Breech Presentation After 36 Weeks of Pregnancy
If you discover your baby is breech at 36 weeks, it can be a lot to process, especially if you had a specific birth plan in mind. The good news is that breech presentation after 36 weeks of pregnancy is more common than you think, and there are several well-established options after 36 weeks of pregnancy that your midwife and obstetrician will walk you through. Let's lay this on the table so you know exactly what to expect and what options you really have.
What Does Breech Presentation Mean at This Stage?
During much of the pregnancy, babies move freely, turning and twisting inside the womb. It is common to have a breech presentation in the first and second trimesters, and by 37 weeks most babies will be head down and ready for birth. If a baby is still bottom or feet first after 36 weeks, they are said to be breech, and it becomes unlikely they will turn on their own from this point, simply because there is less room left to move.
3 to 4 in every 100 babies remain breech at term. This is not unusual and usually means there is nothing wrong with your baby. It is usually a matter of where they happened to settle as the space in the womb got tighter.
There are some recognised types of breech position:
Frank breech: baby's bottom down, legs extended straight up toward the head.
Complete breech: Bottom down, knees bent, feet tucked close to bottom.
Footling breech: one or both feet are pointed downward to come out first.
How Is Breech Presentation Confirmed?
At routine antenatal appointments, usually from about 36 weeks, your midwife will feel your abdomen to check your baby’s position. If you are thought to be in a breech position, you will be offered an ultrasound scan to confirm the exact position and a check of your amniotic fluid levels and where your placenta sits.
At myGynaePlus, all of our ultrasound scans are carried out by senior sonographers and experienced consultants who will give you your results on the day and explain clearly where your baby is positioned and give you advice on what to do next. Knowing this early means you and your care team have more time to calmly talk through your choices, rather than under pressure closer to labour.
What Causes Breech Presentation?
Most women don’t have a good reason why the baby hasn’t turned. That is largely a matter of luck. That said, there are some factors associated with an increased chance of breech presentation, including:
This being a first pregnancy.
A previous breech baby or a parent who was breech themselves.
Uterine abnormalities, such as fibroids or an abnormally shaped uterus
Placenta praevia. The placenta is low in the womb.
Too much or too little amniotic fluid
Twin or multiple pregnancy
Older maternal age
None of these alone mean that your baby will definitely remain breech, and the majority of breech babies are born perfectly healthy.
Options After 36 Weeks of Pregnancy
Once breech presentation has been confirmed after 36 weeks, your midwife and obstetrician will discuss your options. Decision-making here is about weighing up your own wishes with the potential risks to you and your baby. There is no one right answer for all.
1. External Cephalic Version (ECV)
The first option usually offered is an ECV. Your obstetrician presses gently but firmly on your abdomen in an effort to turn your baby to the head-down position. You will be given an injection to relax your womb before the procedure, and your baby's heart rate will be checked before and after.
ECV is successful about half the time to 60 per cent of the time. It’s a relatively safe procedure and can feel uncomfortable at times. If you succeed, your chance of a simple vaginal birth goes up significantly. There is a very small chance the baby could turn back to breech afterward, but this is closely monitored.
2. Planned Vaginal Breech Birth
If you are eligible, you may be able to plan to give birth vaginally in the breech position. This is usually more difficult than a head-down delivery because the biggest part of the baby's body, the head, is born last, not first. Not every hospital or every pregnancy is suitable for this route, and your obstetric team will consider factors such as the type of breech position, your baby’s estimated size, and the shape of your pelvis before suggesting this route.
3. Planned Caesarean Birth
Many women with a breech baby at term opt for a planned caesarean section, as it generally has fewer risks than a vaginal breech delivery. Your obstetrician can talk with you about what to expect and how the recovery usually happens and how that compares with a vaginal breech birth for your particular situation.
4. Watching and Waiting
You don’t have to make a final decision when a breach is confirmed. There is a small possibility your baby will turn their head down even after 37 weeks, but the closer you get to your due date, the less likely this is. Your midwife can book you another scan nearer the time to see if there is any change.
Complementary Approaches Some Women Try
In addition to the main clinical options, some women also think of other ways to encourage their baby to turn, often with the knowledge and support of their midwife rather than instead of it. These comprise:
Moxibustion is a form of Traditional Chinese Medicine that involves the application of gentle heat to an acupuncture point on the little toe. A Cochrane review found that moxibustion before 37 weeks probably reduces the chance of a baby being breech at birth but does not seem to reduce the overall number of caesarean births.
Optimal foetal position includes postures such as the breech tilt or forward-leaning posture, which is meant to provide the baby more room to turn.
Acupuncture, sometimes combined with moxibustion to aid relaxation and stimulate movement.
These approaches are not currently available on the NHS, and evidence of how well they work varies. If you are thinking of having any of these, it is a good idea to go to a properly qualified practitioner and tell your midwife or obstetrician so that it can be taken into account in your ongoing care.
What to Expect at Your Appointments
Your antenatal appointments after 36 weeks will usually include:
Physical examination of your baby's position. Feeling of your abdomen.
If breech is suspected, an ultrasound scan to confirm position and check fluid levels.
Options for you, including ECV, vaginal breech birth, and caesarean birth.
A follow-up plan including when to re-evaluate if you choose to wait and see.
If you have concerns or want more detail on any of these routes before you make your choice, you can ask to speak to a consultant midwife or obstetrician at any time.
When to Contact Your Midwife or Doctor
Contact your maternity team straightaway if you see:
A sudden change in your baby’s movements
New or unusual pain, bleeding or loss of fluid
Worries about your baby’s position as labour approaches
No matter what position your baby is in, always get any reduced or altered foetal movement checked out straight away.
Final Thoughts
Finding out your baby is breech after 36 weeks is not the end of your birth plan; it is just a point where you and your care team sit down and map out the safest route forward together. Whether that means trying an ECV, planning a vaginal breech birth, choosing a caesarean, or waiting a little longer to see if your baby turns on their own, you have real, well-supported options after 36 weeks of pregnancy. If you’d like to have your baby position checked or talk through what’s right for you, the antenatal team at myGynaePlus can arrange a scan and walk you through each option clearly.
Frequently Asked Questions
Can a baby still turn head-down after 36 weeks?
It can happen, but the closer you are to your due date, the less likely it is, as there isn't much room left in the womb. Many women are offered an ECV to help encourage the turn at this time.
Is ECV painful?
Most women say that ECV is uncomfortable, rather than painful, because of the firm pressure on the abdomen. You will be closely monitored throughout, and the procedure is stopped immediately if you experience too much discomfort or if your baby shows signs of distress.
Do all breech babies need a caesarean?
“Not a bit. Depending on the type of breech, the size of the baby and the resources of the hospital, some women will go on to have a planned vaginal breech birth. Your obstetric team will help you weigh up what is the safest route for your situation.
How successful is ECV at turning a breech baby?
ECV is effective in turning the baby about half to 60 per cent of the time. Women may have a slightly higher success rate if they have had children before, as the uterus and abdominal muscles are more relaxed.
What happens if my baby stays breech until labour begins?
If labour starts before a decision is reached, your midwife and obstetrician will quickly assess the situation and discuss the safest delivery option based on how established labour is and your baby’s position at that time.
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