If your baby is breech

If, close to birth, your baby is lying bottom or feet first instead of head down, this is called a breech position. It's very common earlier in pregnancy, and most babies turn on their own before birth. If yours doesn't, you still have options.

How common is breech?

Most babies turn head down by 36–37 weeks; at term, only 3–4 in every 100 babies are breech. Often there's no particular reason. Still, it's more common in a first pregnancy, when the placenta is low, when there's too much or too little amniotic fluid, in a multiple pregnancy, or when the uterus has an unusual shape. In the final weeks, your doctor checks your baby's position with an exam and ultrasound. There's no scientific evidence that lying or sitting in particular positions helps the baby turn.

Turning the baby from the outside

If your baby is still breech at 36 weeks, your doctor may suggest an external cephalic version (ECV). In this procedure, the doctor presses on your belly to try to turn the baby head down. It's usually done around 36–37 weeks, in a hospital where an emergency cesarean can be performed if needed. An ultrasound is done before and after, and your pulse, blood pressure and your baby's heartbeat are checked. An injection that relaxes the uterus can improve the chance of success. The procedure can be uncomfortable and sometimes painful; it's stopped if the pain becomes severe. Most women go home the same day.

• ECV works for about 1 in 2 women; the chance is higher if you've had a vaginal birth before.
• Fewer than 5 in 100 babies who are turned successfully go back to breech. If the first attempt doesn't work, it can be tried again on another day.
• Immediately after the procedure, there's about a 1 in 200 chance of needing an emergency cesarean because of bleeding from the placenta or changes in the baby's heartbeat.
• If your blood type is Rh negative, you'll need an anti-D injection and a blood test afterward.
• ECV isn't done if you've had recent bleeding, your water has broken, your baby's heart monitoring shows a problem, you're expecting twins, or you already need a cesarean for another reason.

After the procedure, call the hospital right away if you have bleeding, belly pain or contractions, or if your baby's movements change.

If your baby stays breech

If ECV isn't tried or doesn't work, two options are discussed: a planned cesarean or a planned vaginal breech birth. A planned cesarean is safer for the baby, but it raises some risks in future pregnancies, such as problems with the placenta. A vaginal breech birth carries less risk for the mother, but it needs an experienced team and a hospital that can do an emergency cesarean; about 4 in 10 women who plan one end up needing a cesarean. Vaginal birth is usually not recommended if the baby is coming feet first, is much larger or smaller than average, if the placenta is low, or if you have preeclampsia. Which options are possible also depends on what your hospital can offer. Right before a planned cesarean, an ultrasound checks again whether the baby is still breech.

“Breech isn't an illness, it's a position; what matters is choosing the safest way for you and your baby together.”

If labor starts early

If labor starts before your planned cesarean, go to the hospital; the team will examine you and decide how to proceed. If the baby is about to be born, a vaginal breech birth may be safer. If your water breaks, you have bleeding, your baby moves less, or regular contractions start before 37 weeks, go to the hospital without waiting.

Breech babies are considered at higher risk for developmental dysplasia of the hip. In Türkiye's screening program, babies in the risk group have a hip ultrasound at 3–4 weeks of age; don't miss this appointment. This applies in Türkiye; if you live elsewhere, follow your doctor's advice and your own country's health program.