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Pregnancy and birth

Breech presentation: turning the baby and choosing how to give birth

A breech baby lies bottom first or feet first instead of head down. It is common early in pregnancy and still affects a small number of babies at the end. A midwife or obstetrician can offer a manual turn called external cephalic version, and, if the baby stays breech, a discussion about planned caesarean or vaginal breech birth.

Last checked: 2026-10-03

Key facts

At a glance.

  • How often

    Roughly 3 to 4 in every 100 babies are breech towards the end of pregnancy, although being breech is very common in early pregnancy.

  • When ECV is offered

    Usually around 36 to 37 weeks, and it can still be tried up to early labour. A medicine to relax the womb is given first.

  • Chance of turning

    ECV works for about 1 in 2 women, and more often if you have already had a vaginal birth.

  • Reverting

    Fewer than 5 in 100 babies turn back to breech after a successful ECV.

  • Where to give birth

    Breech birth, vaginal or by caesarean, is planned in hospital with a team experienced in breech delivery.

What breech means and the three positions

Most babies settle head down by the last weeks of pregnancy. A breech baby has the bottom or the feet at the lower end of the womb, nearest the cervix. Midwives usually suspect it when they feel a firm round head near the top of the bump, and an ultrasound scan confirms the position.

The Royal College of Obstetricians and Gynaecologists describes three patterns. Extended, or frank, breech is the most common: the bottom comes first, with the legs folded up so that the feet sit near the ears. In flexed breech the knees are bent and the feet lie beside the bottom. In footling breech one or both feet hang below the bottom, which matters because it changes which birth options are safe.

Why a baby ends up breech

In many pregnancies there is no explanation. Some factors make breech more likely, and knowing them helps a doctor decide whether a scan for something else is needed.

  • A first pregnancy.

  • A low-lying placenta, which can leave less room at the bottom of the womb.

  • Too much or too little amniotic fluid, which changes how freely the baby moves.

  • A multiple pregnancy, where space is shared.

  • An unusually shaped womb.

External cephalic version step by step

External cephalic version, usually shortened to ECV, is an attempt to turn the baby head down by pressing firmly on the abdomen. It is done in hospital by a trained clinician, normally around 36 to 37 weeks, and it can be offered up to the early stage of labour. Before starting, you are likely to have a scan, a heart-rate trace of the baby and an injection of a drug called terbutaline to relax the womb.

It can be uncomfortable, and you can ask to stop at any point. If it works, the baby is monitored for a period afterwards. The RCOG quotes success in about one woman in two, with better odds if you have had a vaginal birth before. A small minority of babies, fewer than 5 in 100, turn back to breech.

The main risk is a sudden change in the baby's heart rate or bleeding that leads to an emergency caesarean; the RCOG puts this at about 1 in 200. ECV is not advised when the placenta is low over the cervix (placenta praevia), when there has been recent bleeding, when the baby's heart trace is abnormal, when the waters have broken, or in most multiple pregnancies.

Planned caesarean or vaginal breech birth

If the baby stays breech, you will be offered a conversation about two options. The RCOG leaflet explains that the risk to the baby of dying around a planned caesarean is about 1 in 2,000 births, compared with about 4 in 2,000 for a planned vaginal breech birth. The leaflet also notes that about 4 in 10 women planning a vaginal breech birth end up with a caesarean.

A planned caesarean carries the usual surgical considerations and can add some complications to later pregnancies, including problems with the placenta. A vaginal breech birth is only suitable when there is a hospital team with skills in breech delivery and when the baby is in a suitable position, so not every unit can offer it in the same way. If you would prefer a vaginal breech birth, ask early, because a referral to another unit may be needed.

  • Planned caesarean: scheduled, usually from 39 weeks, with a planned team in theatre.

  • Planned vaginal breech birth: needs continuous monitoring and an experienced practitioner, and may convert to caesarean.

  • Going into labour before a planned caesarean is possible; staff will assess the baby's position and how quickly labour is progressing.

If labour starts early or the waters break at home

If you know your baby is breech and your waters break or contractions start, call your maternity unit straight away and plan to go in. Breech babies, particularly footling breech, carry a higher chance of the umbilical cord slipping down after the waters break. If you can see or feel the cord, call 999, get onto your hands and knees with your bottom raised, and do not touch the cord.

Looking after yourself while you wait

Between a breech diagnosis and the birth, keep going to your routine appointments and keep paying attention to your baby's movements. A change in pattern needs same-day contact with your midwife or maternity unit. Some people try positions or complementary approaches to encourage turning; the evidence for these is limited, and your midwife can tell you whether they are reasonable in your circumstances.

Frequently asked

Questions people ask.

Quick, plain-English answers to the questions we hear most.

  • Is a breech baby at 30 weeks a problem?

    Not usually. Many babies are breech earlier in pregnancy and turn on their own, so the position that matters most is the one at the end of pregnancy, which is checked from about 36 weeks.

  • Does ECV hurt?

    It can be uncomfortable or painful, because firm pressure is applied through the abdomen. The womb-relaxing injection helps, and you can ask the clinician to stop whenever you want.

  • Can I eat before ECV?

    Your hospital will give you instructions, because a caesarean is occasionally needed straight afterwards. Follow the advice in your appointment letter.

  • What if ECV does not work?

    You will be offered a discussion about planned caesarean and, where it is available and suitable, vaginal breech birth. In some pregnancies a second ECV attempt may be offered.

  • Does breech mean something is wrong with the baby?

    Usually not. Most breech babies are healthy; the position mainly changes how the birth is planned.

  • Can I have a home birth with a breech baby?

    A breech birth is normally planned in hospital, because an emergency team and theatre need to be on hand.

  • Does a planned caesarean affect future pregnancies?

    It can. The RCOG notes that caesarean birth is linked with extra complications in later pregnancies, including placental problems, and it is part of the discussion about how many children you hope to have.

  • When should I call the maternity unit?

    If the waters break, contractions start, you bleed, or your baby's movements reduce or change, call straight away rather than waiting for the next appointment.

  • How does the position get checked?

    A midwife palpates the abdomen, and a scan confirms the position if there is any doubt.

Where this comes from

Sources and checking.

This guide is for information, not medical advice.

Your GP or consultant knows your history and can tell you which parts apply to you. If your symptoms are severe, rapidly worsening, or come with red-flag features, seek urgent medical care. Figures and availability change, so treat them as a guide and confirm with the provider.

Published 2026-10-03, next review 2027-10-03.

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