OpenMFM Patient Guide

Breech Presentation
& External Cephalic Version

A clear guide to what breech means, whether ECV may be an option, and how to plan a safe birth.

Breech at term ECV counseling Shared decisions

Your Roadmap

The plan starts with one question: Can your baby safely turn?

1. Confirm the positionUltrasound confirms breech type, placenta, fluid, and fetal wellbeing.

2. Assess ECVYour team decides whether an external cephalic version is appropriate for your pregnancy.

3. Plan the birthThe next step depends on whether the baby turns and your individual clinical situation.

Breech is a position, not a diagnosis. Most breech babies are otherwise healthy.

The Basics

Breech means the baby is bottom- or feet-first

Most babies turn head-down before birth. At term, about 3% to 4% remain breech.

Frank breech

Bottom first, with the legs extended upward. This is the most common type.

Complete breech

Bottom first, with both hips and knees bent, similar to sitting cross-legged.

Incomplete or footling

One or both feet lie below the bottom and may present first.

Source: ACOG, “If Your Baby Is Breech,” reviewed November 2024.

Why It Matters

Breech changes the birth plan because the largest part may deliver last

During vaginal breech birth

The head and cord need special protection

The umbilical cord can become compressed, and the after-coming head can be difficult to deliver.

The practical result

Experience and hospital protocols matter

Most term breech babies in the United States are born by planned cesarean. Selected vaginal breech birth may be reasonable with an experienced team and a specific hospital protocol.

You have time to ask questions and make a plan. A breech position discovered before labor is usually a planning problem, not an emergency.

Source: ACOG Committee Opinion No. 745, reaffirmed 2026.

The Main Option

ECV offers a chance to turn the baby head-down before labor

ECV

External cephalic version

A trained clinician applies firm, controlled pressure to the abdomen to guide the baby through a forward or backward roll.

≈ 1 in 2

attempts succeed

ACOG reports that more than half of attempts succeed; RCOG uses about 50% for patient counseling. Your individual chance may be higher or lower.

The goal is not to force a turn. The goal is to make a careful attempt while monitoring the baby.

Sources: ACOG FAQ079, reviewed 2024; RCOG patient information on breech at the end of pregnancy.

Eligibility

ECV is an option only when a vaginal birth could otherwise be considered

Often considered when

There is one baby in a breech presentation near term
Fetal assessment is reassuring
There is enough information from ultrasound to attempt the procedure safely
Cesarean delivery can be performed promptly if needed

Usually not attempted when

Cesarean is already required for another reason, such as placenta previa
There is a concerning fetal heart-rate pattern
Placental abruption, recent significant bleeding, or ruptured membranes changes the risk
There is a multiple pregnancy or another major clinical concern

A prior cesarean is not an automatic “no.” ACOG and RCOG note that ECV can be considered after one prior cesarean in appropriately selected patients.

Timing

Timing balances the chance of spontaneous turning with readiness for birth

Before 36 weeks

Many babies still turn

Position is followed because spontaneous turning remains common.

Around 36 to 37 weeks

Discuss ECV

ACOG advises that ECV may be suggested when a breech pregnancy is beyond 36 weeks. Local timing may differ by clinical situation and practice.

After the attempt

Confirm the plan

Your team reassesses presentation and discusses next steps based on the result.

Do not schedule yourself from a slide. Your obstetric team will choose timing based on gestational age, fetal wellbeing, and delivery resources.

What to Expect

The ECV visit is a monitored hospital procedure

1

Check

Ultrasound confirms the position. Fetal heart rate and maternal vital signs are assessed.

2

Prepare

Consent is reviewed. A medication to relax the uterus may be given. Local fasting and arrival instructions vary.

3

Turn

The clinician uses their hands to guide the baby. The attempt lasts minutes and stops for pain or concern.

4

Monitor

The fetal heart rate and final position are checked before discharge. Rh-negative patients may need anti-D immune globulin.

Follow the hospital’s exact instructions about eating, medications, transportation, and arrival time. These protocols are not identical everywhere.

Chance of Success

Success is individual, not guaranteed by a score

Prior birth

ECV is often more successful after a previous vaginal birth.

Fluid & engagement

Amniotic fluid and how deeply the breech is engaged can affect mobility.

Placenta & fetal position

Placental location and the orientation of the baby’s back may influence the attempt.

Technique & setting

Clinician experience and use of uterine-relaxing medication also matter.

Use about 50% as a population estimate, then ask your clinician what features of your pregnancy move your personal chance up or down.

Evidence summary: ACOG Practice Bulletin No. 221; ACOG FAQ079; RCOG Green-top Guideline No. 20a.

Safety

Serious complications are uncommon, but readiness matters

More common

Brief discomfort or heart-rate changes

The attempt can be uncomfortable. Temporary fetal heart-rate changes may occur and are watched closely.

Rare but important

Urgent cesarean delivery

RCOG counseling estimates an immediate emergency cesarean risk of about 1 in 200, usually because of bleeding or fetal heart-rate changes.

Other potential complications include rupture of membranes, labor, placental abruption, or fetomaternal bleeding.
Monitoring and rapid access to cesarean delivery are what make the setting safe.

Most patients go home the same day after reassuring post-procedure monitoring.

After ECV

The result creates the next decision

If the baby turns

Plan for a head-down birth

Most patients await labor. A small number of babies turn back to breech, so presentation may be checked again.

If the baby does not turn

Review the birth options

Your team may discuss another ECV attempt, planned cesarean, or in selected settings, planned vaginal breech birth.

An unsuccessful ECV is not a failure by you or your baby. It is information that helps the team choose the safest next plan.

Birth Options

If breech persists, birth planning is individualized

Path	When it may be considered	Key counseling point
Planned cesarean	The usual approach for persistent term breech in the United States.	Avoids the specific intrapartum risks of vaginal breech birth, while carrying the short- and long-term risks of abdominal surgery.
Planned vaginal breech birth	Only for carefully selected patients under a hospital-specific protocol with an experienced team.	ACOG advises detailed informed consent because perinatal or neonatal mortality and serious short-term neonatal morbidity may be higher than with planned cesarean.
Repeat ECV	Sometimes considered after an unsuccessful first attempt when the clinical situation remains appropriate.	The timing, analgesia, and expected benefit should be discussed with the treating team.

Guideline: ACOG Committee Opinion No. 745, reaffirmed 2026.

Evidence & Uncertainty

Alternative methods have uncertain evidence

Maternal positioning

Specific postures and exercises are commonly suggested, but reliable evidence that they turn a term breech baby is limited.

Moxibustion or acupuncture

Research has produced mixed and sometimes low-certainty findings. These approaches do not replace obstetric assessment.

Manual or chiropractic techniques

Evidence is insufficient to recommend them as a substitute for ECV or delivery planning.

“Natural” does not mean risk-free. Ask your obstetric clinician before using any technique, especially if you have bleeding, ruptured membranes, contractions, pain, or a pregnancy complication.

Evidence context: Cochrane reviews of ECV at term and adjuncts to ECV.

Shared Decision-Making

Ask questions that change the decision

About your pregnancy

What type of breech presentation does my baby have?
Is there any reason ECV would not be appropriate for me?
What makes my personal chance of success higher or lower?
Could a prior cesarean or another condition change the plan?

About the plan

Where and when would the ECV be performed?
What pain relief or uterine-relaxing medication do you use?
What happens if the ECV works, or if it does not?
If my baby remains breech, what birth options and expertise are available here?

Safety Net

Know when to call now

Contact your obstetric team or Labor & Delivery urgently for:

Decreased movement

Your baby is moving less than usual or you are concerned about movement.

Bleeding

Vaginal bleeding or symptoms your care team has told you to report.

Fluid leakage

A gush or ongoing trickle that may mean your membranes have ruptured.

Labor or severe pain

Regular painful contractions, severe abdominal pain, or any urgent concern.

Follow your own care team’s emergency instructions. If you believe you have an emergency, seek emergency care immediately.

Summary

Three ideas to remember

01

Breech is common enough to have a plan

About 3% to 4% of babies remain breech at term.

02

ECV is a monitored option

It succeeds in about half of attempts and should be performed where cesarean is readily available.

03

The next step is personal

Eligibility, success, and the safest birth route depend on your pregnancy and local expertise.

The best plan is one you understand, made with a team prepared for both the expected path and the uncommon complication.

Download the one-page ECV decision guide (PDF)

Educational information only. This presentation supports, and does not replace, counseling from your obstetric clinician. Use the Sources button for full citations.

Breech Presentation& External Cephalic Version