Frank breech
Most common, around 65%
Baby's bottom is down, legs folded straight up against the body with feet near the head. Hips flexed, knees extended. Most suitable for vaginal breech birth if attempted.
You have time and you have options
Most babies settle into a head-down position before 36 weeks. If your baby is still breech at your 36-week appointment, your midwife will discuss your options with you, including a procedure called ECV that can safely turn your baby. You will have a choice and time to think.
This information is for general guidance only.
It does not replace advice from your midwife or obstetric team. Read more about our approach.
Breech baby: what it means and what your options are
What does breech mean?
A baby in the breech position is lying bottom-first or feet-first in the uterus rather than head-down. Throughout most of pregnancy this is perfectly normal. Babies move frequently, and many are breech until the third trimester. Around 3 to 4% of babies are still breech at the time of birth.
There are several positions a baby can be in. The most important distinction for birth planning is between breech and a transverse (sideways) position, which always requires a caesarean section.
Types of breech position
Complete breech
Knees and hips both flexed
Baby's bottom is down, knees and hips both flexed, so baby is sitting cross-legged. Can be suitable for vaginal breech birth in some cases.
Footling breech
Least common
One or both feet point down below the bottom. RCOG advises against attempting vaginal birth in footling breech. Caesarean section is recommended.
Transverse lie
Sideways, not strictly breech
Baby is lying sideways across the uterus. Cannot be born vaginally. Caesarean is required. If persistent at term, hospital admission may be advised due to a small risk of cord prolapse if membranes rupture spontaneously.
When is breech position checked?
At your 36-week appointment, your midwife will feel your bump (abdominal palpation) to assess your baby's position. If breech is suspected, an ultrasound scan will confirm.
Most babies turn spontaneously before 36 weeks. If still breech at 36 weeks, your options will be discussed. It is possible for a baby to turn to head-down after 36 weeks, either spontaneously or following an ECV.
External cephalic version (ECV)
What is ECV? A procedure where an obstetrician applies firm, gentle pressure to the outside of the abdomen to encourage your baby to turn to a head-down position. It is done in hospital with monitoring.
When is it offered? Routinely from 36 weeks for uncomplicated breech pregnancies. NICE recommends that ECV should be offered to all women with an uncomplicated breech pregnancy from 36 weeks.
How ECV works
- A relaxant medication (tocolytic) is given via injection to relax the uterine muscles.
- Continuous CTG monitoring of baby's heart rate throughout.
- The obstetrician places hands on your abdomen and guides baby through a somersault movement.
- Usually takes 5 to 10 minutes. Stopped after 2 unsuccessful attempts.
- Baby's heart rate monitored for at least 30 minutes afterwards.
How successful is ECV?
- Around 50% success overall.
- Higher if you have had a previous vaginal birth.
- A small proportion of babies revert to breech afterwards.
Is ECV safe?
- Yes. Serious complications are rare (around 1 in 200 procedures).
- Done in hospital so emergency caesarean is available if very rarely needed.
- You can decline ECV. It is entirely your choice.
When ECV is not suitable
- Placenta praevia
- Recent vaginal bleeding
- Certain uterine abnormalities
- Ruptured membranes
- Some cases of pre-eclampsia
Your consultant will assess whether ECV is suitable for you.
Can you encourage your baby to turn?
Some women try home techniques to encourage a breech baby to turn. Evidence is limited, but these are generally safe:
- Moxibustion: a traditional Chinese medicine technique with a moxa stick near the little toe. Some small studies suggest possible benefit. Best done by a trained practitioner.
- All-fours position (hands and knees): rocking or spending time this way may encourage baby to engage head-down.
- Swimming and gentle exercise: some women find babies turn after swimming. No strong evidence, but no harm.
What does not work: playing music near the pelvis, shining a torch near the bump, or ice packs are sometimes suggested but have no evidence of effectiveness.
Do not try to turn your baby yourself. ECV must only be performed by a trained obstetrician in hospital.
Birth options if your baby remains breech
Option 1: Planned caesarean section
- The most commonly recommended option for breech babies in the UK.
- Planned at 39 weeks for uncomplicated breech.
- RCOG advises that planned caesarean carries slightly lower short-term risk to baby than vaginal breech birth.
Recovery: see our c-section recovery guide.
Option 2: Planned vaginal breech birth
- A valid option at consultant-led units with obstetricians experienced in vaginal breech birth.
- RCOG: vaginal breech birth is an acceptable option for carefully selected women at units with appropriate expertise.
- Best suited to frank or complete breech, adequate pelvis size, no other complications, and an experienced clinical team.
- Not suitable for footling breech, previous caesarean, very large or very small baby, or certain maternal conditions.
- Not all hospitals offer it. Ask your consultant whether it is available at your unit.
Option 3: Emergency situation
If you go into labour before your planned caesarean with a breech baby, call your maternity unit immediately. If birth is imminent on arrival, a vaginal birth may proceed under specialist supervision.
Asking for a second opinion
You have the right to discuss your options fully, ask questions, and seek a second opinion. AIMS (Association for Improvements in the Maternity Services, aims.org.uk) can provide information on your rights around birth choices.
Related guides and tools
A note from our team
This guide reflects NHS UK, NICE and RCOG guidance on breech presentation and ECV. Your obstetric team is the best source of advice for your individual pregnancy. Read more about us.
Frequently asked questions
What is a breech baby?
A breech baby is one lying bottom-first or feet-first in the uterus rather than head-down. Many babies are in breech position earlier in pregnancy and turn spontaneously. Only around 3 to 4% of babies are still breech at the time of birth.
When should I worry about a breech position?
Before 36 weeks there is usually no reason to worry, as babies move frequently. If your baby is still breech at 36 weeks, your midwife will discuss your options including ECV, planned caesarean and planned vaginal breech birth where available. You will have time to think and ask questions.
How successful is ECV?
External cephalic version succeeds around 50% of the time overall, higher if this is not your first baby and slightly lower if it is. Even when successful, a small proportion of babies turn back to breech afterwards. ECV is a safe procedure, with serious complications in roughly 1 in 200.
Can I have a natural birth if my baby is breech?
Planned vaginal breech birth is an acceptable option at consultant-led units with experienced obstetricians, according to RCOG guidance. It is best suited to frank or complete breech, adequate pelvis size and no other complications. Not all UK hospitals offer it, so ask whether it is available at your unit.
Will I need a caesarean if my baby is breech?
A planned caesarean at 39 weeks is the most commonly recommended option for breech babies in the UK. RCOG guidance is that planned caesarean carries slightly lower short-term risk to the baby than vaginal breech birth. A caesarean is definitely recommended for footling breech, transverse lie, or if other complications are present.
Can a breech baby turn after 36 weeks?
Yes. Babies can turn spontaneously after 36 weeks, and ECV from around 36 weeks is designed to help them turn. Even close to term some babies turn on their own. It becomes progressively harder as space reduces, so if you are choosing ECV, doing it promptly after being offered gives the best chance.
What is moxibustion and does it work?
Moxibustion is a traditional Chinese medicine technique using a burning moxa stick near the little toe to stimulate foetal movement. Some small studies suggest possible benefit and it is generally considered safe when done by a trained practitioner, but the evidence is limited. It does not replace an ECV or an obstetric discussion.