Navigating breech birth decisions for your natural hospital birth
Blog Overview:
In this blog, we explore the different types of breech positions—like frank, complete, and footling breech—to help you make sense of your baby’s position and what it might mean for your birth. We share gentle, evidence-based techniques to encourage your baby to turn, and what to consider as you explore your choices if your baby remains breech, so you can feel supported and confident in making decisions that align with your birth philosophy.
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It’s good to know your options if your baby turns head-up (aka breech) in 3rd trimester.
Discovering your baby is in a breech position can be a pivotal moment in your pregnancy journey. However, it's important to understand that a breech presentation doesn't necessarily mean the end of your natural birth plans. In 2019, there were 150,678 breech babies in the U.S., accounting for 4% of all births. While 93.8% of these were delivered via Cesarean section, it's crucial to know that this isn't always the only option.
This blog aims to equip you with the knowledge to engage in meaningful, informed discussions with your practitioner about breech births. We'll explore exercises that may help encourage your baby to turn, discuss medical interventions like External Cephalic Version (ECV), consider alternative approaches such as chiropractic care, and examine current research on vaginal breech births.
By the end of this article, you'll be well-informed about your options and better prepared to select a practitioner skilled in breech deliveries, rather than simply hoping to avoid this situation. Remember, informed decision-making is key to navigating your unique birth journey. Let's delve into the world of breech presentations and empower you with the information you need.
There are a few breech positions to be aware of before 3rd trimester.
When a baby is ready to be born, they will typically turn “head down”— this is also known as the cephalic or vertex position. The ideal positioning for a baby would be for their head to be down and facing your back with their chin tucked into their chest. But with breech positions, it’s baby’s butt or feet that are set to come out first rather than their head.
There are three common breech positions that your baby could settle into: the Frank Breech, Complete Breech, and Incomplete (or Footling) Breech positions. Let’s take a closer look at these breech positions to understand how each differs and how prevalent they are at birth.
Frank Breech
Frank Breech (also known as the “pike” position) is the most common of the breech presentations. Out of the 3-4% of term breech births, this breech position makes up a whopping 50-70%! This position is when the baby’s butt is the presenting part (meaning the body part that is closest to the cervix) with their legs straight up and feet around their head.
Complete Breech
Complete Breech is when both baby's knees are bent and crossed (think crisscross applesauce) and their feet and bottom are resting on the cervix. The complete breech is the least common among the typical breech positions, accounting for 5-11% of breech presentations. The Complete position — along with the Frank position — is considered to be the easier of the breech positions to birth vaginally.
Incomplete, or Footling, Breech
Incomplete Breech can take on multiple forms and accounts for 12-38% of breech presentations. One variation of this is when baby has one leg folded while the other is extended upward, a cross between the Frank and Complete breech positions. Another form of Incomplete Breech involves a foot presenting in the birth canal, known as a Footling Breech.
Footling Breech makes up roughly 20% of breech babies and is considered one of the riskier breech positions. In this presentation, the baby is upright, and one or both feet are in the birth canal. This position can lead to several complications, such as:
Ineffective dilation due to insufficient pressure on the cervix
Increased risk of cord prolapse. Since larger parts of the baby (head or hiney) aren't sealing off the birth canal, the cord may slip alongside the foot or feet. Footling Breech carries the highest risk of prolapse, at 15-18%.
While understanding the different breech positions is important for birth planning, it's also helpful to know that most breech babies are born healthy and do not experience any lasting negative effects from their time in the womb. The most common problem associated with breech presentation is hip dysplasia, due to their reduced ability to move in utero. This condition is where the ball of the femur doesn’t fit well into the hip socket, leaving the hip joint loose. This is a painless musculoskeletal condition affecting approximately 1 out of 1000 babies born in the U.S. each year and is often detected soon after birth during routine wellness exams.
Why do breech turns happen, and can it be prevented?
As you prepare for your natural birth, it's important to ask plenty of questions. When it comes to understanding breech babies, two key questions to consider are “Why does it happen?” and “Is there anything I can do to prevent it?”
Although it’s not understood why babies are breech, there are some factors that may contribute to it. According to the American College of Obstetricians and Gynecologists (ACOG) website, some of these factors include:
Being pregnant before
Carrying multiple babies
Too little or too much amniotic fluid
The uterus having an abnormal shape or growths such as fibroids
The placenta covering the opening of the uterus (placenta previa)
The baby being preterm
The baby having certain birth defects (although rare)
While some factors may increase the likelihood of a breech position, there’s no surefire way to prevent it. Many of the reasons, like the shape of your uterus or the amount of amniotic fluid, are simply beyond your control. But don’t be discouraged! While preventing a breech presentation isn’t always possible, there are still options for getting your baby to turn head down. I’ll go into more detail in the next section.
If your baby does turn breech in 3rd trimester, here are proactive steps you can take.
I’m really excited to dive into this topic with you because it hits close to home as I went through a breech pregnancy myself. It’s been about 9 years, so I don’t remember every little detail, but I do know how limited my options felt.
The moment I found out my son was breech, I was already being prepared that I’d need a cesarean. So now, I want to share with you what I wish I had known back then. Because you deserve to be an informed mama, whether your practitioner gives you the information or not.
Use the toggles below to explore at least five options you have if carrying a breech baby, besides a cesarean outcome.
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Sometimes waiting can feel a lot like doing nothing, but there are statistics that support this valuable option! The breech position is more common prior to term. In fact, research indicates that 25% of singleton babes are breech before 28 weeks. That number decreases to 7% percent by 32 weeks and rests at just 3-4% by 37 weeks.
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Sometimes movement is all that’s needed to stretch tissues and connective tissue supporting the uterus and pelvis, allowing baby more room to move. Walking, swimming, lunges, and stretching are all low impact movements that can help flip baby. There are also programs you can utilize that specialize in getting baby head down.
Preparing your body for birth ahead of time is also a key to helping your baby get in a more optimal position. For this preparation, we highly recommend the Body Ready Method® Prenatal and/or Birth Programs, (#afflink) which specialize in addressing physical imbalances and tensions throughout the entire body (not just the pelvis), so there can be more space and balance for baby to rotate head down.
You can watch the Body Ready Method® “What to do when baby’s breech?” class below, complete with exercises that can help effectively turn a baby head-down. Using these options with the Body Ready Method® Prenatal and/or Birth Programs (#afflink) can provide comprehensive body preparation for birth.
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Don’t underestimate this very useful option. Some chiropractors can use what’s called The Webster’s Technique for turning breech babies. This technique focuses on the pelvis and sacrum as well as the muscles and ligaments in the surrounding area. The belief is that this technique loosens intrauterine constraint, making more room in the uterus and allowing baby more freedom to move. In 2002, there was a small study done that showed very promising results. The study showed that this technique had a success rate of 82% during the 8th month of pregnancy, when breech presentation is less likely to convert on it’s own. Simply put, this is a low risk, non-invasive and highly effective option for flipping a breech baby.
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External Cephalic Version (ECV)is a medical procedure that can be a game-changer for expectant mothers with breech babies. During an ECV, a healthcare provider manually turns the baby to a head-down position from the outside of the mother's belly. This procedure has shown impressive results, reducing the risk of cesarean birth by 43% and decreasing the chance of breech presentation at birth by 58%.
It has been shown that ECVs are often more successful (61% odds) for women who have given birth before compared to first-time mothers (33% odds), but this is worth considering given the higher odds of cesarean overall with a breech presentation.
Typically, ECVs are performed at or after 37 weeks of pregnancy. While attempting ECV earlier than 37 weeks may increase the chance of success, it doesn't lower the overall cesarean rate and may slightly increase the risk of preterm birth. There are techniques that can be used to increase the chances of success including moms having an epidural or spinal. Using medications known as Tocolytics, which help prevent labor contractions, during an ECV has an even higher success rate.
So, what are the risks?
Evidence shows that risks relating to an ECV are low, but there are a few times when it’s contraindicated — meaning, not recommended. These times include cases where a mama has a history of or suspected placental abruption, severe pre-eclampsia, or if there are any signs of fetal distress.
The overall complication rate during an ECV is about 6%, with serious complications (like placental abruption or stillbirth) occurring in only 0.24% of cases. The most common risk is a temporary change in baby’s heart rate, but other risks include cord prolapse (0.18%), vaginal bleeding (0.34%), and water breaking (0.22%).
For these reason, this procedure is typically done in a hospital setting where access to surgical intervention is available if necessary.
It’s worth noting that a prior cesarean is not a contraindication for an ECV, so if you’re a previous cesarean mama with a breech baby, this may still be an option for you!
Some moms do say the ECV can be uncomfortable, but there are ways to make it easier, like using laughing gas, IV meds, a spinal, or even an epidural to help with the pain. In fact, as mentioned earlier, it’s believed that using a combination of a spinal and epidural can increase the odds of a successful ECV. This is thought to be because the combination helps keep your abdominal muscles relaxed making it easier to turn the baby.
As you can see, an ECV can be a powerful, although underused, option for mamas who have been trying to get their sweet baby head down.
Additional Resources
Evidence Based Birth® Signature Article on Breech Version
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Current evidence on breech birth shows that vaginal births generally result in fewer complications for mom compared to cesarean sections. In fact, when conducted by a skilled practitioner, following strict selection criteria, and adhering to safe practices, a planned breech vaginal birth can be nearly as safe as a planned head-first vaginal birth The estimated risk of intrapartum loss for vaginal breech birth is about 2 in 1,000, compared to 1 in 1,000 for head-down vaginal births.
Pro-Tip: Begin discussing breech options with your practitioner early to learn more about their comfort level and experiences. If they are not comfortable with vaginal breech birth, perhaps someone else in their practice or an adjacent provider may be in your area. It’s good to know your options so that a cesarean birth may not have to become a default that’s not based on medical necessity.
Want to fully prepare your body for birth? We highly recommend the Body Ready Method® Prenatal and Birth programs for your birth prep needs! Click here to learn more! (#afflink)
How the Term Breech Trial may be affecting your practitioner’s care decisions.
You may be wondering, “If vaginal breech birth is often very safe, why is cesarean the ‘go-to’ option for breech birth?’ To answer that, we have to look at the impact of the Term Breech Trial.
The Term Breech Trial was a study published in 2000 that involved 2,088 participants from 26 different countries. The purpose of the study was to compare the safety of a planned cesarean to a planned vaginal breech birth. The study found that it was much safer for breech babies to be delivered via cesarean, effectively ending vaginal breech births.
Unfortunately, the study had significant methodical flaws since the researchers did not follow their own safety guidelines. For instance:
Despite the requirement for a "skilled breech provider" to be present for all planned vaginal breech births, 19% of the time, there was no skilled provider.
Many study locations did not have access to emergency cesarean sections, compromising safety protocols.
Some participants were included despite not meeting study criteria. For instance, two cases of stillbirths that occurred before study enrollment were incorrectly counted in the vaginal breech birth outcomes.
Sadly, this study cemented a trend that had already been in motion since the 1970s — that when it comes to breech babies, cesareans were the standard operating procedure.
In a podcast interview hosted on EBB, guest speaker and founder of Breech Without Borders, Dr. Rixa Freeze, had this to say about the rise of cesareans for breech births:
“I was shocked that we had almost already completely shut down vaginal breech birth before we had the evidence backing up that practice. So in 1970, for example, the national cesarean section rate for all babies in the U.S. was 5%. And it was about 15% for breech. By time we hit the 1980s, I think in 1980, it was 66% (for breech babies). By the time we had 1985, it was 79%. And by the time we hit the year 2000, it (the cesarean rate) was around 83% (for breech babies). So it skyrocketed long before we had any strong evidence saying that it (cesareans) was a good idea.”
That was a powerful and telling statement from Dr. Freeze. Another insightful comment came from another guest in that same episode, Dr. David Hayes, OBGYN. He described how breech vaginal births are considered special training and aren’t offered in standard medical programs. He shared how it is up to the practitioner to seek out someone willing to mentor them in that particular skill.
That’s important to know because there can be an assumption in the birth space that because a practitioner went to med school, they’ve been trained in all things medical. That’s simply untrue. So when you’re looking for a provider, asking if they’ve been trained in breech births would be an excellent question to put forth.
Remember: A breech turn doesn’t have to mean a turn for the worse for your natural hospital birth plan!
As you can probably imagine, learning your baby is breech can feel like a rollercoaster, but remember - you’ve got options, mama.
Whether you're playing the waiting game, trying out some intentional moves with Body Ready Method® (#afflink) or Spinning Babies®, considering an ECV, or even thinking about a vaginal breech birth with a skilled provider - there's no one-size-fits-all approach here.
While the Term Breech Trial shook things up back in the day, newer research is showing that vaginal breech births can be safe when done right. The part you’ll want to navigate wisely is finding a skilled and supportive practitioner for breech birth.
As you move forward, don't be shy about speaking up for yourself or getting a second opinion if you need it. Your pregnancy journey is uniquely yours, and you deserve care that respects your choices. Remember, whether your little one decides to flip or stay breech, your body is capable of incredible things. Trust your gut, make the choices that align with your values for you and your baby, and know that being breech is just one small part of your amazing journey to becoming a mom. You've got this!
