Even as your baby’s accommodations become increasingly cramped, she may still perform some pretty remarkable gymnastic feats during the last weeks of pregnancy. But between week 32 and week 38 (usually around week 36), most babies finally start to settle head-down. In this ideal delivery position, her head is near your cervix, and she’s usually facing your back.
However, not every fetus makes this turn to head south in the womb. About 3 to 4 percent of babies still hang out head-up by the time they’re full-term.[1] But just because your baby is bottom-down in the weeks before your due date doesn’t mean she’ll remain breech when it comes time for delivery.
Some babies don’t let on what end will ultimately be up until just before birth. But if your full-term baby stays in breech position come delivery day, a vaginal birth can be difficult and maybe impossible. Fortunately, there are steps you and your doctor can take to change direction before you go into labor.
For some help understanding what breech means, including each type of breech position and whether turning your baby is possible before you deliver, read on.
What does it mean if a baby is breech?
A breech position is when baby’s buttocks, feet or both are poised to come out of the vagina first during birth. This is instead of the coveted vertex presentation, which means positioned vertically in utero with her bottom up so she can exit your vagina head first.[2]
What are the different types of breech positions?
Your baby on board could be in a number of different breech positions, such as the following:
- Frank breech: This is the most common breech position, with your baby’s bottom down, her hips flexed with legs pointing upward and her feet near her head — as if she were in "V" pike position.
- Complete breech: In this position, baby's head is up and her buttocks are down with both hips and knees flexed — so now imagine she's tucked into a little ball.
- Footling breech: Your baby is head-up with one or both feet hanging down (meaning she’d come out feet-first if delivered vaginally).
What causes a baby to be breech?
Although doctors sometimes can’t determine why a baby winds up in a breech position, there are some possible conditions that contribute to this outcome. Keep in mind, however, that most of the time, none of these risk factors are present and your baby just ends up with her little butt down.[3]
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- Uterine abnormalities. Usually the uterus looks like a hollow, upside-down pear — but in some women it’s a different shape, often detected by a pelvic exam or ultrasound before or during pregnancy. You may have an abnormality from birth or develop one later due to scar tissue from surgery (including a C-section), fibroids or a severe uterine infection. As a result, your baby may not have enough space to flip and exit head down.
- Location of the placenta. If your placenta is low-lying (placenta previa), covers the cervix or is located up near the top of your uterine wall but blocking the space near your baby’s head, she may not be able to wiggle her way into a downward position.
- Volume of amniotic fluid. Too little or too much amniotic fluid can also cause a breech position. Not enough fluid makes it difficult for your baby to “swim” around, while too much means she has too much space and can flip between breech and a head-down position.
- Multiple gestation. If you’re pregnant with multiples, one or more of the babies may not be able to get in the head-down position since there’s less space to move around.
- Previous breech. If you've had a previous breech baby, you run a somewhat higher chance of subsequent babies turning out breech as well.
- Premature birth. The earlier your baby is born, the higher the chance she’ll be breech: About 25 percent of babies are breech at 28 weeks, but only 3 percent or so are breech at term.
- You or your partner were breech. If so, there’s a higher chance your own baby will be breech, according to some research.[4]
- Fetal abnormalities. Very rarely, a problem with the baby’s muscular or central nervous system can cause a breech presentation. Having an abnormally short umbilical cord may also limit your baby’s movement.
- Smoking. Data shows that smoking during pregnancy may up the risk of a breech baby.
How can you tell if your baby is in a breech position?
As your due date nears, your doctor or midwife will determine your baby's position by feeling the outside of your abdomen and uterus — the term used to describe this series of abdominal palpations is Leopold maneuvers.
If your baby is breech, her firm, round head will be toward the top of your uterus and her softer, less round bottom will be lower. The accuracy of this assessment varies widely, so many times, especially with availability of technology, a routine ultrasound will be performed to confirm physical exam findings.
What does it mean to turn a breech baby?
If your doctor decides to try to turn your baby from the outside, they will attempt what’s known as an external cephalic version (ECV). This procedure is a literal hands-on manipulation of your belly in order to coax your infant from a breech or side-lying position to one where she’s got her head pointing down toward your cervix. An ECV should always be performed in a hospital where delivery occurs rather than an offsite clinical office.[5]
ECV is usually attempted around the 36- or 37-week mark, before labor begins. Sometimes, a version can be tried during early labor before your water has broken, but once labor has spontaneously started, the likelihood of a version being successful is very low. If it works, an ECV allows women to try for a vaginal birth. When ECV isn’t successful, you’ll be scheduled to deliver via C-section.
How can you turn a breech baby?
Turning a baby with an external cephalic version involves your practitioner placing their hands on your stomach and pushing the baby into the head-down position using firm pressure. You’ll be given medication to relax your uterus (don’t worry — it won’t affect your baby). ECV tends to be uncomfortable, and sometimes painful, but the procedure is quick and more than half of all attempts are successful. So for many women, the benefits of a successful version with the ability to attempt a vaginal delivery greatly outweighs the brief discomfort associated with the procedure itself.
Sometimes, however, babies flip back into the breech position after being successfully turned. If this happens, your practitioner can try to reposition your baby again — but this usually gets tougher the closer you are to your due date, since there’s less room for baby to move around.
You may have heard of other alternative ways to try to get a baby to turn, including chiropractic techniques, relaxation techniques like professional hypnosis or moxibustion, where an acupuncturist burns mugwort herb near your smallest toe to stimulate an acupuncture point. Some say moxibustion increases fetal activity, making your baby more likely to wriggle her way to a head-down position. Keep in mind that these methods may not be particularly effective and there is no scientific evidence they work, so few physicians actively recommend them. But they also do not cause harm to you or your baby. So if you are motivated to try these alternative therapies, talk to your doctor, and they might be worth a try for you.
Here are some other at-home methods that you can do in an attempt to coax your baby into the head-first position. Again remember, none of these have scientific backing, but they are safe and nearly free, so they may be worth a try:
- Rock on your knees. Sway back and forth gently on your hands and knees with your buttocks higher than your head.
- Do pelvic tilts. Try these for five minutes, several times a day.
- Maintain good posture. Sit upright on an exercise ball, which can help open up the pelvic area and can make it easier for your baby to make her move.
- Play music. Turn on a song or have your partner speak near the bottom of your belly and wait for your baby to (hopefully) follow the tune.
- Try frozen veggies. Place a bag of frozen peas at the top of your stomach (some experts and moms think the uncomfortable cold sensation sends baby headed in the other direction).
How does labor usually start with a breech baby?
If your membranes haven’t ruptured (for instance, you arrive to the hospital for a scheduled C-section or induction), your doctor may attempt a version before delivery. But if you’re at term, your water has broken or you’re having contractions, it’s too late for an ECV.
In the United States, greater than 90 percent of singleton breech babies are delivered by C-section.[6] However, there are still some doctors that may agree to attempt a vaginal delivery in the right patient, particularly if the following apply to you:
- Your baby is full-term, not too big, in the frank breech position and shows no signs of distress
- Your pelvis is roomy enough for your baby to pass safely (odds are better if you’ve delivered vaginally before)
- You’ve experienced no complications (including gestational diabetes or preeclampsia)
- Your provider has experience doing vaginal breech births
Also, if you have a twin pregnancy with your first baby head down, while the second twin is in the breech, there is a good chance your provider will agree to a breech delivery of the second baby. This is because the first baby’s head will open the cervix and “prove” your pelvis can safely pass a baby. So, this helps make the breech delivery of the second twin safer than the higher risk breech delivery of just one baby.
If your cervix dilates too slowly, if your baby doesn’t move down the birth canal steadily or if other problems arise, you’ll likely have a C-section. Talk your options over with your practitioner now to be prepared. Remember that though you may feel disappointed things didn’t turn out exactly as you envisioned, these feelings will melt away once your bundle of joy safely enters the world.
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