Learn about your birth options if your baby isn’t head down, including the pros and cons of a vaginal breech birth versus an elective c-section, and what’s involved in an ECV.
The most common and optimal position for your baby to be in for birth is with their head down in your pelvis, but some babies lie in different positions in the womb.
If your baby is breech as your due date approaches, you could be offered an opportunity to try to turn the baby around, or the choice between an elective c-section or vaginal breech birth.
Does it matter what position my baby is in for the birth?
Your midwife will check your baby’s position at every antenatal appointment in your third trimester and note down how your baby is lying in your handheld notes. You can find out more in our guide to maternity notes.
With a cephalic birth, the head – the biggest part of your baby – is born first. This means they’re less likely to suffer from a lack of oxygen during the birth than if they were breech.
However, a lot of babies are born vaginally in the breech position (some because it’s not noticed that they’re breech until labour has started) without any problems.
While the most important aspect of your baby’s position is whether they’re head down, which way they’re facing can also have an impact on your birth experience.
Having your baby facing your back (OA) is considered the ideal position for birth. If the baby is facing your belly (OP), your labour can last longer and be more painful in your back (a ‘back labour’, or ‘back-to-back baby’). However, even if your baby starts out as OP, they’re likely to turn around during labour before they’re born.
When will my baby turn head down?
There’s no need to feel worried if your baby’s not head down the first time the midwife checks the position at the start of your third trimester – it’s very likely your baby will turn around by their own accord.
At 28 weeks, one in five babies (20%) are in the breech position in the womb, but by 37 weeks, only 3-4% of babies are still in that position.
Can you turn a breech baby?
If your baby is in the breech position at 36 weeks, you usually have three options:
- external cephalic version (trying to turn the baby around)
- choosing to have a vaginal breech birth
- choosing an elective c-section.
Trying to turn the baby around via external cephalic version (ECV) is recommended for most, but not all, women whose babies are in the breech position. Your doctor or midwife will be able to talk through your specific circumstances and options before you make up your mind.
ECVs are usually performed when you’re around 36 or 37 weeks pregnant and they’re successful in around half of women.
What is an external cephalic version (ECV)?
During an external cephalic version (ECV), a specially trained doctor or midwife places both their hands on your bump and manually attempts to rotate your baby to the head down position in your womb.
Beforehand, you’ll have a scan to confirm the position of your baby, and you’ll be given a muscle relaxant via injection.
There’s a very small risk of your baby becoming distressed during the ECV and needing to be delivered immediately via emergency c-section. This happens in fewer than one in 200 cases (0.5%), but ECVs are always performed at the hospital so you can get into surgery quickly if need be.
Should I have a vaginal breech birth or an elective c-section?
If your baby is still in the breech position when you’re full-term, either because the ECV was unsuccessful or because you chose not to attempt it, you’ll have a choice between having an elective c-section or a vaginal breech birth.
You should get the chance to talk through the pros and cons of each option thoroughly with your doctor or midwife, including how your own circumstances can affect how safe a vaginal breech birth would be.
Some factors that can make a vaginal birth higher risk include:
- a much larger or much smaller baby than average
- a low-lying placenta
- if your baby’s feet are below their bottom
- if you have any pregnancy health conditions, for example pre-eclampsia.
Statistically, having a planned c-section is safer for your baby than a vaginal breech birth. For you, a c-section carries a slightly higher risk of complications than a vaginal breech birth.
Around four in ten women who plan to have a vaginal breech birth end up having an emergency c-section.
What should I do if I want to have a vaginal breech birth?
Having a doctor or midwife who is skilled in vaginal breech births present during labour can make the birth almost as low-risk as if your baby were head down. So, if you want to give birth vaginally, making sure that you have the right support for the birth is key.
However, as hospitals in the UK today recommend a planned c-section when the baby is in the breech position, vaginal breech births are rare. As a result, there is a shortage of midwives and doctors experienced in these type of births, so you might need to do a bit more research to get the birth you want.
- Find out if there any midwives or doctors who specialise in vaginal breech births at your local hospital – ask your consultant or the head of midwifery.
- If there isn’t, request to be referred to the nearest maternity unit that does have a specialist, so you can plan for the birth.
Find out how to negotiate your care if you’ve been told you’re at higher risks of complications.
Can I have a breech birth at a birth centre?
To give birth in a birth centre, you normally have to have a pregnancy that’s classed as low-risk. Your baby being breech means that you have increased risk of complications during labour and birth, and you’re likely to be advised to have your baby at a labour ward.
You can check the admission criteria for your local birth centre, under the heading ‘Who can give birth here?’.
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What does it mean if my baby is transverse?
If your baby is lying sideways, it’s sometimes possible to attempt an external cephalic version (ECV) to turn them head down. However, your baby being in the transverse position at the end of pregnancy is more complicated than having a breech baby.
You may need to be admitted to hospital in the final weeks if an ECV isn’t possible or successful, as you have a slight risk of umbilical prolapse (where the cord is born before the baby) with a transverse baby. If you do have an umbilical prolapse, you need to have a c-section immediately.
If your baby is still lying sideways as your due date approaches, you’ll most likely be advised to have an elective c-section to make sure the delivery is safe for both you and your baby.
These are the sources of information used in this article:
Hofmeyr G, Hannah M, Lawrie TA, Planned caesarean section for term breech delivery, Cochrane Database of Systematic Reviews. (2015)
Royal College of Obstetricians and Gynaecologists, External cephalic version and reducing the incidence of term breech presentation (green-top guideline no. 20a), RCOG, London. (2017)
Royal College of Obstetricians and Gynaecologists, Management of breech presentation (green-top guideline no. 20b), RCOG, London. (2017)
University Hospital Southampton, Breech babies (patient information factsheet), University Hospital Southampton NHS Foundation Trust. (2014)