Receiving a diagnosis that your baby is in a breech position at 35 weeks can feel stressful as the end of pregnancy approaches. Breech presentation means the baby is positioned with their feet, buttocks, or knees aimed toward the birth canal instead of the head. While most babies naturally move into the head-down position earlier in the third trimester, approximately three to four percent remain breech by the time pregnancy is considered full-term. Discovering this position around 35 weeks prompts discussion between parents and care providers about options for turning the baby or planning for delivery.
Understanding the Breech Diagnosis
The term breech presentation encompasses several distinct ways a baby can be oriented in the uterus, and the specific type is confirmed through an ultrasound examination. The most frequently observed position is a Frank Breech, where the baby’s buttocks are positioned downward, but the legs are extended straight up with the feet near the head. This “pike” position is seen in more than half of all breech presentations.
Another variation is the Complete Breech, characterized by the baby sitting with both the hips and knees flexed, resembling a crossed-legged, tucked position. In contrast, the Footling or Incomplete Breech occurs when one or both of the baby’s feet are positioned lowest, below the buttocks, ready to enter the pelvis first. The precise diagnosis of the breech type helps guide discussions about potential delivery methods or attempts to reposition the baby.
Spontaneous Turning and the Window of Opportunity
While the vast majority of babies have settled into a head-down position by 34 weeks, a small chance remains for spontaneous turning between 35 and 37 weeks. The likelihood of a natural shift decreases significantly as the baby grows and the volume of amniotic fluid relative to the baby’s size diminishes. This reduction in space makes maneuvering more difficult.
Many parents explore non-medical methods to encourage the baby’s rotation during this window. Techniques that involve specific maternal positioning aim to optimize the pelvic space and relax the uterine ligaments. Examples include pelvic tilting, where the mother lies with her pelvis elevated, or the forward-leaning inversion, which temporarily uses gravity to create more room.
Acupuncture and moxibustion are also commonly discussed non-invasive approaches. Moxibustion involves safely burning dried mugwort near a specific acupuncture point on the mother’s little toe, with the theory that the heat stimulates fetal movement. While scientific evidence supporting these non-medical techniques varies, any non-medical intervention should be discussed with a healthcare provider before beginning.
External Cephalic Version (ECV)
If the baby remains breech around 36 to 37 weeks, the primary medical intervention offered is an External Cephalic Version, or ECV. This procedure involves a healthcare provider using their hands to apply firm pressure to the mother’s abdomen to manually guide the baby into a head-down position. The ECV is performed in a hospital or clinic setting where emergency services are readily available, typically around 37 weeks of pregnancy.
Prior to the attempt, mothers are often given a medication called a tocolytic, such as Terbutaline, which temporarily relaxes the uterine muscle. This relaxation increases the flexibility of the uterus, significantly raising the chances of a successful turn. Throughout the procedure, the baby’s heart rate is continuously monitored to ensure the baby is tolerating the external manipulation.
The success rate for ECV is approximately 50 to 60 percent, though it is often higher for women who have had previous vaginal births. Although generally safe, the procedure carries a small risk of serious complications, including placental abruption, where the placenta separates from the uterine wall. There is also a slight chance the procedure could trigger early labor or cause temporary changes in the baby’s heart rate, which is why immediate access to an operating room for an emergency Cesarean section is mandatory.
If the ECV is successful, the mother can proceed toward a standard vaginal delivery, although there is a slight chance the baby could turn back to a breech position, which happens in about three percent of cases. When the ECV is unsuccessful, or if a mother chooses not to attempt the procedure, the focus shifts to planning the safest delivery method for a persistent breech presentation.
Planning Delivery for a Persistent Breech
When the baby remains breech after 37 weeks and an ECV has either failed or was not attempted, the final stage is to plan the delivery. For a persistent breech presentation, a scheduled Cesarean section is the most common and safest route for delivery in modern obstetrical practice. A planned C-section allows the healthcare team to manage the risks associated with the baby’s non-head-down positioning during birth.
A planned vaginal breech delivery is rarely performed and is considered only under very specific and limited circumstances. These criteria typically include a Frank or Complete breech presentation, an estimated fetal weight that is neither too small nor too large, and a mother who has a pelvis deemed adequate for birth. Furthermore, a vaginal breech birth should only be attempted when an experienced provider is available who is skilled in managing the nuances of this delivery.
Due to the increased risks associated with a vaginal breech birth, such as cord prolapse or the baby’s head becoming trapped, the standard recommendation is a Cesarean delivery. Ultimately, the decision for the final delivery plan is a collaborative one, made by the parents and the medical team, balancing the risks of a C-section against the potential complications of a vaginal breech delivery.