Babies tumble and turn a lot in the womb, but most flip head down by 36 weeks and stay that way, the optimal position for delivery, until they are born.
Don’t get concerned earlier in your pregnancy if your baby isn’t yet head down. By 24 weeks’ gestation, about half of all babies are still in what is called a breech position, which means their bottom and sometimes their feet are closest to the birth canal instead of their head. By 37 weeks, only 3% to 4% of babies are breech.
These are the three different types of breech positions (illustration from Medline):
In the complete breech position, the baby is sitting cross-legged.
In the frank breech position, the bottom is down but the legs are pointed up, with the feet by the head.
The incomplete breech position is sort of a cross between the other two positions, with the bottom down and one knee bent, foot near the bottom, while the other leg is straight up, foot near the head.
Your doctor or midwife might be able to tell if your baby is breech by feeling your abdomen. Ultrasound or a pelvic exam might be used to confirm that he or she is right. Most breech babies are normal except for their position.
Several factors increase the chances of your baby being breech, according to the American College of Obstetricians and Gynecologists (ACOG):
- You’ve been pregnant before.
- You’re carrying twins or more.
- There’s too much or too little amniotic fluid in your uterus.
- Your uterus is not shaped normally or contains fibroids.
- The placenta covers all or part of the opening to your uterus.
- Your baby is preterm.
If your baby is still breech late in your pregnancy, your prenatal care provider could try to turn him or her, a technique called external cephalic version, or ECV.
(Not all women are candidates for ECV, and the reasons why you shouldn’t attempt it overlap the reasons that increase your baby’s chance of being breech: You’re carrying more than one baby, there are concerns about your baby’s health, you have certain abnormalities in your reproductive system, or the placenta is in the wrong place or has become detached from the uterine wall.)
To perform ECV, the care provider places his or her hands on your abdomen and applies firm pressure to get the baby to roll into a head-down position. Sometimes it takes two people perform ECV, one on each side of your abdomen. Ultrasound might be used to guide ECV, and the baby’s heart rate will be checked with fetal monitoring before and after the procedure.
More than half of all ECV attempts succeed, according to ACOG. Unfortunately, some babies still flip back into a breech position at the last minute. You could try ECV again, but the further along your pregnancy, the more difficult it is to turn the baby, because there is less room to move in your uterus.
If your baby is breech and you’re into the 39th week of your pregnancy, you’ll likely have to schedule a c-section delivery. That’s because relatively few doctors in practice today know how to deliver a breech baby vaginally, which can be a little tricky. Possible complications of a vaginal delivery of a breech baby include the head or shoulders getting wedged against the bones of the mom’s pelvis or the umbilical cord slipping into the vagina before the baby is delivered.
Still, back in 1970, only one in six breech babies was delivered by c-section, which, like any major surgery, has its own set of risks. But today, in an era when c-sections represent a much bigger proportion of total births, virtually all breech babies are delivered that way. If your baby is breech and you’d like to try a vaginal delivery, you need to check with your prenatal care provider to see if he or she has enough experience with such births to feel comfortable attending one.