Yes, breech presentation is a variation of normal late pregnancy, but delivery plans and risks depend on type and timing.
Breech presentation means a baby sits bottom-first or feet-first near term instead of head-down. Most turn by 36–37 weeks, yet a small share stay bottom-first at delivery. If a scan shows this position late in pregnancy, the question shifts from “why” to “what next.” This guide lays out what it means, common types, safety, and the choices your team may offer.
Is Breech Presentation Normal In Late Pregnancy?
Earlier in pregnancy, bottom-first positioning is common and often flips on its own. Near term, it settles to roughly three to four in one hundred births (RCOG patient information). That makes it uncommon at delivery, yet not a mistake by the body. The key is matching the plan to the exact type, the week of pregnancy, the baby’s well-being, and the skills available in your hospital.
Types Of Breech And What They Mean
Not all bottom-first positions act the same in labor. The three classic patterns guide counseling, monitoring, and the plan for birth. Use the table to get a quick feel for the differences.
| Type | What It Looks Like | Why It Matters For Birth |
|---|---|---|
| Frank | Hips flexed, legs straight up by the chest, bottom nearest the cervix | Most common near term; can suit planned vaginal breech birth in select units |
| Complete | Hips and knees flexed, sitting “cross-legged,” bottom first | May be compatible with planned vaginal delivery in trained settings |
| Footling / Incomplete | One or both feet or knees come first | Higher risk of cord issues; usually steers plans toward cesarean |
Why A Baby Might Stay Bottom-First
Sometimes it is chance. Sometimes the uterus shape, placenta location, fluid levels, or twins leave less room to flip. A late scan checks the exact position, the baby’s head tilt, growth, fluid, and where the placenta sits. These details shape the plan far more than a single label.
How Providers Confirm The Position
A hands-on exam can hint at the lie, yet ultrasound settles it. Imaging also checks the neck posture, leg position, placenta, and fluid. Near term, your team will also watch the heart rate pattern and talk through choices for turning the baby or planning the safest birth route.
Options When The Baby Is Still Bottom-First At 36–37 Weeks
Choices usually include trying to turn the baby on the outside, scheduling a birth by surgery, or planning a vaginal breech birth in a unit with clear protocols and skills. Each path has benefits and trade-offs that depend on your history and local services.
Trying To Turn The Baby (External Cephalic Version)
External cephalic version (ECV) uses firm, steady pressure on the belly to guide the baby head-down. It is done near term with ultrasound, baby monitoring, and medications that relax the uterus. Many centers also offer epidural or spinal pain relief to lift the chance of success. Guidance on technique, timing, safety checks, and counseling sits in the ACOG bulletin on ECV.
Across large reviews, the average success rate sits near the mid-fifties percent range, with low rates of serious problems. If the turn works, the odds of a head-first vaginal birth go up. If it fails, you can still plan the birth route that fits your situation.
Planning A Cesarean Birth
Many hospitals schedule surgery for a persistent bottom-first position, as this lowers certain baby risks. For the mother, surgery brings the usual recovery time and adds risks that rise with repeat procedures. Shared decision-making weighs today’s safety with future pregnancy plans.
Planning A Vaginal Breech Birth
Some units offer vaginal breech birth with strict criteria, continuous monitoring, a trained team, and readiness to move to surgery if labor stalls or the tracing changes. Frank or complete types with a flexed head and average size are the usual candidates. Footling presentation, a very tilted neck, growth extremes, or a low-lying placenta generally rule it out.
Safety, Risks, And What The Numbers Say
With head-first births, the head molds and leads. With bottom-first births, the largest part may come last, which can trap the head or pinch the cord. Modern care reduces those risks through selection, positioning maneuvers, and clear thresholds for switching course. ECV has a small chance of needing urgent surgery the same day, so it is done where a team and theater are ready.
What To Expect During An ECV Visit
Before the attempt, staff check the lie with ultrasound, review the placenta and fluid, place monitors, and give a shot to relax the uterus. During the attempt, a clinician uses their hands to roll the baby into a head-first position. If it feels too sore, they stop. Afterward, they recheck with ultrasound and monitoring. If your blood type is Rh-negative, you receive anti-D.
Who Might Not Be Offered A Turn
ECV is not offered when a vaginal birth would be unsafe for other reasons, with current heavy bleeding, an abnormal tracing, waters already broken, or certain multiple pregnancies. A prior cesarean does not automatically rule it out in many centers.
Is A Bottom-First Baby Viewed As Normal Near Term?
Yes in the sense that the body often makes healthy babies that simply settle in a different pose. The plan changes because labor mechanics differ, not because the baby is “abnormal.” The next steps are to confirm the pattern, review your history, and match the plan to skills available where you will give birth.
How Your Birth Plan Gets Tailored
Good plans write out a default path and a flip path. Many teams book a surgery date while still offering a turn attempt. If the baby flips, the plan shifts back to head-first labor. If the turn fails or the baby flips back, the team follows the default route. That way, you avoid last-minute scrambles.
Signals That Favor A Turn Attempt
- Frank or complete type, average fluid, and a flexed head
- Healthy placenta location and no heavy bleeding
- Reassuring heart tracing and a term pregnancy
- Access to staff who do ECV often
Signals That Reduce The Odds Of A Successful Turn
- Low fluid, a tight belly wall, or a back-forward baby spine
- Very firm uterus or early contractions
- First pregnancy in some data sets
- Hospitals with low ECV volumes
Birth Room Care When Proceeding With Vaginal Breech
Units that offer this path keep a ready team, use continuous monitoring, and avoid early induction. Upright or hands-and-knees positions may help the baby descend. If progress stalls or the tracing dips, the team moves quickly to surgery. A pediatric specialist is often present to check the baby after birth.
Second Table: Options, Timing, And What To Expect
| Choice | When It’s Used | Key Points |
|---|---|---|
| Watchful Waiting | Late third trimester while natural turning may still occur | Some babies flip on their own; recheck position by 36–37 weeks |
| External Cephalic Version | Usually 36–38 weeks in hospital with monitoring | About half succeed; small chance of same-day surgery if the tracing changes |
| Planned Cesarean | When risks for vaginal breech are high or unit lacks trained staff | Reduces certain baby risks; extends recovery and may affect future births |
| Planned Vaginal Breech | Select cases with a trained team and clear criteria | Needs continuous monitoring and rapid access to theater |
Turning Methods Outside The Hospital
Many posture routines trend online. Evidence for do-it-yourself methods is thin. If you want to try gentle moves, run them by your midwife or doctor and stop if anything hurts. Some centers mention moxibustion in weeks 33–35; ask about local practitioners and safety steps.
Chances In A Future Pregnancy
After one bottom-first birth, the odds are a bit higher next time, but most babies will still settle head-down. Early third-trimester checks help spot the lie and reserve an ECV slot if needed. If you had surgery, talk through spacing, placenta risks, and the plan for mode of birth next time.
Long-Term Outlook For The Baby
Near-term bottom-first position links to labor mechanics, not to how a child grows or learns. With modern selection and timely decisions during labor, families can expect reassuring long-term outcomes once a safe route to birth is chosen.
How To Read Guidelines And Local Practice
National bodies publish broad guidance, yet care always reflects the staff and setup where you will deliver. Ask which pathways your unit offers, whether a trained breech team is available around the clock, and how they rehearse drills for a quick change of plan. Clear answers help set expectations, ease nerves, and keep everyone on the same page.
What To Ask Your Team
- Does our unit offer ECV and pain relief for it? What are local success rates?
- Who on the team is trained for vaginal breech birth and what are the criteria?
- If surgery is booked, how will skin-to-skin and feeding be arranged?
- What signs during labor would switch us to a new plan?
Practical Next Steps
- Confirm the exact type and head posture with ultrasound near 36–37 weeks.
- Ask whether your unit offers ECV, typical success rates locally, and pain relief options.
- If ECV is offered, plan monitoring the same day and set a backup route.
- Review candidacy for vaginal breech birth if your hospital runs a trained program.
- If surgery is booked, ask about timing, skin-to-skin, and feeding plans in theater.
Trusted Sources For Deeper Reading
Clear public guides explain the numbers, safety checks, and choices. Strong starting points include the RCOG breech page and the ACOG bulletin on ECV. Bring these to your visits when you map out a plan together.