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Labor & postpartum Call your provider

Breech Presentation

Also known as Breech baby, Breech position. Assessed near term; decisions are made around 37 weeks.

A breech baby sits bottom-first or feet-first instead of head-first as the due date nears. It is common earlier in pregnancy and usually sorts itself out, most babies turn head-down on their own before term, but about 3 to 4 in 100 are still breech at the end. If yours is one, it mostly affects how you will deliver, and you have options. Your provider can try to gently turn the baby with a procedure called an ECV; if that does not work or is not suitable, a planned cesarean is the usual, safest way to deliver a breech baby.

Know the warning signs When to call a provider
How common
3% to 4% at term
Much more common earlier: about 25% of babies are breech before 28 weeks, but most turn.
When
Decided around 37 weeks
Position is not settled until late; the plan is made in the final weeks.
Urgency
Plan the delivery
Not an emergency, but if your water breaks or labor starts while breech, go in promptly.
Outlook
Very manageable
Turning succeeds often, and a planned cesarean delivers a breech baby safely.

Understanding it

What is breech presentation?

Most babies settle head-down by the end of pregnancy, ready to be born head-first. A breech baby lies the other way, bottom or feet toward the birth canal. It is described by how the legs sit: frank breech (bottom first, legs straight up toward the face), complete breech (bottom first, knees bent, sitting cross-legged), or footling breech (one or both feet pointing down first).

Being breech is common earlier and usually temporary. At 28 weeks about a quarter of babies are breech, but as the due date nears most turn head-down; by term only about 3 to 4 in 100 remain. Because the position can still change late, a firm diagnosis usually waits until around 37 weeks, confirmed by feeling your abdomen and, if needed, an ultrasound.

Usually there is no clear reason a baby stays breech, but some things make it likelier: prematurity (less time to turn), twins or more, too much or too little amniotic fluid, a differently shaped uterus or fibroids, and a low-lying placenta. Being breech itself usually causes no symptoms, though some feel the hard lump of the head up near the ribs and kicks low in the pelvis.

The practical question is how you will deliver, and around 37 weeks you generally have three options. Your provider can try an external cephalic version, or ECV, gently pressing on your abdomen to turn the baby head-down, which succeeds well over half the time. If the baby stays breech, a planned cesarean is the standard, safest route for most, though a vaginal breech birth is possible in selected situations with an experienced team. Your provider will help you choose.

Symptoms

What are the symptoms?

Breech position usually causes no symptoms and is found when your provider feels your abdomen or does an ultrasound. Any signs are subtle positional cues.

Early signs

  • Usually no symptoms; found on exam or ultrasound
  • Feeling a hard, round lump (the baby's head) up near your ribs
  • Feeling kicks low in the pelvis rather than under the ribs
  • Often no noticeable difference at all

Emergency signs — call 911

  • Your water breaking while the baby is breech: go in promptly, as there is a higher risk of the cord slipping down (cord prolapse)
  • Feeling something in the vagina, especially after your water breaks, which is an emergency
  • Regular contractions or the start of labor while known to be breech
  • Vaginal bleeding or severe pelvic cramping

Why it matters

Risks to you and baby

Cord prolapse if labor starts

If the water breaks or labor begins with the baby breech, the cord can slip down ahead of the baby, an emergency, especially with a footling breech. That is why a breech baby whose water breaks should be evaluated immediately.

A more complicated vaginal birth

In a vaginal breech birth, the body delivers before the head, the largest part, so the head can become trapped or the cord compressed. This is the main reason a planned cesarean is usually recommended for a breech baby.

The interventions themselves

The ways of managing breech, an ECV to turn the baby or a cesarean to deliver, each carry small risks. ECV complications are uncommon and cesarean is common surgery, but both are weighed against the risks of a vaginal breech birth.

Usually a healthy baby

Being breech does not mean anything is wrong, and most breech babies are perfectly healthy. It is mainly a question of the safest way to deliver, not a threat to the baby in the womb.

How it's found

How is it diagnosed?

Breech position is suspected when your provider feels your abdomen and confirmed with ultrasound. Because the baby can still turn, the diagnosis is usually made around 37 weeks.

Abdominal exam (Leopold maneuvers)

Feeling the head, back, and bottom through your abdomen, your provider can often tell which way the baby lies and suspect a breech.

Ultrasound

Confirms the baby's position and type of breech, checks the fluid and placenta, and helps decide whether an ECV is suitable.

Timing the assessment

Because babies can turn late, a firm diagnosis is generally made around 37 weeks, when the position is much less likely to change.

Position is checked in the final weeks of pregnancy, with an official diagnosis usually around 37 weeks.

Treatment

How is it managed?

Around 37 weeks, there are generally three options: try to turn the baby with an ECV, plan a cesarean, or, in selected cases, a vaginal breech birth with an experienced team.

Treatment paths

The first option for suitable candidates is an external cephalic version (ECV), steady pressure on your abdomen to coax the baby head-down. Done after 37 weeks, it succeeds in roughly 58% of attempts, and when it works most people go on to a vaginal birth. If the baby stays breech, a planned cesarean is the standard, safest route; a vaginal breech birth is possible in specific situations with an experienced provider, but not the usual approach.

Monitoring

During an ECV, the baby's heart rate is monitored, and the procedure is done where an emergency cesarean is available in the rare event it is needed.

Can it recur?

Having had a breech baby raises the chance of another, about 10% in the next pregnancy and higher after two. Your provider will check the baby's position in future pregnancies and can offer an ECV again if needed.

What you can do

Can it be prevented?

  • Consider an ECV

    If you are a candidate, an ECV is the one proven way to turn a breech baby head-down, and success often means avoiding a cesarean. Ask whether it is suitable for you.

  • Have the baby's position checked

    Having the position assessed in the final weeks means a breech is caught in time to plan, whether that is an ECV or a scheduled cesarean.

  • Know what to do if labor starts

    If you are breech and your water breaks or labor begins, go in promptly, because of the higher risk of cord prolapse. Knowing this in advance keeps you and your baby safe.

  • Be cautious with unproven methods

    Home positioning techniques, moxibustion, and chiropractic approaches are often discussed, but there is little evidence they turn a breech baby. They are generally harmless; just do not rely on them in place of the medical options.

Who is more at risk

Risk factors

Prematurity
A premature baby has had less time to turn head-down, so breech is much more common the earlier the birth.
About 25% of babies are breech before 28 weeks, versus 3% to 4% at term.
Twins or more
With more than one baby, there is less room and more variation in position, making breech more likely.
Too much or too little fluid
Excess amniotic fluid gives the baby room to stay in an unusual position, while too little can restrict turning.
Uterine or placental factors
A differently shaped uterus, fibroids, or a low-lying placenta (placenta previa) can leave the baby breech.
A previous breech baby
Having had a breech baby before makes another more likely.
About 10% recurrence in the next pregnancy, higher after two.

Do not wait

When to call your provider or 911

  • Go in promptly if your water breaks while your baby is breech, because of the higher risk of cord prolapse.
  • Call 911 or go in immediately if you feel something in your vagina, especially after your water breaks.
  • Contact your provider if labor starts or you have regular contractions while known to be breech.
  • Seek care for vaginal bleeding or severe pelvic cramping.
  • Ask your provider whether an ECV is an option for you, and when it would be done.

Talking to your team

Questions to ask your provider

  • What type of breech is my baby in?
  • Am I a candidate for an ECV, and what are its chances and risks for me?
  • If the baby stays breech, when would you schedule a cesarean?
  • Is a vaginal breech birth an option in my situation?
  • What should I do if my water breaks or labor starts before my scheduled date?
  • Could my baby still turn on its own at this point?

Keep reading

More on breech presentation

All pregnancy guides articles

Good to Know

Breech Presentation FAQs

Common questions about breech presentation, answered.

Will my breech baby turn on its own?

Very possibly, especially if you are not yet at term. About a quarter of babies are breech before 28 weeks, and most turn head-down before delivery; by term only 3 to 4 in 100 remain. Because babies can still turn late, the delivery decision usually waits until around 37 weeks.

What is an ECV?

An external cephalic version: your provider presses firmly on your abdomen to gently turn the baby from breech to head-down. It is done after 37 weeks, with the baby's heart rate monitored, and succeeds in roughly 58% of attempts. When it works, most people go on to a vaginal birth. Complications are uncommon.

Do I have to have a cesarean?

If your baby stays breech, a planned cesarean is the standard, safest option for most, but not your only path. Many first try an ECV, which can avoid one, and a vaginal breech birth is possible in selected situations with an experienced team.

Why is a vaginal breech birth riskier?

In a head-first birth, the head, the largest part, comes first and opens the way, so the body follows easily. In a breech birth the body delivers first and the head comes last, so it can occasionally become trapped, or the cord compressed. Because of that, a planned cesarean is usually recommended, though a vaginal breech birth can be done safely in specific circumstances with an experienced provider.

Do the exercises and tricks to turn a baby work?

There is little evidence that home positioning, moxibustion, or chiropractic methods turn a breech baby, though they are commonly tried and generally harmless. The one proven way to change the position is an ECV, so do not rely on the alternatives in its place.

What if my water breaks while my baby is breech?

Go in promptly. With a breech baby, a broken water raises the risk that the cord slips down ahead of the baby, called cord prolapse, an emergency, particularly with a footling breech.

Is being breech a sign something is wrong with my baby?

Usually not. Most breech babies are perfectly healthy, and the position is often just a baby that has not turned, not a threat to the baby in the womb. Your provider may do an ultrasound to check the position and rule out contributing factors, which is routine.

Will my next baby be breech too?

The chance is somewhat higher after a breech baby, about 10% next pregnancy versus the roughly 3 to 4% baseline, and higher after two. Your provider will check the position in future pregnancies, and if a baby is breech again, an ECV can be offered just as before.

Medically Reviewed · Updated

Reviewed by Dr. Grace Lin, MD, FACOG · OB-GYN

Obstetrician-gynecologist focused on reproductive and sexual health for women: pregnancy, BV, yeast, trichomoniasis and HPV/cervical screening. Our editorial guidelines →

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