Being told your baby is in a breech position at 35 weeks means the baby is positioned with their bottom or feet facing down toward the cervix. This orientation occurs in about 3 to 4% of pregnancies carried to term, though most breech babies earlier in the third trimester turn spontaneously. At 35 weeks, the window for medical and non-medical interventions is open. You should work closely with your healthcare team to understand your specific circumstances and make an informed decision about the path forward.
Understanding the Specific Position
The term “breech” encompasses several different positions, and the baby’s exact posture inside the uterus has a direct bearing on the risks and potential success of turning attempts. The three main types are distinguished by the position of the baby’s legs and hips.
The most common type is the Frank Breech, where the baby’s buttocks are aimed at the birth canal, with both legs extended straight up toward the head. This accounts for about 50 to 70% of all breech presentations at term. The Complete Breech is less common, involving the baby sitting cross-legged with both hips and knees flexed.
The Footling Breech occurs when one or both of the baby’s feet are positioned to present first through the cervix. This presentation carries a higher risk of complications, such as cord prolapse, because the small foot may not provide enough pressure to prevent the umbilical cord from slipping down first. Due to this increased risk, the Footling Breech is generally the most concerning type for attempting a vaginal delivery.
External Cephalic Version (ECV)
External Cephalic Version (ECV) is a medical procedure performed by a trained obstetrician to manually rotate the baby from a breech to a head-down position. This procedure is typically attempted around 36 to 37 weeks of pregnancy, as the baby is still small enough to move, but the risk of spontaneous reversion is lower. ECV is usually performed in a hospital setting near an operating room, ensuring emergency resources are immediately available.
During the procedure, the doctor uses firm, gentle pressure on the abdomen to guide the baby’s head downward in a somersault motion. An ultrasound monitors the baby’s position, and the heart rate is continuously tracked. To increase success, medication called a tocolytic, such as Terbutaline, is often administered to relax the uterine muscles.
The overall success rate for an ECV is approximately 58%, though success is higher for women who have delivered before. The most common risk is a temporary change in the baby’s heart rate, occurring in about 60% of cases, which usually resolves when pressure stops. Serious complications, such as placental abruption or the need for an emergency C-section, are rare, occurring in less than 1% of attempts.
Non-Medical Methods for Encouraging Turning
Several non-invasive, complementary techniques can be used to encourage the baby to turn, often starting before 37 weeks. These methods focus on creating more space in the pelvis and relaxing the uterine muscles to allow the baby to move on their own.
Gravitational Techniques
Gravitational techniques are common, such as the Forward-Leaning Inversion. This involves kneeling with hips elevated and forearms on the floor, allowing the belly to hang freely.
Webster Technique
The Webster Technique is a specific chiropractic adjustment that aims to balance the pelvis and release tension in surrounding ligaments and muscles. The theory is that removing structural restrictions allows the uterus to relax, offering the baby more room to maneuver into the head-down position.
Moxibustion
Moxibustion, rooted in Traditional Chinese Medicine, involves burning mugwort near an acupuncture point on the little toe. The heat is thought to stimulate the point, which can increase fetal activity and encourage the baby to move. These supportive techniques are best used in consultation with a healthcare provider.
Delivery Options if the Baby Remains Breech
If all attempts to turn the baby, including ECV, are unsuccessful, the final decision involves selecting the safest method of delivery. The most common path for a persistent term breech presentation is a planned Cesarean Section (C-section). A planned C-section is often recommended because it reduces the risk of perinatal mortality and severe short-term neonatal morbidity compared to a planned vaginal breech delivery.
A Trial of Labor and a planned vaginal breech delivery may still be an option under specific, strict criteria. These criteria include:
- The baby must be a specific type of breech, typically Frank or Complete.
- The baby’s weight must be within a particular range, generally not excessively large or small.
- The provider must have specialized expertise in managing a vaginal breech birth.
- The birth must occur in a hospital fully equipped for an immediate emergency C-section.
The decision between a planned C-section and a trial of labor requires a detailed discussion with your obstetrician, weighing the risks and benefits. While a planned C-section carries a higher risk of severe maternal complications compared to a vaginal delivery, it offers a reduced risk of serious complications for the baby in a breech presentation. Ultimately, the choice involves shared decision-making, prioritizing the safety of both the birthing person and the baby.