Call your provider right away if your water breaks and your baby is breech
If you know your baby is breech and your water breaks, go to the hospital right away. When a breech baby’s water breaks, the umbilical cord can slip down before the baby does, which can be dangerous. Also call your provider right away for heavy bleeding, severe belly pain, contractions before 37 weeks, or if you notice your baby moving much less than usual.
What does breech mean, and how common is it?
Breech means your baby’s bottom or feet are pointed toward the birth canal instead of the head. It happens in about 3% to 4% of full-term, single-baby pregnancies. Most babies who are breech earlier in pregnancy turn head-down on their own before labor starts.
There are a few types of breech position:
- Frank breech: The baby’s legs are stretched up near the head, with the bottom leading.
- Complete breech: The baby is bottom-first with both knees bent.
- Footling breech: One or both feet are lowered toward the cervix.
Why do some babies stay breech?
Doctors don’t always know why a baby stays breech. Some things that make it more likely include:
- Having been pregnant before
- Carrying more than one baby
- Too much or too little amniotic fluid
- An unusual uterus shape, or fibroids
- Placenta previa (the placenta covers part or all of the cervix)
- Going into labor early, before the baby has had time to turn
Your provider checks your baby’s position at prenatal visits in the last weeks of pregnancy, usually by feeling your abdomen. If the position isn’t clear, an ultrasound confirms it.
How is a breech baby turned? External cephalic version explained
External cephalic version, or ECV, is a procedure where your provider uses firm hand pressure on the outside of your belly to try to turn the baby into a head-down position. You are not sedated, though you may be given a medicine to relax your uterus. During the procedure, you can expect:
- An ultrasound to check the baby’s and placenta’s position first
- Firm pushing on your abdomen to guide the turn
- Continuous monitoring of your baby’s heartbeat
ECV is usually tried around 36 to 37 weeks. At this point the baby is a little smaller, there tends to be more room to turn, and the baby is far enough along that an early delivery would be safer if a problem came up during the procedure. ECV cannot be done once you’re in active labor.
The American College of Obstetricians and Gynecologists (ACOG) says people who are near term with a breech baby, and who have no reason it would be unsafe, should be offered ECV as an option before deciding on delivery. ACOG also recommends that ECV only be attempted at a hospital where an emergency cesarean is readily available, in case it’s needed.
Does ECV work, and is it safe?
Research reviewed by ACOG has found that ECV lowers the chance of needing a cesarean, with success rates that vary by pregnancy and provider experience. Anesthesia given during the procedure, such as an epidural, has been shown in research to improve success rates compared to no anesthesia. Ask your provider what success rate they typically see and what would make ECV a poor fit for your specific pregnancy.
ECV is generally considered low-risk when performed by an experienced provider in a hospital setting. In rare cases, it can lead to an emergency cesarean if:
- Part of the placenta separates from the uterine wall
- The baby’s heartbeat drops too low, which can happen if the umbilical cord gets pulled tight
Some babies turn back to breech after a successful ECV. Your provider can tell you how likely that is in your situation.
If ECV doesn’t work: your delivery options
If your baby stays breech, you and your provider will talk through delivery options. The two main paths are a planned cesarean or, in some cases, a planned vaginal breech delivery.
- Planned cesarean: Surgical delivery, typically scheduled for no earlier than 39 weeks. This is the most common path for breech babies in the U.S. today. An ultrasound confirms your baby’s position again just before surgery.
- Planned vaginal breech delivery: Labor and vaginal birth with the baby breech, managed under a hospital-specific protocol. This is only offered at some hospitals with providers experienced in breech vaginal birth, and it requires a detailed informed consent conversation about the risks involved.
ACOG’s guidance notes that planned vaginal breech delivery may be reasonable under a hospital’s specific eligibility and labor-management protocols, but that the informed consent process should cover the possibility of higher risk to the baby compared with a planned cesarean. Because of this, provider experience and hospital resources play a large role in whether vaginal breech delivery is even offered to you. This is a decision to make with your own care team, based on your specific pregnancy and their protocols — this article does not tell you which option is right for you.
Extra caution: when vaginal breech delivery is less likely to be offered
Most U.S. hospitals do not currently offer planned vaginal breech delivery, largely because fewer providers are trained in it. Your own provider can tell you whether it’s available at your hospital and whether your specific pregnancy would qualify under their protocol.
Quick checklist: questions to bring to your appointment
- Is my baby breech, and which type of breech is it?
- Am I a candidate for ECV, and when would you schedule it?
- What is your personal ECV success rate, and would I have the option of anesthesia during the procedure?
- If ECV doesn’t work or isn’t an option for me, is planned vaginal breech delivery available at this hospital?
- What would make you recommend a cesarean over a vaginal breech attempt in my case?
- What signs during pregnancy or labor mean I should go to the hospital right away?
Evidence limits
Research on ECV success rates and on the safety of vaginal breech delivery varies between studies, and outcomes depend heavily on provider experience and hospital protocols. This article summarizes general guidance from ACOG and MedlinePlus. It is not a substitute for your own provider’s evaluation of your pregnancy, your baby’s specific breech type, and your hospital’s available protocols.
Frequently Asked Questions
At what week is a baby usually checked for breech position?
Providers check fetal position at regular prenatal visits in the last weeks of pregnancy, often confirming with ultrasound if the position feels unclear on exam.
Can ECV be done during labor?
No. External cephalic version cannot be performed once you are in active labor.
Is a breech baby always delivered by cesarean?
Not always, but most breech babies in the U.S. today are delivered by planned cesarean. Planned vaginal breech delivery is only offered at some hospitals, under specific protocols, when a provider experienced in the technique is available.
What should I do if my water breaks and I know my baby is breech?
Go to the hospital right away. With a breech baby, there’s a higher chance the umbilical cord can slip down ahead of the baby once your water breaks, which needs urgent medical attention.
Educational Disclaimer
This article is for general education only. It does not diagnose any condition, recommend a specific treatment, or replace advice from your own obstetric care provider. Breech presentation and delivery decisions depend on your individual pregnancy, and only a qualified provider who has examined you can advise on the right path for you. Learn more about how we source and review our content in our Editorial Policy, read our full Medical Disclaimer, or find out more About Reproductive Health Center.