Breech Baby: what it means and what to expect

A breech baby is one whose bottom, feet, or knees are positioned to come out first during birth, rather than the top of the head. The reason this position matters or could potentially be a cause for concern is that the baby's head is the largest part of the body. When the baby is head down, the head is the first part to dilate the cervix and pass through the birth canal, allowing for the rest of the body to follow easily. In a breech presentation, the baby's legs and buttocks are the first part to dilate the cervix and pass through the birth canal. The concern is that the cervix may not be dilated enough for the head to pass through and may get momentarily stuck.

The majority of babies will turn their heads down by themselves between 32 and 36 weeks of pregnancy. After 36 weeks, the chances of a baby turning naturally decreases due to the lack of space in the uterus.

We don't always know why some babies present bottom or feet first, however there are certain factors which can contribute to a baby remaining persistently breech after 36 or 37 weeks of pregnancy. These include:

Uterine Shape/Structure: The presence of fibroids or an unusually shaped uterus can limit the amount of space a baby has to move about.

Amniotic Fluid Levels: If there is too much fluid in the uterus (polyhydramnios) this can make it difficult for the baby to adopt a stable head down position, equally if there is too little fluid (oligohydramnios)this can make it difficult for the baby to turn into a head down position.

Placenta Previa: This is when the placenta partially or completely covers the opening of the cervix. If the cervix completely covers the opening of the cervix, this can prevent the baby's head from engaging in a head down position.

Multiple Pregnancies: When there is a twin/multiple pregnancy, space within the uterus is limited and the odds of one or more of the babies presenting as breech is increased.

Understanding the specific type of breech can influence delivery decisions. The main types include:

As part of your antenatal check-ups, your midwife or doctor will routinely check the baby's position.

Your midwife or doctor will assess the baby’s presentation from about 36 weeks onwards, they will do this by palpating your abdomen to determine which part of the baby is presenting. If the baby is head down, the round hard head is very easy to identify. If it's the baby’s bottom or legs which are presenting, they will feel softer, and more irregular.

An ultrasound scan is always performed whenever a breech presentation is suspected. It will confirm the baby’s exact position, placental location and volume of amniotic fluid. Most breech presentations are diagnosed between 32 and 36 weeks. While most babies have turned head down by this time, a small number can still flip spontaneously up to about 37 weeks.

Yes, most breech babies turn head down by themselves!

Before 36 weeks: The odds of the baby being able to turn naturally is quite high due to the fact that it still has plenty of space to do so.

After 37 weeks: Whilst it's not impossible, the odds of the baby being able to turn head down spontaneously after 37 weeks is quite low due to the baby’s size and the now limited space within the uterus.

Early Labour: While it's not very common, some babies may turn head down in the very early stages of labour. I have seen this happen a handful of times over the last 30 years.

If a baby is breech late in pregnancy (37 weeks or more), some people try the following natural methods to encourage the baby to move. It is really important to speak with your midwife or doctor first if you are planning to try these. There isn't much evidence to support them, but they are generally safe to try:

Breech Tilt/Bridge: Laying on your back with your hips raised above your shoulders supported by pillows, the idea is that this position will help your baby's bottom to shift out of the pelvis.

Inversion Poses: Yoga positions such as the Child’s Pose or leaning forward on hands and knees, can help by using gravity to create more space in the lower pelvis allowing the baby's bottom to move freely.

Temperature or Sound: Playing music towards the bottom of your abdomen might encourage your baby to move towards the sound. Placing a bag of cold peas near the top of the uterus may encourage your baby to move away from the cold.

Acupuncture/Moxibustion: Some people try these complementary therapies, but there isn't much evidence to support them.

If you reach 36-37 weeks of pregnancy and your baby is still breech, your doctor may talk to you about the possibility of doing an External Cephalic Version (ECV).

An External Cephalic Version involves a procedure which attempts to physically turn the baby from a breech position to a head down position. The doctor applies a firm but gentle pressure to your abdomen to do this. It is always carried out in the hospital setting and is done around 37 weeks of pregnancy. The ECV is performed using ultrasound guidance (to visualise baby’s position) and the baby’s heart rate is monitored throughout. To increase the chance of it being successful, a medication called a tocolytic (prevents the uterus from contracting) is given before the procedure is carried out.

ECV are successful in about 50% of cases². However, it does come with some potential risks which are rare. These include causing the baby’s heart rate to drop or labour being triggered. Both of these risks are rare. If you have certain complications such as a low lying placenta, it will not be offered as an option to you.

If a baby is still breech after 37 weeks and ECV is not an option or has not been successful, your obstetrician will discuss other options available to you. The decision will factor in your preferences, your medical history, the type of breech, and the level of expertise of your obstetric team.

A breech presentation should not cause you pain. However, due to the positioning of the baby’s head and legs you may well feel discomfort from the hardness of the head or kicking of the legs around your rib cage.

The majority of babies who are born breech, whether by Caesarean section birth or vaginal birth go on to live perfectly healthy lives.

The primary concern which is unique to breech presentation is the development of the hips, especially if the baby was in the frank breech position for a considerable amount of time.There is a marginally higher risk of Developmental Dysplasia of the Hip (DDH), (an instability of the hip joint), with breech presentation.

Every baby has the NIPE exam (Newborn and Infant Physical Examination) within 72 hours of the birth. This can be carried out by a paediatrician or specially trained midwives. Part of this exam is to assess for DDH.

Any baby that was breech at 36 weeks of pregnancy is also offered an ultrasound of the hips as standard in the UK at 6 weeks old to check for DDH. This allows for timely detection and treatment if required.

The position of a baby, whether breech or not, is largely beyond a person's control. Factors that determine the baby's position such as placental location, the shape of the uterus, the orientation of the pelvis, and the volume of amniotic fluid are unchangeable.

The focus should be on raising awareness and making the appropriate preparations for birth, rather than attempting to prevent a breech position.

If you are told your baby is breech at term, it is vital to have open discussions with your midwife or doctor. Shared decision making is crucial.

Key questions you may want to ask include:

"Can you explain the type of breech position my baby is in” and "what are the implications for delivery?"

"Do I meet the criteria for an External Cephalic Version (ECV)?"

"How many ECV’s have you performed?” What is your success rate”?

"What are the hospital's policies and success rates for planned vaginal breech birth?"

"If I choose to have a vaginal breech birth outside of hospital guidelines, will I be supported?"

It is completely understandable to be worried if you are near your due date and your baby is breech. However, please be assured that there are lots of safe options available to you for the birth. It really depends on the baby’s position and your overall health. A safe outcome for both you and your baby is always the goal.