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In a typical pregnancy, a baby’s head is down by delivery time. This is called the “vertex position.” The head paves the way out of the birth canal, and the baby has less potential for body parts to get stuck when coming out this way. However, when you have a breech baby, its head is at the top of your uterus toward your chest, and either its feet or bottom are down toward your cervix. A baby can also be transverse, meaning they lie horizontally across the cervix. These breech baby positions can make for a more complicated delivery.1
Your provider may be able to tell you your baby is breech after seeing your baby’s position on ultrasound, or they may be able to feel your baby’s position by palpating for certain fetal body parts on the outside of your belly.
Finding out that your baby is breech can be scary and overwhelming news if you have dreamed of a vaginal birth, but not all hope is lost. You’ll have some options for your delivery.
Here are some delivery options if you have a breech baby.
If you are in your second trimester and your baby is breech, it is highly likely that your baby will still flip on their own. One study showed that a baby at 25 weeks or less was no more likely than a vertex baby to be breech by full-term.2
As time goes on and the pregnancy progresses, a breech baby is less likely to flip to head down on their own. But still, by the time a pregnancy has reached full term, only about 4 percent of babies are breech. If you have some time before you anticipate delivery, you can wait and see if your breech baby flips on their own. Do not let yourself be pressured into scheduling a C-section for a breech baby when there is still time for them to flip.3
If you would instead take a hands-on approach to encourage your little one to flip, there are many holistic approaches to flip a breech baby. You can try acupuncture, chiropractic care, and different body positions. If these do not work for you and you hope for a vaginal birth, you still have options.4,5
An external cephalic version, or ECV, refers to a provider manually rotating the baby through the mother’s abdomen. Not all pregnant women qualify for it, and it does have risks. It can be pretty painful—some providers offer an epidural. Some babies flip back to breech after it is performed. However, it works about half the time at rotating a baby, giving you a better chance for a vaginal delivery.6
Vaginal breech birth has largely fallen out of practice in the United States; however, depending on other circumstances of your pregnancy, there is a debate that breech vaginal birth may still be safe. A large study in 2000 called the Term Birth Trial compared vaginal versus Cesarean births for breech babies. Criteria for attempting a vaginal breech delivery included:7,8
- gestational age greater than 37 weeks
- frank or complete breech presentation (baby’s bottom is down, not their feet or shoulder)
- no known fetal anomalies
- large-enough maternal pelvis
- estimated fetal weight between 5.5 lbs. and 8.8 lbs.
- the baby’s head is flexed, not extended
- sufficient amniotic fluid
However, this study did report that scheduled C-sections for breech pregnancies yielded safer outcomes for babies when compared to vaginal births. Risks to the baby of vaginal breech birth include complications of getting stuck in the birth canal and a prolapsed umbilical cord.3,9
Maternal complications are similar between vaginal and C-section births of breech babies.8
However, one study showed that experienced providers might be able to offer vaginal breech deliveries to otherwise low-risk mothers safely. If you are passionate about having a vaginal birth, it may be worth researching if any providers in your area are experienced and willing to attempt a vaginal delivery with your baby.10
If all these tactics fail to flip your baby and you are not interested in trying a vaginal birth, a scheduled surgical birth is always an option. You may also be able to wait until labor begins naturally before you go in for a C-section. That way, your baby and body are still deciding on the birth time.3
If you dream of a low-intervention birth, talk to your provider about ways to make your Cesarean “gentle” or as close to a vaginal birth as possible, from the music playing in the operating room to holding your baby immediately after birth.11
Learning that your baby is breech can be disappointing and scary. But just because your baby is breech now does not mean they cannot flip. You can try many holistic and at-home things to encourage your baby to go head down. If these do not work, you can try medical interventions such as chiropractic care and ECV. If your baby remains breech, you can talk to your provider about your delivery options or change providers to attempt a vaginal delivery. The good news is that you and your baby will be just as healthy with the proper care. Hopefully, this comes with your ideal birth as well.
