The chances of your baby being breech goes from about 20% at 28 weeks to 3–4% at full term
Recommendations for a vaginal birth
The Royal College of Obstretricians and Gynaecologists states that:
- the presentation of your baby should be either frank (hips flexed, knees extended)
or complete (hips flexed, knees flexed but feet not below the fetal buttocks)
- a vaginal breech birth should take place in a hospital with facilities for emergency caesarean sections
- induction of labour for breech presentation may be considered, depending on the position of your baby
- augmentation of labour is not recommended
- epidural analgesia should not be routinely advised; women should have a choice
- women may need to adopt a dorsal (lying down) or lithotomy position (lying down, legs in stirrups) to birth their baby
A vaginal birth isn’t recommended if:
- There are additional complications such as placenta praevia or if there are concerns about the health of your baby
- There are concerns about the size and flexibility of your pelvis
- Your baby has a footling or kneeling breech presentation
- You are expecting a large baby (usually defined as larger than 8.4lb)
- Your baby could be growth-restricted (usually defined as smaller than 4.4lb)
- A medical professional with training and experience in vaginal breech delivery is unavailable
- You have had a previous caesarean section
External Cephalic Version (ECV)
- ECV is usually offered from 36 weeks if this is your first baby and from 37 weeks if you’ve
had a baby before.
- About 50% of ECV attempts will be successful however the results can vary from 30% up to 80%.
- According to the Royal College of Obstetricians and Gynaecologists (RCOG) an overall success rate of 40% for first time mums, and 60% for women who have had a baby can usually be achieved.
The success rates of ECV can be affected by:
- how many children you have had
- uterine tone
- how much amniotic fluid there is
- how engaged the baby is into the pelvis
- the use of tocolysis drugs
According to the RCOG Guidelines:
- The highest success rates are seen in non-white women who are not having their first baby and who have a relaxed uterus, where the baby is not engaged and the baby’s head is easily felt.
- Success rates are also higher in women with a high volume of amniotic fluid but, in practice, this can also cause the baby to move back to breech again.
- There is no upper time limit on the right gestation for ECV. Successes have been reported at 42 weeks pregnant and it can be
performed in early labour as long as the waters haven’t broken.
- ECV is rarely associated with complications – it has a 0.5% immediate emergency caesarean section rate.
- ECV can be painful with about 5% of women reporting high pain scores and the ECV procedure may need to be stopped because of this.
ECV can not be performed if:
- A caesarean is needed
- You have had a vaginal bleed within the last 7 days
- There are any concerns about your baby’s heartbeat
- You have any major uterine anomalies such as a bicornate uterus
- Your waters have broken
- You are having more than one baby (except if the ECV is to aid the delivery of the second twin)
Reitberg C, Elferink-Stinkens P, Brand R, van Loon A, Van Hemel 0, Visser G. (2003)
Term breech presentation in The Netherlands from 1995 to 1999:
mortality and morbidity in relation to the mode of delivery of 33 824 infants.
Br J Obstet and Gynaecol 110: 604-9