Breech presentation after 36 weeks of pregnancy

Information for women, birthing people and their families

What is a breech presentation?

During pregnancy babies are very active, twisting and turning, and changing position often. Breech presentation is common in early pregnancy. By 37 weeks most babies have usually settled into the head down position. If your baby is lying bottom, feet, or knees first in your uterus (womb) instead of head down, you will be told that your baby is breech.

Baby in uterus in a bottom down position
Baby in breech presentation

In 3 to 4 in every 100 pregnancies the baby remains in the breech position after 36 weeks. It is unusual for the baby to turn head down after this time.

If your baby is breech after 37 weeks, there are three options that should be considered.

  • External cephalic version (ECV) is where a skilled doctor turns your baby.

  • A vaginal breech birth.

  • A planned caesarean birth.

Decision-making needs balancing your wishes and expectations against the possible risks to you and your baby.

Why is my baby breech?

It may just be a matter of chance that your baby has not turned into the head down position. There are some reasons that make it more difficult for your baby to turn during pregnancy. These include if:

What are my options if my baby is still breech at 36 weeks?

If your baby is still breech at 36 weeks of pregnancy, your doctor or midwife will start discussing the following options with you.

You do not have to make your decision at this time. There is still a small chance your baby may turn into the head down position after 37 weeks on its own. You can ask to speak with our consultant midwife if you have questions.

What is external cephalic version (ECV)?

An ECV is when a doctor tries to turn your baby from a bottom down into the head down position.

An ECV can be uncomfortable because of the pressure on your tummy, but it should not be painful. The procedure will only last for a few minutes. It will be carried out on the labour ward, and you will normally be able to go home on the same day.

When will I have an ECV?

An ECV is usually performed after 36 weeks of pregnancy. However, it can be performed up until the start of labour.

Is an ECV safe for me and my baby?

An ECV is generally safe. Overall, there does not appear to be an increased risk to your baby from having an ECV. When you do go into labour, your chances of needing an emergency caesarean birth, or forceps or kiwi / ventouse (suction cup) birth are slightly higher than if your baby had always been in a head down position.

Immediately after the ECV, there is a 1 in 200 chance you will need an emergency caesarean birth. This could be due to bleeding from the placenta and / or changes in your baby’s heartbeat.

We do not attempt ECV if:

You can still safely have an ECV if you have already had one caesarean birth. Depending on your individual situation an ECV may be done right up until you give birth.

Will it succeed?

ECV is successful for about half of all women and birthing people (1 in 2 pregnancies). There is a small chance (5 in 100 pregnancies), that your baby will turn back to breech after a successful ECV. It is more likely to work if you have had a vaginal birth before. Your doctor will give you their opinion of the chances of your baby turning based on your individual circumstances. If your baby does not turn, your doctor will discuss your options for birth.

If your baby is successfully turned head down, you are more likely to have a vaginal birth. A successful ECV will reduce your chances of needing a caesarean birth and its associated risks.

Is there anything else I can do to help my baby turn?

There is some evidence that the use of acupuncture or moxibustion (burning a Chinese herb called mugwort) may help to turn your baby head down. These options are not offered by our Trust. If you decide to use these you should only do so when consulting a registered healthcare practitioner for advice and treatment.

Some healthcare professionals advise the use of optimal fetal positioning. This involves you getting into certain positions to increase the space in your pelvis. In theory this will give the baby space to move around. You can discuss this further with the consultant midwife. There is no scientific evidence to support that lying or sitting in a particular position can help your baby turn.

You may read about other therapies such as complementary therapies or chiropractic techniques. These are not offered at our Trust, and you are advised to take specialist advice before using any of these methods.

What will happen during an ECV?

You will be seen on the labour ward at the William Harvey Hospital (Ashford) or Queen Elizabeth Queen Mother (QEQM) Hospital (Margate).

If the ECV is unsuccessful on the first attempt, the doctor may discuss the option to try again on another day. This is only if you would like them to. Your doctor will tell you if they feel it is unsuitable.

After your ECV, if you have any of the following, contact Maternity Triage. Their number is at the bottom of this leaflet.

What should I expect afterwards?

You might feel slight discomfort after the procedure. If it is successful, however, you may feel more comfortable as your baby’s head will no longer be under your rib cage.

In the unlikely event of any vaginal bleeding, more severe pain, or a reduction in your baby’s movements, contact Maternity Triage. Their telephone number is at the end of this leaflet.

What if I am Rhesus negative?

If your blood type is Rhesus negative, and your baby is predicted to be rhesus positive, or you did not have cffDNA testing you should have already been offered an anti-D injection during your pregnancy and be aware of why this is needed. More information is available in The Rhesus factor and anti-D leaflet.

During the ECV there is a possibility that some of your baby’s blood cells could mix with yours. For this reason, it is recommended that you have an extra anti-D injection following the ECV, whether the ECV was successful or not.

What are my options for birth if my baby remains breech or I decide not to have an ECV?

If an ECV is unsuccessful or not performed, you will need to discuss your birth options with your doctor or midwife. Depending on your situation, your choices are:

There are benefits and risks associated with both a vaginal breech birth and a caesarean birth. These should be discussed with you so that you can choose what is best for you and your baby. Both options are discussed below.

What happens after the birth?

Most breech babies do not have any concerns following birth. Due to their position in your womb, breech babies do have an increased risk of hip problems. Your baby may keep their legs in the air for the first few days, which is normal and will settle. Your baby will have their hips checked during your stay in the hospital. Your baby will also be offered a follow-up hip ultrasound scan, this appointment is usually sent to you within 6 weeks. You can always contact Maternity Triage should you have any concerns.

What if I have any questions?

If you are asked to make a choice, you may have lots of questions that you want to ask. You may also want to talk over your options with your family or friends. It can help to write a list of the questions you want answered and take it to your appointment.  

Consider ‘Ask 3 Questions’

To begin with, try to make sure you get the answers to 3 key questions, if you are asked to make a choice about your healthcare.

Who can I contact if I have concerns?

Further information