Breech means your baby lying with its bottom, knees or feet at the bottom of your womb. As pregnancy progresses, most baby’s will usually turn into the head first position, but about 3/100 (3%) will not and stay breech after 37 weeks of pregnancy.
Having a breech presenting baby means you will need to make a few more decisions about your care, but we will support you to do this to enable you to have a safe and positive birth experience.
Baby can be lying with their bottom coming first with legs curled up (flexed breech), with their bottom coming first with legs straight up and their feet by their heads (extended breech) or feet coming first (footling breech).
Sometimes a baby is breech because of factors that prevent it from turning such as too much or too little fluid in the womb, the position of the placenta or an issue with the pelvis or womb such as fibroids.
Sometimes it is just a matter of chance that the baby has remained breech rather than turning.
The vast majority of breech babies are healthy, however for a few being breech can indicate that there is a problem with the baby which has prevented it from turning. This will usually have been picked up during antenatal screening and scans but may be discovered after birth.
External Cephalic Version (ECV)
We recommend you try an ECV from 36 weeks of pregnancy onwards. This involves an obstetrician trying to turn your baby through your tummy into a head down position. For more information please read our information leaflet.
There is also some evidence that moxibustion, a herbal Chinese therapy, and acupuncture may help in encouraging your baby to move.
This is not currently available from the NHS, so we recommend you use an appropriately qualified practitioner to give you advice and treatment if you choose this route.
Some clinician’s advise that optimal fetal positioning may help; this would involve you getting into some positions to maximise the space in your pelvis and encouraging your baby to move around. You may also read about chiropractic techniques and other complementary therapies for encouraging breech babies to turn and we would advise you take specialist advice for these if you wish to look into them.
- Planned caesarean section
- Vaginal birth
The Royal College of Obstetricians and Gynecologists (RCOG) currently recommend that you have a planned elective caesarean section at about 39 weeks pregnant, however we are here to support and advise you about your birth options so that you can make an informed choice. You will be referred to a consultant to discuss your options and you will also be able to speak to a supervisor of midwives for further information and support.
Vaginal breech birth
One research study suggested that breech babies were less well around the time of birth when they were born vaginally compared to being born by elective caesarean section. However at 2 years of age the study found there were no differences in the development or wellbeing between babies born vaginally or by caesarean section. More recent research suggests that women and breech babies who are full term (over 37 weeks) and are otherwise healthy and well in pregnancy and who go into labour spontaneously are just as well around the time of birth when compared to those babies born by caesarean section, but with less risk to the mother.
The benefit to having a vaginal birth for the mother is that you will have less chance of heavy bleeding, infections and complications in subsequent pregnancies and births. You will have more chance of being mobile after the birth, have a quicker recovery and be in the maternity unit for less time after birth. The benefit for the baby is that it will have better preparation for breathing after birth as labour squeezes the lungs and promotes hormones that help the adaptation to being outside the womb.
The possible risks to having a vaginal breech birth to the mother is a chance of requiring a caesarean section during labour (estimated to be about 15-20% of all planned vaginal breech births need to have caesarean section in labour) and damage to the perineum / pelvic floor during birth. The possible risks to the baby of being born vaginally (normally) are an increased chance of the baby needing help immediately after birth (this would be needing some support with breathing at birth – for this reason we advise you have your baby in a maternity unit where neonatal support is available). Some breech babies need help for their bodies and heads to be born; if clinicians need to help your baby to be born there is an increased chance the baby may have bruising due to the maneuvers we use (note that these maneuvers can be needed during a breech caesarean section delivery too).
It is suggested in studies that having a clinician with knowledge, skills and confidence in vaginal breech birth may influence the outcome for you and your baby. At BSUH we have a number of midwives and obstetricians who have experience in vaginal breech birth and all our midwives and obstetricians have regular updates on how to support vaginal breech birth. However we acknowledge that, as most known breech babies are born by caesarean section the experience and confidence with breech birth is limited at the moment. For this reason we usually approach care as a team, pooling our knowledge and skills. There is always a Consultant Obstetrician and Supervisor of Midwives on call 24hrs/7days a week who can offer support and guidance. We suggest you consider who you would like with you in your birth plan.
Breech babies will have a higher chance of hip problems in early life due to their position in the womb, so we will ensure the baby’s hips are checked within the first 3 days of life. We will also offer you a scan of the baby’s hips within the first few months. This appointment should be sent to you after you are home from the unit (usually within 6 weeks).
Association for Improvement of Maternity Services (AIMS): Breech Presentation – Caesarean operation versus normal birth