Understanding Breech Position
and Your Options
A guide for expecting parents
🤰
You're not alone. About 3-4% of babies are in breech position at term.
You have options. We'll work together to find the best plan for you and your baby.
Slide 1
What Is Breech Position?
What does "breech" mean?
Breech means your baby is bottom-down or feet-down instead of head-down.
Most babies turn head-down on their own by 36 weeks. Some babies don't turn. This is called breech presentation.
Good news: Breech position doesn't mean anything is wrong with your baby. Some babies just prefer this position!
[Image: Side view showing fetus in breech position in uterus with labeled cervix and vagina]
Slide 2
Three Types of Breech Position
1. Frank Breech
Legs straight up toward head
Feet near baby's face
Most common type
2. Complete Breech
Legs crossed
Bottom down first
Looks like sitting cross-legged
3. Incomplete Breech
One or both feet pointing down
Also called "footling breech"
Slide 3
Why Does Breech Position Matter?
Why can't I just deliver breech?
Breech delivery has higher risks than head-first delivery.
When the head comes last, there's less time for it to pass through the birth canal. This can cause:
- Umbilical cord compression (cord gets squeezed)
- Head getting stuck
- Longer, more difficult delivery
The good news: You have safe options. We'll discuss what's right for you.
Slide 4
What Are Your Options?
What can we do about breech position?
You have four main choices:
1. External Cephalic Version (ECV)
Your doctor tries to turn your baby from the outside
→ Success rate: 30-80% depending on several factors
2. Planned Cesarean Delivery
Schedule a C-section before labor starts
→ Most common choice for breech babies
3. Vaginal Breech Delivery
Deliver vaginally with baby in breech position
→ Only in specific situations with experienced providers
4. Try ECV, Then Decide
Attempt to turn baby first. If it works, you can labor. If not, plan a C-section.
→ Gives you the best chance at vaginal delivery
Slide 5
What Is External Cephalic Version?
How does turning the baby work?
External Cephalic Version (ECV) means turning your baby from outside your belly.
Your doctor uses their hands on your abdomen to gently guide your baby into a head-down position.
Is it safe?
Yes. ECV has been done safely for many years.
Your care team monitors your baby closely during and after the procedure.
Overall complication rate: 1-2%
Slide 6
How Does ECV Work?
What happens during the procedure?
Here's what to expect:
Before
- Ultrasound to confirm breech position
- Check baby's heart rate
- Give medication to relax your uterus
- You may get RhoGAM if you're Rh-negative
During
- Doctor places hands on your belly
- Gentle, firm pressure to guide baby
- Usually takes a few minutes
- Continuous monitoring of baby's heart rate
After
- Monitor baby for 1-2 hours
- Ultrasound to check baby's position
- You go home the same day
Important: If the baby shows any signs of distress during ECV, we stop immediately. Your baby's safety is our top priority.
Slide 7
When Is ECV Done?
What's the best timing?
Most ECVs are done at 37 weeks of pregnancy.
Why 37 weeks?
Before 36 weeks:
- Baby might turn on their own
- More room in the uterus
After 38 weeks:
- Less room to turn baby
- Lower success rate
At 37 weeks, your baby is:
- Full term (safe to deliver if needed)
- Small enough that turning is easier
- Less likely to turn back to breech after ECV
At our practice: We schedule ECV between 37-39 weeks. This gives us the best balance of safety and success.
Slide 8
What Affects ECV Success?
Will it work for me?
Several factors affect whether ECV will be successful.
We use a scoring system to estimate your chances:
| Factor |
Better Success |
Lower Success |
| Previous births |
Had a baby before |
First baby |
| Cervix |
Closed (0 cm) |
Open (>3 cm) |
| Baby's weight |
Over 7 lbs 12 oz |
Under 5 lbs 8 oz |
| Placenta location |
Side or top of uterus |
Front of uterus |
| Fluid amount |
Normal to high |
Low fluid |
Overall success rate: 30-80%
Your doctor will calculate your specific score and discuss your chances.
Slide 9
When Is ECV Not Recommended?
Are there reasons not to try ECV?
ECV is not done if you have certain conditions.
We won't attempt ECV if you have:
Pregnancy Complications
- Placenta previa (placenta covers cervix)
- Low amniotic fluid
- Baby not growing well
- Preeclampsia or high blood pressure
- Certain types of diabetes
Physical Factors
- Uterine abnormality
- Large ovarian cyst
- Tight nuchal cord (cord around neck)
- Abnormal fetal heart rate
- Incomplete breech position
Why these matter: These conditions could make ECV risky or unlikely to succeed. Your doctor will do a thorough evaluation before recommending ECV.
Slide 10
What Are the Risks of ECV?
What could go wrong?
First, the reassuring facts:
- Serious complications are rare (1-2% of cases)
- We monitor your baby closely throughout
- We stop immediately if there are any concerns
- The procedure is done where emergency C-section is available
Possible Risks Include:
- ECV doesn't work (most common outcome when it fails)
- Discomfort during procedure (usually brief and manageable)
- Baby turns back to breech (happens in 2-3% of cases)
- Changes in baby's heart rate (we watch for this continuously)
- Need for emergency delivery (very rare, less than 1%)
Remember: Your doctor will only recommend ECV if the benefits outweigh the risks for you and your baby.
Slide 11
Are There Other Ways to Turn Baby?
What about natural methods?
Some people try alternative methods to encourage baby to turn.
Methods People Use:
- Positions: Tilting exercises, knee-chest position
- Acupuncture: Specific points on toes and ears
- Moxibustion: Burning herbs near acupuncture points
- Chiropractic care: Webster technique
- Hypnosis: Relaxation techniques
- Music: Playing sounds low on belly
What does the research say?
Limited scientific evidence supports these methods. Some studies show moxibustion may help, but results are mixed. These methods are generally safe to try, but don't replace medical evaluation.
Talk to your doctor before trying any alternative methods. They can help you understand what's safe and what might help.
Slide 12
What Happens at Your ECV Appointment?
How should I prepare?
Before Your Appointment:
- Bring all prenatal records from your OB/GYN
- Complete any required COVID testing
- Arrange for someone to drive you home
- Eat a light meal 2-3 hours before
At Your Appointment:
Pre-procedure (30-45 min):
- Sign consent forms
- Ultrasound exam
- IV placement
- Medication to relax uterus
Procedure (5-10 min):
- Doctor attempts version
- Continuous monitoring
- Usually 1-2 attempts
After procedure (1-2 hours):
- Monitoring in recovery
- Ultrasound to check position
- Rest before going home
Important: If your regular OB/GYN doesn't deliver at our hospital, you'll need backup coverage arranged in case you need delivery.
Slide 13
What Can You Do?
How can I help?
Steps You Can Take:
1. Get Informed
Ask questions. Understand your options. There's no such thing as a silly question.
2. Consider Your Preferences
Think about what matters most to you. Talk with your partner or support person.
3. Discuss With Your Doctor
Share your concerns and preferences. We're partners in your care.
4. Try Safe Positioning
If your doctor approves, try gentle positioning exercises. They can't hurt.
5. Stay Positive
Many babies turn on their own before 37 weeks. Even if yours doesn't, we have safe options.
Remember:
You didn't do anything to cause breech position.
You have time to make the best decision for you and your baby.
We're here to support you every step of the way.
Slide 14
Summary: Your Path Forward
💙
Key Takeaways:
✓ Breech is common – About 3-4% of term babies
✓ You have options – ECV, planned C-section, or (rarely) vaginal breech delivery
✓ ECV is safe – Success rate 30-80% depending on your situation
✓ Timing matters – Best done at 37 weeks
✓ We monitor closely – Your baby's safety comes first
Next Steps:
- Schedule your appointment for around 36-37 weeks
- Bring your questions and concerns
- We'll create a plan together
You've Got This!
Thousands of women have babies in breech position every year. With good medical care and informed decision-making, you and your baby will be just fine.
Questions? Call us anytime.
Slide 15
Questions to Ask Your Doctor
❓
About Your Situation:
- What type of breech position is my baby in?
- What is my ECV success score?
- Are there any reasons I shouldn't try ECV?
- How much fluid do I have around my baby?
About the Procedure:
- How many ECVs have you done?
- What's your success rate?
- How long will I be at the hospital?
- When can I return to normal activities?
About After ECV:
- What if the ECV doesn't work?
- What if my baby turns back to breech?
- How will this affect my birth plan?
- Who will deliver my baby if I need a C-section?
Slide 16
Additional Resources
Learn More:
Video Resource:
Watch an animation of how ECV works:
https://youtu.be/8dx3j_KH-MY
Medical Organizations:
- American College of Obstetricians and Gynecologists (ACOG)
- Society for Maternal-Fetal Medicine (SMFM)
Key Research:
Studies show ECV is safe and effective for most women with breech babies. Ask your doctor for current research if you'd like to read more.
Talk to Your Care Team
Your doctors and nurses are your best resource. We're here to answer questions and support your decisions.
Slide 17
Contact Information
📞
Atlanta Perinatal Associates
Questions about ECV?
Call our office to speak with a nurse or schedule a consultation.
To Schedule Your ECV:
Contact the Emory scheduling office with:
- Your prenatal records from your OB/GYN
- Your preferred date (37-39 weeks gestation)
- Insurance information
Emergency Concerns?
If you have decreased fetal movement, bleeding, severe pain, or fluid leaking, call immediately or go to Labor & Delivery.
We're Here for You
Your pregnancy journey is important to us. Don't hesitate to reach out with any concerns.
Slide 18