When Your Baby is Breech at Full Term

What is breech position?

Most babies will move their head down in the pelvis by 36 weeks, a position known medically as vertex. Sometimes, babies may position themselves differently based on how they best fit in the pelvis, resulting in a head-up or butt-down position called breech. Breech presentation occurs in approximately 3-4% of full term pregnancies and when breech presentation persists, most babies in the US are born by cesarean section.

If your baby is breech, there are 3 main pathways for you to consider with your family and our Care Team.

1) Expectant management

Expectant management is the lowest intervention path and a great option if you want to attempt position changes and other supportive measures to encourage fetal position before or instead of an External Cephalic Version (ECV) procedure. This is also an option if you just need some more time to process this diagnosis before deciding on next steps.

While undergoing expectant management, you may want to try some natural methods for turning your baby such as: 

• Moxibustion treatment, provided by a a Licensed Acupuncturist
• Chiropractic treatments, with practitioners trained in the “Webster Technique”
• Physical Positions as outlined by Spinning Babies

You may want to consider that it may be harder to have a successful ECV the longer you delay the procedure, as larger babies and increasing gestational age negatively impact the success rates of ECV. On average, only about 8% of babies breech after 36 weeks turn (of 100 breech babies, only 8 will turn after 36 weeks). This means that 92 out of 100 babies that are not head down at 36 weeks do not turn on their own.  If expectation management is not successful, and the baby is in the persistent breech position at full term, this would lead to a planned cesarean birth at Oula (or in the event you went into labor, an unscheduled urgent cesarean birth.

Learn more about Breech Version and Spinning Babies

2) External Cephalic Version (ECV) 

What is an External Cephalic Version (ECV)?
External Cephalic Version, or ECV, is an in-hospital procedure done by a licensed clinician in either the triage area or in the operating room. In this procedure, the provider attempts to manually rotate the baby into a head down position (vertex) by applying pressure to your abdomen. This is a great option if you want to maximize the likelihood of vertex position with option for vaginal birth at full term. There are some things you may want to consider about ECV:

Benefits of the procedure: increased chance that the baby will turn to vertex and increased chance of vaginal delivery

Risks: The most common risk during the procedure is deceleration of the fetal heart rate (FHR) which occurs about 60% of the time. Majority of FHR decelerations resolve with discontinuation of procedure. During the procedure, the fetal heart rate will be checked every 2 minutes to evaluate and monitored for 1 hour post-procedure to ensure stability. In the rare event that the heart rate does not recover and return to normal baseline, a cesarean birth would be recommended at that time.

Rare risks (occurring in fewer than 1 in 100 procedures):

• placental abruption
• umbilical cord prolapse
• rupture of membranes
• emergent cesarean birth

Learn more about the ECV Procedure

3) Scheduling a Cesarean Birth

If you decline or have an unsuccessful ECV, or your baby persists to be in a breech position regardless of your efforts to move positions, your baby will be born by a scheduled cesarean birth. Our care team will be in touch with you to schedule this procedure, likely around 39 weeks gestational age, and provide anticipatory guidance about how to prepare for this birth experience.