A breech baby at the end of pregnancy Information for you

A breech baby at the end of pregnancy

Information for you

Published August 2008
Review August 2011


What is breech?
Breech means that your baby is lying bottom first or feet first in the womb (uterus)
instead of in the usual head first position. In early pregnancy, breech is very common. As
pregnancy continues, a baby usually turns naturally into the head first position. Between
37 and 42 weeks (term), most babies are lying head first ready to be born.
Three in every 100 (3%) babies are breech at the end of pregnancy.
A breech baby may be lying in one of the following positions:
Extended or frank breech – the baby is bottom
first, with the thighs against the chest and feet up
by the ears. Most breech babies are in this
position.

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Flexed breech – the baby is bottom first, with the
thighs against the chest and the knees bent.

Footling breech – the baby’s foot or feet are below
the bottom.

Why are some babies breech?
Sometimes it is just a matter of chance that a baby does not turn and remains in the
breech position. At other times certain factors make it difficult for a baby to turn during
pregnancy. These might include the amount of fluid in the womb (either too much or too
little), the position of the placenta or if there is more than one baby in the womb. The vast
majority of breech babies are born healthy. For a few babies, breech may be a sign of a
problem with the baby. All babies will have a newborn examination.
What can be done?
If you are 36 weeks pregnant and the baby is in a breech position, your obstetrician or
midwife should discuss external cephalic version (ECV) – see Information leaflet turning
a breech baby in the womb (external cephalic version)
What are my choices for birth?
Depending on your situation, your choices may include a:
• caesarean delivery – this is a surgical operation where a cut is made in your
abdomen and your baby is delivered through that cut

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• vaginal breech birth.
There are benefits and risks associated with both caesarean delivery and vaginal breech
birth and these should be discussed between you and your obstetrician and/or midwife,
so that you can choose the best plan for you and your baby.
Caesarean delivery
The Royal College of Obstetricians and Gynaecologists (RCOG) and the National
Institute for Health and Clinical Excellence (NICE) recommends that caesarean delivery
is safer for the baby around the time of birth.
Caesarean delivery carries a slightly higher risk for you, compared with the risk of having
a vaginal breech birth. Caesarean delivery does not carry any long-term risks to your
health outside of pregnancy. However, there may be long-term effects in future
pregnancies for either you and/or your babies. These effects are not yet fully understood.
If you choose a caesarean delivery and then go into labour before the operation, your
obstetrician should assess whether it is safe to proceed with the caesarean delivery. If
the baby is close to being born, it may be safer for you to have a vaginal breech birth.
Vaginal breech birth
A vaginal breech birth is a choice for some women and their babies. However, it may not
be recommended as safe in all circumstances. It is a more complicated birth, as the
largest part of the baby is last to be delivered and in some cases this may be difficult.
Where a vaginal breech birth is being considered, the RCOG supports this only when:
• the obstetrician is trained and experienced in delivering a breech baby vaginally
• there are facilities at your hospital for an emergency caesarean delivery (should
this be necessary)
• there are no particular features about your pregnancy that make vaginal breech
birth more risky.
Before choosing vaginal breech birth, it is advised that you and your baby are assessed.
Your obstetrician may strongly advise you against a vaginal birth if:
• your baby is a footling breech
• your baby is large (over 3800 grams)
• your baby is small (less than 2000 grams)
• your baby is in a certain position: for example, if the neck is very tilted back
(hyper-extended)
• you have had a caesarean delivery in a previous pregnancy
• you have a narrow pelvis (as there is less room for the baby to pass safely
through the birth canal)
• you have a low-lying placenta
• you have pre-eclampsia.


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What can I expect in labour with a breech baby?
You can have the same choice of pain relief choices as with a baby who is head first.
If you have a vaginal breech birth, you are advised that your baby’s heart rate should be
monitored continuously. In some circumstances, you may need an emergency
caesarean delivery during labour. Forceps may be used to assist the baby to be born –
see RCOG Patient Information Assisted Birth (operative vaginal delivery) . This is
because the baby’s head is the last part to emerge and may need to be helped through
the birth canal. A paediatrician will attend the birth to check the baby.
What if my baby is coming early?
If your baby is born before 37 weeks, the balance of benefits and risks of having a
caesarean delivery or vaginal birth changes and will be discussed with you.
What if I’m having more than one baby and one of them is breech?
If you are having twins and the first baby is breech, your obstetrician will usually
recommend a caesarean delivery. The position of the second twin before labour is less
important at this stage because this baby can change position as soon as the first twin is
born. The second baby then has lots more room to move.
If you would like any further information on any aspects of breech, speak with your
obstetrician or midwife.
Sources and acknowledgements
This information is based on the Royal College of Obstetricians and Gynaecologists
(RCOG) guideline The Management of Breech Presentation (published by the RCOG in
December 2006). This information will also be reviewed, and updated if necessary, once
the guideline has been reviewed. The guideline contains a full list of the sources of
evidence they have used. You can find it online at:
www.rcog.org.uk/resources/Public/pdf/green_top20b_breech.pdf.
Compiled by Caoilin Maclaverty, Consultant Obstetrician & Claire Homeyard,
Consultant Midwife and Supervisor of Midwives.

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