Causes & What To Do If Baby Is In A Breech Position

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 settle into a head-down position. In this ideal delivery position, her head is near your cervix, and she’s usually facing your back.

Not every baby makes this turn to head south in the womb, though. About 3 to 4% are head-up, or breech, when they’re full-term.

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.

Key Takeaways

• Most babies turn head-down on their own, but some don’t. While the majority of babies settle into a head-down (vertex) position by about 36 weeks, roughly 3 to 4% remain breech at full term, meaning their bottom or feet are positioned to come out first.
• We don't know for sure what causes a baby to be in breech position. Factors like uterine shape, placenta location, amniotic fluid levels, multiples, or prematurity can play a role, but many breech babies have no identifiable risk factors at all.
• There are options if your baby stays breech. Doctors may try to turn a breech baby using an external cephalic version (ECV) around 36 to 37 weeks, which is often successful. If a baby remains breech, delivery is most commonly by C-section, though vaginal breech birth may be possible in cases with experienced providers.

What does it mean if a baby is breech?

A breech position is when a 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.

Keep in mind that even if your baby is breech in the weeks before your due date, that doesn’t necessarily mean she’ll remain breech until delivery. Some babies keep their parents guessing right up until the end.

If your baby is breech on delivery day, a vaginal birth can be more challenging and may not be possible. Fortunately, there are steps you and your doctor can take to encourage your baby to change direction before labor begins (more on that below).

Want daily updates about your baby’s development and helpful tips for the final weeks of pregnancy? The free What to Expect app offers expert-backed advice and guidance for every stage of the third trimester.

What are the different types of breech positions?

Your baby on board could be in a number of different breech positions, such as:

• 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, a baby's head is up and her buttocks are down with both hips and knees flexed — 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?

Most of the time, a baby just ends up with her little butt down for no particular reason. But there are some possible conditions that may contribute to a breech position:

• 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 amniotic fluid 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 more easily flip between positions.
• 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% of babies are breech at 28 weeks, but only 3% 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.
• 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 ultrasoundwill be performed to confirm physical exam findings.

"This baby has been all over and it's stressing me out," says What to Expect Community mom hellomelon1. "Baby was breech at 28 weeks. Head down at 33 weeks. Then breech again at 34 weeks. Today at 36+2, baby was head down. I won't let myself get too happy or excited until my next ultrasound also confirms it."

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.

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 success 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.

"We were basically always breech and I kept telling myself it was still early and the baby will turn," says What to Expect Community member atonoflov. "We tried all the things. But he didn't and when we hit 37 weeks, we had a successful ECV!"

How is an ECV done?

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 outweigh 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.

"We found out our baby was still breech at 36 weeks, and our OB offered to do an ECV at week 37," says What to Expect Community mom lilpebble. "We went in hopeful, but our little girl didn't want to budge. Oh well... I don't regret trying it!"

Are there other ways to turn a breech baby?

You may have heard of other 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 alternative methods may not be particularly effective, and there's no scientific evidence they work, so few physicians recommend them. But they're generally considered safe, so talk with your doctor if you're interested in giving an alternative therapy a try.

Here are some simple at-home methods that you can do in an attempt to coax your baby into the head-first position. Again, none of these have scientific backing, but they're 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 pelvic tilt exercises 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).

What will happen if my baby is breech when our due date arrives?

If your membranes haven’t ruptured (for instance, you arrive at 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% of singleton breech babies are delivered by C-section.[4] However, there are still some doctors who 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.