Babies often twist and turn during pregnancy, but most will have moved into the head-down (also known as head-first) position by the time labour begins. However, that does not always happen, and a baby may be:
- bottom first or feet first (breech position)
- lying sideways (transverse position)
Bottom first or feet first (breech baby)
If your baby is lying bottom or feet first, they are in the breech position. If they're still breech at around 36 weeks' gestation, the obstetrician and midwife will discuss your options for a safe delivery.
Turning a breech baby
If your baby is in a breech position at 36 weeks, you'll usually be offered an external cephalic version (ECV). This is when a healthcare professional, such as an obstetrician, tries to turn the baby into a head-down position by applying pressure on your abdomen. It's a safe procedure, although it can be a bit uncomfortable. Around 50% of breech babies can be turned using ECV, allowing a vaginal birth.
Giving birth to a breech baby
If an ECV does not work, you'll need to discuss your options for a vaginal birth or caesarean section with your midwife and obstetrician.
If you plan a caesarean and then go into labour before the operation, your obstetrician will assess whether it's 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.
The Royal College of Obstetricians and Gynaecologists (RCOG) website has more information on what to expect if your baby is still breech at the end of pregnancy.
The RCOG advises against a vaginal breech delivery if:
- your baby's feet are below its bottom – known as a "footling breech"
- your baby is larger or smaller than average – your healthcare team will discuss this with you
- your baby is in a certain position – for example, their neck is very tilted back, which can make delivery of the head more difficult
- you have a low-lying placenta (placenta praevia)
- you have pre-eclampsia
Lying sideways (transverse baby)
If your baby is lying sideways across the womb, they are in the transverse position. Although many babies lie sideways early on in pregnancy, most turn themselves into the head-down position by the final trimester.
Giving birth to a transverse baby
Depending on how many weeks pregnant you are when your baby is in a transverse position, you may be admitted to hospital. This is because of the very small risk of the umbilical cord coming out of your womb before your baby is born (cord prolapse). If this happens, it's a medical emergency and the baby must be delivered very quickly.
Sometimes, it's possible to manually turn the baby to a head-down position, and you may be offered this.
But, if your baby is still in the transverse position when you approach your due date or by the time labour begins, you'll most likely be advised to have a caesarean section.
Video: My baby is breech. What help will I get?
In this video, a midwife describes what a breech position is and what can be done if your baby is breech.
Media review due: 7 February 2023