You are well into your third trimester, and your midwife tells you the baby is sitting bottom-down — in a breech position. Now what?

Breech position means your baby is lying with their feet or bottom pointing downward in the uterus, instead of head-down. It is very common in the middle of pregnancy, but most babies turn on their own before their due date. Here you will find out what breech position means, what options you have for turning your baby, and what delivery choices are available.

What Is a Breech Position?

In a breech presentation, the baby lies with their bottom or feet toward the cervix, instead of head-down (vertex presentation). About 3–4% of all babies at term are in a breech position.

There are several types of breech presentation:

Frank Breech

The baby has their legs stretched straight up along their body, with the bottom pointing down. This is the most common form, occurring in about 65% of breech cases.

Complete Breech

The baby is sitting "cross-legged" with knees bent and feet near the bottom.

Footling Breech

One or both feet are pointing down toward the cervix. This form is less common and carries specific considerations for delivery.

At 28 weeks, about 25% of babies are in a breech position. By 36 weeks, most have turned, and only 3–4% remain in breech presentation at term.

Why Is My Baby in a Breech Position?

Often no specific cause is found. But some factors that may contribute:

First-time pregnancy: A tighter abdominal wall can make it harder for the baby to turn
Placenta location: A low-lying placenta (placenta previa) or unusual placenta placement can limit space
Amniotic fluid levels: Both too little and too much amniotic fluid can affect the baby's ability to turn
Multiple pregnancy: Less room in the uterus
Uterine shape: Congenital uterine anomalies
Short umbilical cord: Can restrict the baby's freedom of movement
Premature birth: The baby has not had time to turn

When Is Breech Position Detected?

Your midwife or OB checks the baby's position at prenatal visits, feeling the abdomen (Leopold's maneuver) to locate the head, spine, and bottom.

Weeks 28–32: Breech is common and there is a good chance the baby will turn on their own
Weeks 34–36: If the baby is still breech, options are discussed
Weeks 36–37: External cephalic version (ECV) is typically offered

If there is uncertainty about the baby's position, an ultrasound can confirm it.

Can the Baby Turn on Their Own?

Yes! Most babies in breech position turn spontaneously before their due date:

Before 32 weeks: Very good chance of spontaneous turning
Weeks 32–36: Still good chances, but the probability decreases
After 36 weeks: Some babies turn all the way until labor, but this is less common

Track your baby's movements with the Babysential pregnancy timeline to learn more about what is happening week by week during your pregnancy.

External Cephalic Version (ECV) — Turning the Baby

External cephalic version (ECV) is a procedure where an experienced doctor attempts to turn the baby from breech to head-down by applying pressure on the abdomen.

How Is ECV Performed?

Timing: Typically at 36–37 weeks (first-time mothers), 37 weeks (experienced mothers)
Preparation: Ultrasound to confirm position, placenta location, and amniotic fluid level
Monitoring: Fetal heart rate monitoring (NST/CTG) before, during, and after the procedure
Relaxation medication: Some hospitals give a medication to relax the uterus
The procedure itself: The doctor uses both hands on the abdomen to roll the baby around
Post-procedure: Fetal heart rate monitoring for 30–60 minutes afterward

How Successful Is ECV?

Success rate: approximately 40–60%
Higher success rate in women who have given birth before (up to 70%)
Lower success rate in first-time mothers (around 40%)

When Can ECV Not Be Performed?

ECV is not recommended if:

There is bleeding from the uterus
The placenta is covering the lower part of the uterus
Amniotic fluid levels are too low
There is concern about umbilical cord complications
The water has broken
You are expecting twins or multiples
There are certain maternal medical conditions

ECV must always be performed in a hospital with the ability to perform an emergency cesarean section if complications arise. It is a safe procedure, but monitoring is essential.

Exercises and Self-Help Methods

Although the scientific evidence is limited, many pregnant women try various positions to encourage the baby to turn. These are not harmful and may be worth trying:

Knee-to-Chest Position (Knee-Chest)

Kneel on the floor with knees apart, lean your upper body down, and rest your forehead on the floor or a pillow. Bottom up. Hold the position for 10–15 minutes, 2–3 times daily.

Pelvic Tilt

Lie on your back with your pelvis elevated (use pillows under your hips). Hold for 10–15 minutes.

Swimming

Swimming may give the baby freedom to move and possibly turn. Many midwives recommend swimming regularly.

Moxibustion (Acupuncture)

Some studies suggest that moxibustion (burning moxa herbs near an acupuncture point on the little toe) may increase the chance of spontaneous turning. Some midwives and acupuncturists offer this treatment.

The WHO and ACOG (American College of Obstetricians and Gynecologists) recommend external cephalic version (ECV) as the evidence-based method for turning babies in breech position. Exercises and alternative methods are not harmful, but have limited scientific documentation.

Giving Birth with a Breech Baby

If your baby does not turn, you have two main options:

Planned Cesarean Section

ACOG guidelines generally recommend a planned cesarean section for most first-time mothers with a breech presentation. The reason is that the risk of complications during vaginal breech delivery is somewhat higher for this group.

Typically performed at 39 weeks
A planned procedure with preparation time
Predictable and controlled

Vaginal Breech Birth

Vaginal breech birth is possible, but requires specific criteria to be met:

Frank breech — not footling breech
Normal amniotic fluid levels
Estimated fetal weight between 5.5–8.8 lbs (2500–4000 grams)
Women who have given birth before generally have better outcomes
The hospital has experience with breech vaginal delivery
Continuous monitoring during labor

Use the Babysential birth plan tool to create a birth plan that accounts for a breech presentation. You can include your preferences for both vaginal birth and cesarean section.

What Should You Consider?

Discuss with your OB or midwife:

Your health and obstetric history
Your baby's size and type of breech presentation
Your hospital's experience with breech delivery
Your own wishes and values

It is important that you feel confident in your decision, whatever you choose.

After the Birth

Regardless of whether the baby was born vaginally or by cesarean:

Babies who were in a breech position may have some stiffness in their hips in the first few days
All newborns should be screened for developmental dysplasia of the hip (DDH) — this is especially important after a breech presentation
The vast majority of babies who were in a breech position are completely healthy

Frequently Asked Questions

Can the baby turn after 37 weeks?

Yes, some babies turn all the way until labor, though it becomes increasingly unlikely the closer you get to your due date. It happens more often in women who have given birth before.

Is ECV painful?

Most people experience discomfort and pressure, but rarely severe pain. The procedure is stopped if it is too painful or if the baby shows signs of stress.

Can I choose vaginal breech birth even if my doctor recommends a cesarean?

You always have the right to be involved in your own healthcare decisions. Discuss thoroughly with your doctor, get information about risks and benefits, and make an informed decision.

How long does an ECV appointment take?

The actual turning attempt usually only takes a few minutes, but the whole visit including preparation, ultrasound, and post-procedure monitoring can take 2–3 hours.

Can breech position recur in a future pregnancy?

There is a slightly increased likelihood of breech position again, but it is far from certain. Most people who have had a breech baby in one pregnancy have a head-down baby next time.

Breech Baby: When Your Baby Is in the Wrong Position