While the vast majority of babies come out head first, a few like to make themselves nice and comfy in the breech position (bottom or feet first in the womb) as their due date nears. If you think your baby is breech, the first thing to do is to speak to your midwife or doctor, who will be able to advise you on your options.
What is the breech position?
Most babies are in the head down position by the time you come to give birth. But a few – about 3%, according to this NHS factsheet – are in the bottom first or feet first position when they reach term (37-42 weeks). We call this the breech position – not to be confused with transverse position, which is when the baby is lying sideways.
Of course, the ideal way for a baby to be born is head first, as that means one of the smallest parts of the baby comes out first and clears the way as it goes, but, as with due dates, sometimes the baby calls the shots. While it's not impossible to give birth to a bottom/feet first baby, it does make a vaginal delivery more complicated. You will be advised by your obstetrician and midwife about your options.
Information from the Royal College of Obstetricians & Gynaecologists states that “Breech is very common in early pregnancy, and by 36–37 weeks of pregnancy most babies will turn into the head first position. If your baby remains breech, it does not usually mean that you or your baby have any problems.”
How do I know if my baby is lying in the breech position?
You midwife will try to tell at 30 weeks what position your baby is lying in, although she might not be able to say for certain. Unfortunately, the only way to confirm for sure your baby's position is by having a scan. There are, however, a couple of tell-tale signs that you can look out for:
- If you can feel your baby kicking you around your ribs (ouch), it might be because she is lying in frank breech (feet up around her ears).
- If you're getting kicked around your belly button then she might be lying in complete breech (cross-legged). This will mean her head is behind your ribs. You'll likely be very much aware of this because, well, it's pretty uncomfortable.
My first baby was breech at 33 weeks but thankfully, he ended up turning on his own. Now I'm pregnant again and I'm doing yoga classes. Our teacher talks about 'the scoop' which is supposed to be good for getting babies to turn.
Why do babies lie in the breech position?
The reasons that babies get themselves into this position are fairly arbitrary, but doctors believe there are a few possible factors:
- First time mothers are more likely to have breech babies, as are mothers who have had them in the past
- A low lying placenta (lying in the lower part of the uterus, near the cervix). The placenta position will be recorded at your 18-21-week scan and checked again at 30 weeks.
- The baby is large or small for her gestational age
- There is too much, or too little, fluid around your baby
- You're having multiple babies
Turning a breech baby
Babies move about in the womb. If you're in your second trimester then this probably sounds like the understatement of the year, as that's when babies move about a lot, and can turn from bottom first to head first and back again. Your baby might lie in the bottom/feet first position at several points during your pregnancy, but most are lying head first by 34 weeks.
If your obstetrician or midwife thinks your baby is in the breech position at 36 weeks, the first thing they’ll do is a scan to find out.
Natural methods for turning a breech baby
If the scan shows your baby lying bottom/feet first then your midwife might suggest you try some natural methods to get her to play ball and lie head first. If you have suffered from back ache or pelvic pain, though, it's wise not to try these methods, so do check with your midwife before going ahead. The following exercises are for women who are 34 weeks or more pregnant.
- Breech tilt. You can do this for 10 to 15 minutes, up to three times per day, ideally when you have a fairly empty stomach and you can feel your baby already moving. You simply lie on your back with a pillow beneath your hips, then elevate your hips slightly.
- Knees to chest. Kneel with your head, shoulders and chest flat to the floor. You're trying to let your baby move back up out of your pelvis so that she has more room to move around and could, hopefully, turn into the head first position.
- Moxibustion. This form of Chinese heat therapy is designed to get your baby moving. Moxibustion is a herb that's packed into a cigar-like tube which is then burned close to your skin – probably between your toes. The intention is to warm and invigorate the flow of Qi (life force) in the body. It could well get your baby moving but whether it will get her to flip to head down is uncertain. You might just end up with smoky toes and be about £50 worse off. Suffice to say, Moxibustion is not available on the NHS (there's no scientific evidence that it works) but it is considered to be safe and “may be effective between 34-36 weeks of pregnancy.”
I tried Moxbustion and just ended up £40 poorer, with tender toes, many hours wasted and a house that stank. But I'm glad I tried it.
Finally, it's still possible that your baby will simply turn to the head first position and none of the above methods will be necessary. If so, that's called spontaneous cephalic version.
ECV for turning a breech baby
Alternatively – or if natural methods fail to encourage your baby to reposition – your obstetrician might offer you an external cephalic version (ECV), which the NHS will provide. This involves a medical professional applying pressure to your abdomen, encouraging your baby to move around in the womb and trying to turn your baby into the head first position. It's carried out at hospital and has a success rate of about 50%.
On the day of the ECV, you will undergo another scan to confirm that your baby is still lying bottom/feet down. Your heart-rate and blood pressure will be checked, and you'll be given an injection of tocolytic to relax your uterus and ease your baby's movement. It might make you feel a little flushed and increase your heartbeat, but not for long.
My ECV was done by my consultant on the delivery suite. It worked and was at most just a bit uncomfortable.
The ECV procedure only lasts for a few minutes. In terms of how it feels, Mumsnetters report differing experiences of ECV, with some saying it hurts like hell and others describing mild discomfort. It shouldn't hurt, though, so if it does, tell your doctor right away.
Afterwards, you'll have another scan to see if the procedure has been successful, and your heart rate and blood pressure will be checked again. Later, if you're experiencing abdominal pain, bleeding, contractions or reduced movements, call the hospital.
If you've tried the natural methods and ECV, and your baby is still refusing to budge (they can be stubborn like that), then your doctor and midwife will talk you through your two options:
Some people will tell you that breech births were taking place long before the advent of ultrasounds and argue that you should simply go through it. If we applied that principle more broadly, though, we'd never bother with antibiotics, vaccinations or central heating. While we don't know how many women suffered through deliveries throughout the centuries, what we do know is that, in the UK at least, most doctors believe the safest way for a breech baby to be born is by caesarean.
Doctors may well advise you to have a caesarean, especially if:
- You've had a caesarean before
- The placenta is low lying
- You're having more than one baby and the first is breech
- You have pre-eclampsia or another condition that could put you or your baby at risk
- Your baby is estimated to weigh under 2kg (4.4lbs) or over 4kg (8.8lbs)
- Your baby is tilting backwards, with hyper-extended neck, in the womb
- You've been diagnosed with a narrow pelvis
If you choose to have a caesarean, you will be given a date and time to come to the hospital to give birth. If you go into labour in the meantime, you should go to the hospital where you will be examined by a doctor or midwife who will decide whether you can have an emergency caesarean. This will depend on the stage of your labour. If the baby is close to being born, then a natural birth might be the best option.
Planned vaginal breech birth
To have a vaginal breech birth you will need to be looked after by an experienced specialist team. It will have to be in hospital in case you require an emergency caesarean. Home births are not advised for babies coming out bottom/feet first, as the risk of complication is higher.
Your medical team will discuss the procedure with you and talk you through your options beforehand. These will include lying on your back, with your legs in stirrups, or adopting an upright position.
Vaginal breech birth was what I wanted to do. But after talking to the consultant I changed my mind. There is an increased chance of the cord becoming compressed, the baby being deprived of oxygen and suffering brain damage. It was a risk I couldn't take.
Now, here's a risk that is rare, occurring in about one in 100 breech births, but is worth considering:
It is possible that, if your waters break before your baby’s bottom is engaged, the umbilical cord could be swept down into your vagina. If you see or feel the umbilical cord, call the midwives at the hospital immediately, so that they can send an ambulance and prepare for the birth.
Is breech birth painful?
With a team of experienced specialists in place to guide you, there is no reason why a bottom/feet first birth should be more painful than a head first birth. But, of course, all births are different and Mumsnetter's report varying experiences.
Much will depend on your baby's position. The safest positions, according to the National Childbirth Trust, are the frank breech (feet by her ears) or complete breech (legs crossed with her feet higher than her bottom). They advise that: “If a baby’s feet or knees are coming first, labour is less likely to go smoothly.”
Whatever position your baby is lying in, the team of specialists will monitor you and your baby's safety throughout and try to make you as comfortable as possible.
After your baby is born
All babies lying in the bottom/feet first position after 36 weeks of pregnancy are at a slightly increased risk of unstable hips. For this reason, all such babies must be tested for developmental dysplasia of the hip within six weeks of birth.
There will be a hip assessment as part of your baby's 'first medical examination' to assess the stability of her hip joints. An ultrasound scan at around six weeks will also be arranged. Only one to three per cent of newborns have developmental dysplasia of the hip, although it is more common among babies born bottom/feet first.
The majority of breech babies are born healthy, but the risk of complications is higher than with babies who are born head first. If you have any questions please don't hesitate to ask your midwife or your paediatrician.