Breech position

Written by Graham Hutchings, British gynaecologist who works in Delta hospital, Brussels. See for more about Graham and his practice.

This explanation is based on Graham’s own approach, and can serve to inform you about possible approaches and help you in discussions with your own care provider.

A baby is in breech position when it is bottom first. Many babies change position throughout early pregnancy and most come to lie head-down towards the later stages so that only around 3% are in breech position from 36 weeks onwards.

Usually this is due to ‘bad luck’ and in a normal pregnancy is often associated with the position of the placenta.

If your baby is in breech position at 36 weeks there are three possible choices:

  • External Cephalic Version (ECV) – turning the baby around so that it faces the right way
  • Caesarean section
  • Vaginal breech birth

External Cephalic Version (ECV)

Graham writes: “If your baby is in breech position at 36 weeks, I usually suggest that we should try and turn the baby.

This procedure is performed in hospital – you arrive in the morning and receive a medicine to relax the uterus. Around an hour later, I push gently on your abdomen so that the baby turns from the breech position to being head-down. This can last between a few seconds and a couple of minutes.

I check on the health of the baby regularly during the procedure with the ultrasound machine and the baby is monitored for half an hour afterwards.

Although the procedure is sometimes uncomfortable, it should not be painful. The procedure is successful in around 50% of cases.

Around 1 baby in 200 is ‘distressed’ by the procedure and needs to be delivered by caesarean section straight away. For this reason I always perform ECVs next to the operating room with a medical team on standby in case this is necessary.

If the ECV is successful I see you one week later and the pregnancy continues with the standard care.

If unsuccessful or if an ECV is not attempted then the baby needs to be born by caesarean section or by vaginal breech birth.”

For those thinking about having their baby turned, Graham suggests looking at this video of the procedure (with the sound turned on).

Caesarean birth for a breech baby

Many women are advised or choose to deliver by caesarean section for a breech baby.

The concern with delivering normally is that the largest part of the baby (the head) is delivered last and this can be difficult.

The best medical evidence for this is given by the Term Breech Trial published in the Lancet which concluded that it was safer for a baby to be born by caesarean section. Some doctors disagree with the findings of this trial and some women choose to deliver vaginally anyway.

Vaginal breech birth for a breech baby

Graham writes that: “As in all decisions, there is a balance of ‘positives’ and ‘negatives’ and this may lead some to try for a vaginal breech birth.

This is undertaken with strict criteria before and during labour so that only around 20% of babies end up being born vaginally. However, with this ‘selection’ the delivery of these 20% appears relatively safe.

The Royal College of Obstetricians and Gynaecologists have put together two excellent information sheets for patients on a breech baby at term and on ECV.

For those thinking about having their baby turned, I suggest that you look at this video of the procedure (with the sound turned on).”