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Breech Presentation

When a baby is positioned in the womb bottom-down, this is called ‘breech’ position. A breech birth requires careful consideration and consultation with your midwife or doctor.

A vaginal breech birth is possible for some women after planning with your doctor.

What are my options if my baby is breech?
Most babies will settle into a head-down position by about the last month of pregnancy. About 3 in 100 babies are still in a breech position near the due date.

If your baby is in a breech position at 36 weeks, your doctor or midwife might suggest you think about an ECV, or external cephalic version, after 37 weeks. This will increase the chance of your baby turning to a head-down position.

If you don’t have an ECV, or if you have it but it doesn’t work, then your options are to have an elective caesarean birth or to have a vaginal birth. Things may be different if you have had a caesarean section before – in this case, if you wish to explore the option of vaginal breech birth, you will need to discuss this with your obstetrician. You may be advised to have a caesarean section again.

Often, women are encouraged to have a caesarean birth if their baby is breech because it might be safer for the baby. But a vaginal birth is still an option in the right circumstances, such as:
• no other issues that would suggest a vaginal birth is unsafe, such as placenta praevia
• facilities that can handle an emergency caesarean, if necessary
• an obstetrician or midwife who is skilled in vaginal breech births

What is involved in a vaginal breech birth?
When babies are in a cephalic (head-down position) ready for birth, the birth process is more straightforward because the crown of the baby’s head is born first. The head is the largest part of the baby’s body, so it makes way for the rest of the body to follow.
The birth process might be more challenging if your baby is breech. When a baby is born bottom first, the baby’s body is born before the largest part, its head. Often this doesn’t cause a problem. But there is a chance that the head, or the head and arms, may not follow easily, once the body is born. In this case, it is important that a midwife or obstetrician with skills and experience in breech births is present to assist your baby to be born.

Upright maternal positions, such as kneeling or a hands and knees position, are recommended when you give birth to a breech baby. The obstetrician or midwife will be standing by, observing closely, with a ‘hands off‘ approach, unless your baby’s progress during the birthing process slows down. In such cases, there are a number of techniques that can be used to assist your breech baby to complete the birth vaginally, or it may be necessary to proceed to an emergency caesarean section.

The progress of your labour will be monitored closely. If there is any delay in the descent of your baby, a caesarean section might be recommended. This is because a delay in the baby’s descent inside may be an indication that the birth process could also be delayed, which is more risky for your baby.

In many settings where vaginal breech births are offered, it is preferred that your baby is monitored continuously with a cardiotocograph (CTG). Ask for a cordless, waterproof CTG so you can remain upright and mobile, and so you can use the bath or shower for pain management during labour.

What should I ask my doctor or midwife?
It is worth discussing whether you might benefit from an ECV, because if this is successful, you can go on to try a vaginal birth.
You should also ask if:
• a vaginal birth is safe for the type of breech position your baby is in
• the health service you are planning to use can manage a breech vaginal birth
• your doctor or midwife has training and experience in managing a breech vaginal birth