Breech presentation and turning the baby
What is a breech presentation?
Towards the end of pregnancy, most babies will move into a position to allow them to be born headfirst through the birth canal.
This normal head first presentation is the safest and easiest position for birth and in most cases, will occur naturally.
Some babies however may present in a:
- breech position (bottom first)
- transverse position (lying sideways).
Breech presentation is when the baby is positioned bottom first before birth.
It is common in premature or twin pregnancies.
Preparation for birth
If your baby is in a breech position 4 to 5 weeks before you are due to give birth, your obstetrician (doctor) may recommend turning your baby into a normal head first position. This procedure is called external cephalic version (ECV).
ECVs take place after 36 weeks gestation.
Turning the baby
Before your ECV you will need an ultrasound to:
- check the position and wellbeing of your baby
- make sure the doctor can go ahead with the procedure.
There are a number of reasons why your doctor may not decide to do an ECV, such as the position of the placenta and the size of your baby. For you and your baby’s safety, your doctor may recommend a caesarean section instead.
The ECV procedure is usually performed in the Maternal Fetal Assessment Unit where a midwife can care for you.
You will need to empty your bladder before the procedure can take place and will be given an injection 20 to 30 minutes prior to the procedure in your leg. The injection contains a medication called terbutaline which will relax the muscles of your uterus and make it easier to turn your baby.
Your doctor will ask you to either:
- lie on your back with your knees slightly bent
- position yourself on all fours.
The doctor will use both hands to gently turn the baby. Another ultrasound is performed to make sure you baby is in the normal head first position.
If the baby remains in the new position, a vaginal birth will be much easier.
Sometimes the baby will turn back to a breech position, either immediately or within several days. The doctor may discuss with you the possibility of repeating the ECV.
The procedure can take up to 2 or more hours.
What are the risks?
When an ECV is performed by a doctor as described above, the risks are very low. However, as with any medical procedure complications may occur.
These include:
- failure to successfully turn the baby
- bleeding from the placenta (this may mean an urgent caesarean is needed)
- decreased movements of the baby.
Discharge advice
Whether the procedure was successful or not, it is important that you contact your doctor or Hospital if you notice any of the following changes:
- vaginal bleeding
- baby is less active than usual
- vaginal fluid loss
- contractions
- abdominal (stomach) pain.
Costs
For an Australian patient in a public hospital in Western Australia:
- public patient – no cost to you unless advised otherwise
- private patient – costs can be claimed through Medicare and your health insurance provider.
For a patient in a private hospital or private imaging site in Western Australia – ask your doctor or the staff where you are having your test done.
Where to get help
- See your doctor.
- Talk to your midwife.
- Ring healthdirect Australia on 1800 022 222.
Remember
- Most babies move into a normal head down position 4 to 5 weeks before their due date.
- Breech presentation is when the baby is positioned bottom first.
- Your doctor may recommend moving your baby into a normal head down position.
- This procedure is called external cephalic version (ECV).
Acknowledgements
King Edward Memorial Hospital
This publication is provided for education and information purposes only. It is not a substitute for professional medical care. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your healthcare professional. Readers should note that over time currency and completeness of the information may change. All users should seek advice from a qualified healthcare professional for a diagnosis and answers to their medical questions.