Between around 32 and 36 weeks, your baby will almost always move so that he is 'head down', inside the womb. Some babies, though, don't. These maverick babes (estimated at 3 or 4 in every 100 babies) look like they want to be born feet, or bottom-first, and are in what's called a breech position.
Your midwife will check the position of your baby (by feeling your bump with her hands) at your routine last-trimester antenatal appointments, and will tell you if she thinks your baby is in a breech position.
These checks pick up most breech presentations but aren't 100% reliable (and, of course, your baby could always turn – either way – 5 minutes after your appointment is ended). Researchers from the University of Cambridge are now recommending (April 2019) that all pregnant women are offered a 'breech scan' at 36 weeks.
Some breech positions make it more difficult, maybe even hazardous, to vaginally than others. But if your baby is found to be breech in your last few weeks of pregnancy, don't panic: there are still quite a few options open to you and your midwife team, usually starting with an attempt to 'turn' your baby...
Why do we have to turn a breech baby?
Historically, if a baby was breech, the mother just had to get on with it and deal with the consequences - which may or may not be in the mum's and/or baby's favour. But these days, although many medical professionals may be concerned about a breech birth, it's not the worst problem to deal with if the midwife present, is experienced and other conditions make for a smooth and efficient labour.
However, it's still preferable the head comes down first, because the skull is the hardest, largest part of the body - and if it comes first, then the rest of the body will usually efficiently flow through after its delivery, while the baby is already exposed to air. If another body part comes down first and the head comes out last, there could be a danger that physiological injury could occur to the baby's body, and most importantly, there's a risk that the baby's air supply will be limited.
What will happen if my baby is breech in the last trimester?
Routine antenatal checks often reveal that babies are in the breech position early in the last trimester - and most of these babies will turn head-down in their own time and of their own accord. But if your baby is still breech at full term, at 37 weeks, you may be offered an external cephalic version, or ECV, where your practitioner externally manipulates your baby's position.
An ECV has around a 50 - 70% success rate for breech babies (and higher for transverse, or sideways presenting, babies) - depending on the practitioner. But you should be aware that there is a very small risk of the procedure causing placental abruption or foetal distress - which would result in an emergency caesarean section.
If you do end up having an ECV, your baby's heart rate will be closely monitored and you'll often have a scan during the procedure to alert doctors to any problems. Some doctors use a drug to relax the uterus during an ECV. Kim Kardashian's doctor did this when she was 37 weeks into her 2nd pregnancy and trying to turn her breech baby.
After she'd had the ECV, Kim said: "They don’t give you any pain medication, and let me tell you: This was soooooo painful. Probably more painful than childbirth. BUT it worked!!!”
And what are my options with a breech position just before term?
If you're still breech between around 32 and 36 weeks, your midwife will probably just adopt a 'watch and wait' policy on the situation - because some babies simply take longer than others to find their way head down.
If you have a large baby, an extra scan may be suggested in order to determine if there is enough room in the womb (which sounds a bit like the title of a Julia Donaldson kids' book!) and what the possibility of successful turning is.
Your midwife or specialist might begin to the discuss the need for a hospital birth (if you were hoping to have your baby at home). And as your due date nears, if the baby still can't be turned or hasn't turned itself, or is not in one of the 'easier' vaginal birth breech positions (if the baby's legs are folded and straight up for example), the likelihood of needing a caesarean section will be discussed with you.
Which is nothing to be frightened of, as MFMer Gina625 found out: "My baby was still breech at 37+2 and the consultant decided it was best in my case to have planned C-section in week 38.
"My baby was predicted to be large, over 9 pounds, plus they thought I had pregnancy related diabetes. All these factors made it safer for baby and me to have C-section. The baby's birth weight turned out to be higher than the scan showed. He was 10 pound 6!
"I did have plans for natural birth, TENS, water bath etc. But under the circumstances, I had to do what was best for baby."
So what does an ECV entail, exactly?
In most cases, an ECV means attending a normal antenatal clinic session rather than checking into hospital as an inpatient. As it is very unlikely to bring on labour, this will be a daytime appointment.
If you're offered medication to help relax your uterus, rest assured it's completely safe for your baby. Then your midwife will manipulate your bump with the aim of moving your baby into a head-down position. It can be a little uncomfortable but should not be extremely painful. (Tell that to Kim Kardashian!)
An ECV can be incredibly successful at moving your baby into the correct position for labour, if it's done right. Don't just take our word for it: this amazing video shows you just how it's done. In just 2 minutes. Wow!
You'll be asked to look out for bleeding afterwards as, in about one in 200 cases, the baby will require delivery by emergency caesarean after an ECV. However, the baby's heart beat is always monitored before and after an ECV to make sure that he or she has not been put under any dangerous stress.
If all that sounds a bit scary, take heart from MFMer cloclo's experience of an ECV: "My baby was breech. I went in to try and get her turned it really wasn't too bad. They gave me a muscle relaxant then put loads of talc on my tum (gives the doctor a better grip) then they scan to see baby is OK while they are trying turn."
Following the ECV, you'll be told how to look after yourself and your bump, in order to ensure that bleeding or discomfort do not signal any danger for you and your baby.
If the baby goes breech again, a further ECV may be attempted, but it's unlikely that a 3rd procedure would be suggested if the baby is still not head down. At that point your consultant may suggest an elective caesarean.
And what if they tell me I can't have an an ECV?
If you don't have a 'regular-shaped' womb, or there is another medical reason why a caesarean has already been advised, then you won't be offered an ECV.
And if you've experienced recent bleeding, it's unlikely this procedure will be suggested. Also, if your baby's heart rate is uneven or fast, then an ECV will not be carried out.
If you're expecting more than one baby, it's unlikely you'll have an ECV, unless this is the last child to be delivered and the other (or others) has been delivered safely before this last baby needs to be turned.
If you feel you need this procedure, but it hasn't been suggested by your midwife and/or consultant, feel free to discuss the issue with them as there may be ongoing medical reasons why they don't feel it's advisable in your case - and you're totally entitled to know what these may be.
Can I do anything myself to encourage my baby to turn?
There are complementary therapies that are scientifically unproven as helping to turn a breech baby, but often sworn by and recommended by some midwives and other mums. So do talk to your doctor before trying any of these:
- Exercises Many mums try to use gravity in an effort to get their baby to turn, raising their pelvis for between 5 and 15 minutes at least twice a day, and preferably every couple of hours. You can either lie on your back and raise your pelvis off the horizontal, supported by a cushion, or go on all fours with your bottom in the air and rest your head on your forearms.
- Acupuncture Some doctors are super-enthusiastic about acupuncture - others remain unconvinced. And while there's some evidence to support its efficacy for turning breech babies, it's far from conclusive. But if you choose to go down this route, you can expect your practitioner to concentrate on the acupressure point of your little toe, regularly stimulating it with a heated needle, moxibustion or massage. Hope you're not too ticklish!
- Hypnotherapy There's some evidence that women who use deep-relaxation methods in the final weeks of pregnancy have a higher chance of a breech baby turning.
- Homeopathy This is probably the most contentious of all complementary therapies. If you're interested in homeopathic treatment you should consult a qualified homeopath.
MFMer Busymamma says: "I was mooching thru the web - as you do - as my baby is 30 weeks and likes the transverse position, she switches occasionally but next morning viola ! She's back to transverse!
"So I was looking at ways of encouraging baby to move without intervention ( as I'm thinking she's going to be stubborn and stay put) and came across a blog of a lady who was carrying breech. She tried a few things and said the one that worked was a warm bath ( water almost over bump) and after a few minutes adding an ice pack for top of bump, baby didn't like a few mins of cold and turned on its own ( apparently!)
"Anyway I don't know for sure how successful it would be but I guess it could be worth a go? I'd suppose it's not far off having a really big cold drink lol"
To sum up, don't get scared if your baby's breech in the last 2 months of pregnancy: some babies like to keep you guessing till the very end!