A breech presentation means your baby’s bottom, feet, or both are positioned to come out first during birth, instead of the head. This happens in about 3 to 4% of full-term pregnancies. If your baby is breech near your due date, your provider will talk with you about options, which may include external cephalic version (ECV) to try to turn the baby, a planned cesarean delivery, or in some cases a planned vaginal breech birth.
Seek medical care right away if you notice any of the following after your water breaks or during labor:
- You feel something in your vagina, or you can see or feel the umbilical cord — this can be a sign of cord prolapse, which cuts off blood flow to the baby and needs emergency treatment
- A sudden change in your baby’s movement
- Vaginal bleeding
- Contractions or your water breaking before 37 weeks
Call your provider or go to the nearest emergency department immediately if any of these happen. The information below is general education. It does not replace guidance from your own obstetric provider, who knows your specific pregnancy.
Why Do Babies Present Breech?
Most babies naturally turn head-down by the last weeks of pregnancy. It is not always known why some babies stay breech. Factors that make breech presentation more likely include:
- You have been pregnant before
- There is more than one baby in the uterus (twins or more)
- There is too much or too little amniotic fluid
- The uterus has an abnormal shape or growths, such as fibroids
- The placenta covers all or part of the cervix (placenta previa)
- The baby is preterm
There are also different types of breech position. In a complete breech, the baby’s bottom is down with knees bent. In a frank breech, the legs are stretched up with feet near the head. In a footling breech, one or both feet are down near the cervix.
How Is Breech Position Diagnosed?
Your provider can often tell how your baby is positioned by placing their hands on specific points of your abdomen to feel where the head, back, and buttocks are. An ultrasound can confirm the position and is often used to check this in the last weeks of pregnancy.
What Is External Cephalic Version (ECV)?
ECV is a procedure where your provider places their hands on your abdomen and gently lifts and turns the baby from the outside, trying to move it into a head-down position. Sometimes a second provider helps.
When Is ECV Done?
ECV is usually not attempted until you are at least 36 weeks pregnant. Trying earlier isn’t useful because the baby may still turn on their own. As your due date gets closer, there is less room in the uterus for the baby to move, which can make the procedure harder to do.
How Successful Is ECV?
More than half of ECV attempts succeed. Some babies turn back to breech afterward, and ECV can sometimes be tried again. Your provider will assess your health and pregnancy to see if ECV is a safe option for you — certain conditions may lower the chance of success or raise the risk, and in those cases your provider may not recommend it.
What Are the Risks of ECV?
Risks are low when a skilled provider performs the procedure. In rare cases, ECV can lead to an emergency cesarean delivery, such as if part of the placenta separates from the uterine wall or if the baby’s heart rate drops too low, which can happen if the umbilical cord becomes compressed. Your care team monitors the baby’s heart rate before and after the procedure.
Delivery Options If Your Baby Stays Breech
If ECV isn’t successful, isn’t recommended, or isn’t something you want to try, you and your provider will discuss delivery options. This decision depends on your health, your baby’s position, your hospital’s protocols, and the experience of your care team.
Planned Cesarean Delivery
- Most breech babies today are born by planned cesarean delivery
- It is the most common approach because fewer providers are trained and experienced in vaginal breech delivery
- As with any major surgery, possible complications include infection, bleeding, and problems related to anesthesia
- Cesarean delivery can also raise the risk of complications in future pregnancies, such as uterine rupture or placenta problems, and this risk increases with each additional cesarean
Planned Vaginal Breech Delivery
- Some hospitals offer planned vaginal breech delivery under specific protocols for eligibility and labor management
- The American College of Obstetricians and Gynecologists (ACOG) states this may be reasonable in the right hospital setting, but requires detailed informed consent that documents the risks involved
- Research has found that the risk of serious harm to the baby, including mortality, may be higher with planned vaginal breech birth than with planned cesarean delivery
- There is also a higher chance of umbilical cord prolapse, which can cut off blood flow and oxygen to the baby
- Because fewer providers today have the training and hands-on experience for vaginal breech delivery, this option may not be available at every hospital
Questions to Ask Your Provider
- Is ECV a safe option for me, and when would we schedule it?
- What is my hospital’s protocol for breech delivery if ECV isn’t successful?
- Does my care team have experience with vaginal breech delivery, or will I be referred elsewhere?
- What specific risks apply to my pregnancy, given my health history and my baby’s type of breech position?
- What would informed consent for a planned vaginal breech birth involve at this hospital?
Situations That Call for Extra Caution
Certain situations are linked with higher risk or may rule out some options altogether. These include a footling breech position, placenta previa, carrying more than one baby, and a pregnancy that is preterm. If any of these apply to you, your provider will walk you through how they affect your specific options.
Evidence Limits
Vaginal breech delivery has become far less common, which means fewer providers are trained in it today. This makes it harder to study and harder to access in many areas, even in hospitals that permit it under protocol. Guidance in this area continues to be reviewed as more evidence becomes available, so what’s offered can vary by hospital, region, and your provider’s individual experience. This article reflects current published guidance and does not replace a conversation with your own obstetric provider about your specific situation.
Frequently Asked Questions
How common is breech presentation?
It happens in about 3 to 4% of full-term pregnancies. Most babies who are breech earlier in pregnancy turn head-down on their own before delivery.
Can I still try for a vaginal birth if my baby is breech?
Some hospitals allow planned vaginal breech delivery under specific protocols, but it requires informed consent about added risks and depends on your provider’s experience and your hospital’s resources. Most breech babies today are delivered by planned cesarean. Talk with your provider about what’s available and appropriate for your pregnancy.
Is ECV painful, and is it safe for me and my baby?
ECV can feel uncomfortable, and your provider can talk with you about what to expect and how they monitor you and your baby during the procedure. Risks are low when it’s performed by a skilled provider, though rare complications can require an emergency cesarean.
What if my baby turns breech again after ECV?
It can happen. If your baby moves back into a breech position, your provider may try ECV again or move forward with discussing your delivery options.
Educational Disclaimer
This article is for general educational purposes only. It is not medical advice and does not diagnose, treat, or replace care from a qualified obstetric provider. Always talk with your own doctor or midwife about your specific pregnancy, your baby’s position, and which delivery options are appropriate and available to you. See our Medical Disclaimer for more information about how we approach health content. You can also learn more about our sourcing standards in our Editorial Policy, or read more About Reproductive Health Center.