Breech Position and Breech Birth

Treatment Overview

By the 36th week of most pregnancies, the fetus naturally turns head-down (vertex). In this position, the fetus is ready for a head-first delivery through the birth canal. If your fetus is bottom-down (breech position) as your due date approaches, your doctor will most likely recommend a scheduled cesarean delivery (C-section). But if your fetus can be turned before labor starts, you can try for a vaginal labor and delivery.

See pictures of different breech positions.

Turning a breech fetus

Trying a version procedure to turn your fetus increases your chances of being able to deliver vaginally.^{5, 1} You may also try at-home postural management. Even though it is not a well studied or proven method, it is considered safe and has the potential to be effective.⁶

• External cephalic version (or version) is done in a medical setting with constant fetal heart rate monitoring. You will have an ultrasound before and after the version attempt. Your doctor may first give you a medicine to relax your uterine muscles. To turn the fetus, your doctor will press on specific areas of your abdomen. Version can be repeated several times if the first attempts to turn the fetus are unsuccessful.
• Postural management is something you do at home. You carefully position yourself with your hips raised above your head several times a day for several weeks.

If a version is successful, your fetus's position will be checked regularly until labor begins. If your fetus stays head-down, a planned cesarean is not needed, and you can expect to go through labor. You may deliver vaginally or by cesarean, depending on how the birthing process goes. In one study, women who had given birth before had a lower cesarean rate after a successful version procedure compared to women delivering for the first time.²

Delivering a breech infant

Most breech infants are delivered by planned cesarean section (C-section) to prevent harm to the infant. If your fetus remains in or returns to breech position near your due date, your doctor will likely schedule a cesarean. For more information, see the topic Cesarean Section.

Sometimes a cesarean breech birth is neither possible nor recommended. When a breech labor progresses too quickly, a vaginal birth may be the only delivery option. During a twin birth, a second twin who is breech may best be delivered vaginally.⁴ Risks are lowest for the newborn when a doctor has a lot of experience doing this kind of delivery.⁷

A fetus in a breech position can be delivered by:

• A perinatologist.
• A family medicine doctor with training in cesarean deliveries.
• An obstetrician.

If you have a certified nurse-midwife or certified professional midwife for obstetric care, she will refer you to a doctor for a cesarean or a vaginal breech delivery.

Your pediatrician or family medicine doctor may be present during the delivery in case your newborn needs care after birth.

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Author:	Bets Davis, MFA	Last Updated: April 28, 2008
Medical Review:	Joy Melnikow, MD, MPH - Family Medicine William Gilbert, MD - Perinatology
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