assist a vaginal breech birth and manage any complications. Not all hospitals have these resources, so if you are planning a vaginal breech birth, it's important to prepare in advance.

If your doctor, midwife or hospital can't support a vaginal breech birth, and it's important to you, you can ask them to refer you to another health service.

Read more about having a baby in hospital.

Here are some examples of questions you may want to ask your doctor or midwife:

• Is it dangerous for my baby to be in breech position?
• What should I do if my waters break or I go into labour and my baby is in a breech position?
• Can I have an ECV?
• What are my options if my baby is in a breech position after 37 weeks?
• Is a vaginal birth safe for the type of breech position my baby is in?
• Is your health service able to manage a vaginal breech birth?
• Are you trained and experienced in managing a vaginal breech birth?

It is important you discuss your options with your doctor or midwife.

Together with your doctor or midwife, you will consider your values, preferences, and medical situation to make the right decision for you. This way you can make an informed decision. This is called shared decision making.

Read more about understanding informed consent and your rights when having a baby.

If your baby is breech and you are planning a home birth, discuss options for your care with your midwife or doctor.

A planned homebirth is only considered safe if your baby is head-first.

If your baby is breech when you go into labour, it is safest to give birth at a hospital with staff experienced in supporting vaginal breech births, and facilities for an emergency caesarean. Your midwife may be able to continue supporting you during your birth in hospital and after you go home. This will depend on the arrangement between your midwife and the hospital.

Read more about choosing where to give birth.

• Read NSW Health's informative brochure about preparing for an external cephalic version (ECV) (Opens in new tab).
• Learn more about caesarean sections (Opens in new tab) in the Royal Australian New Zealand College of Obstetricians and Gynaecologists factsheet.
• Know your healthcare rights (Opens in new tab) by visiting the Australian Charter of Healthcare Rights.