A breech baby is one who is positioned bottom or feet first in the uterus instead of head down. Early in pregnancy this is completely normal, because babies have plenty of room to tumble. By the last month, most have settled head down, but roughly 3 to 4 percent of babies are still breech at term. If your provider tells you your baby is breech at your 36 week visit, you are not out of options, and you still have time to make a plan.
When do babies usually turn head down?
Most babies move into a head down position between 32 and 36 weeks. Before then, your provider will note the position at each prenatal visit but will not act on it. After 36 weeks, the baby is larger and the amount of fluid around them is smaller, so spontaneous turning becomes less likely with each passing week. That is why 36 to 37 weeks is the point where we stop simply waiting and start talking about next steps.
Why is my baby breech?
Often there is no clear reason. Some things make breech more likely, including a first pregnancy, twins, more or less amniotic fluid than usual, a placenta positioned low in the uterus, fibroids, or an unusually shaped uterus. Babies born early are also more often breech simply because they have not yet turned. A breech position is not caused by anything you did, and it does not by itself mean something is wrong with your baby.
Can I turn a breech baby myself?
You will find many suggestions online, from knee-to-chest positions and forward-leaning inversions to swimming, music, and cold packs. These are safe for most healthy pregnancies, and some women find them comforting to try. The honest answer, though, is that good studies have not shown they reliably turn babies. If you want to try positioning techniques, ask your provider first, especially if you have high blood pressure or any bleeding, and do not let them delay the conversation about medical options.
What is an external cephalic version (ECV)?
An external cephalic version is a procedure in which your provider uses their hands on your belly to gently guide the baby into a head down position. It is done in the hospital, usually at 37 weeks, with ultrasound to check the baby’s position and continuous monitoring of the baby’s heartbeat before, during, and after. Many women receive medication to relax the uterus beforehand, which makes the turn easier. The attempt itself takes only a few minutes.
ECV works in roughly half to two thirds of cases, and success is more likely if you have had a baby before, if there is a normal amount of fluid, and if the baby’s bottom has not yet dropped into the pelvis. Most women describe strong pressure rather than sharp pain. Serious complications are rare, but because they can happen, ECV is only performed where a cesarean could be done right away if needed. You may not be a candidate if you have a low-lying placenta, twins, certain uterine scars, or signs your baby is not tolerating pregnancy well. If your blood type is Rh negative, you will receive an Rh immune globulin shot afterward.
Planning a cesarean for a breech baby
If your baby stays breech or an ECV does not succeed, a planned cesarean is the most common and safest route to delivery for most breech babies in the United States. It is typically scheduled at about 39 weeks, which gives your baby the most time to mature while avoiding the start of labor. Because it is planned, you can still create a birth plan that reflects what matters to you, from who is in the operating room to skin to skin contact and early breastfeeding.
A small number of women are candidates for a planned vaginal breech birth with an experienced provider. Whether that is an appropriate option depends on the type of breech, the size of the baby, and other factors your provider will review with you.
What a breech birth means for your next pregnancy
One cesarean for a breech baby does not mean every future birth has to be a cesarean. Many women who deliver by cesarean for breech are good candidates for a vaginal birth after cesarean (VBAC) in a later pregnancy, and Complete Care ObGyn offers VBAC as part of our labor and delivery care. Breech positioning does have a slightly higher chance of repeating, so your provider will watch position closely next time.
If your baby is breech, schedule an appointment at Complete Care ObGyn in Henderson. Our board-certified providers will confirm the position by ultrasound, walk you through whether an ECV is right for you, and help you build a delivery plan you feel ready for.
