Numbered among all the amazing ways our bodies and our babies work together to prepare for birth, is this: towards the end of pregnancy, both gravity and anatomy contrive to allow the biggest part of the baby (that is, the head) to be born first so that the cervix can dilate properly.
By approximately 36 weeks, you’ll find out from your pregnancy healthcare professional, either by manual assessment or by ultrasound, whether your baby has achieved this ideal, head-down (called “cephalic” or “vertex”) position. If your baby isn’t head down by this point (that is, if he or she is breech), your doctor may want to discuss the possibility of a C-section delivery. The good news? Most babies will be in this position by this time.
But what if your baby не head down? If you find yourself with a stubbornly breech baby, what can be done? Are you destined to give birth via a Кесарево сечение you might not prefer? Maybe not. There are plenty of things you can try to get your baby to “flip” to the head down position during these last weeks of pregnancy.
But first, what exactly do we mean by “breech”?
For the majority of pregnancy, your baby’s dancing around in there
For the first couple of trimesters, your little baby has plenty of room to move around in your spacious uterus. That’s why there’s really no standard direction for a baby to settle into until at least 24 weeks. But, as he or she approaches full term (37 weeks) and starts to reach the limits of the available space, the weight of the baby’s head will typically start to turn him or her downwards (thank you, gravity!). By this point in pregnancy, approximately 96-97% of babies will be head down, aka vertex.
The other 3-4% are either sideways (transverse), diagonal (oblique), or head-up, ( breech). There are three basic categories of breech presentations:
- Complete (both knees tucked) or incomplete breech (one knee tucked)
- Footling breech (feet presenting first, legs extended)
- Frank breech (feet straight up, buttocks presenting first)
In some parts of the world, and in some select medical practices, you might be able to deliver a breech baby vaginally. However, in many parts of the world, including the US, the standard recommendation is to schedule breech babies for C-section deliveries.
While you always have medical autonomy, you’re also just not going to be able to twist your OB’s arm into attempting a delivery she deems too risky or hasn’t been adequately trained to do. So, in many places, breech = C-section… если только you can manage to get the baby to turn head-down before delivery.
How to turn a breech baby
In another brilliant feature of pregnancy engineering, the tightening quarters of the Матка, combined with gravity and maternal movements, push the baby downwards against the шейка матки. This helps the uterus’ exit prepare for effacement and dilation in anticipation of birth. This means that, whatever position your baby is lying in, he’s probably wedged down into your pelvis in some way. This means that if you want to flip your baby, you’ll first have to loosen him up a bit and lift him out of that pelvic bowl, then give him the opportunity to settle back down again, hopefully in the proper orientation. Keep this order of operations in mind, because all the maneuvers we’ll be discussing follow this same basic goal. Lift, flip, settle.
If you want to flip your baby, you’ll first have to loosen him up a bit and lift him out of that pelvic bowl, then give him the opportunity to settle back down again, hopefully in the proper orientation. Keep this order of operations in mind, because all the maneuvers we’ll be discussing follow this same basic goal. Lift, flip, settle.
There are several ways to attempt to do this, and some are more hands-on than others. Every success story will probably swear by a different method, and at the end of the day, a baby is an entire person who might just not want to be budged. All we can do is everything we can to make it as easy as possible for him to flip—if he wants to.
Note: it’s also okay if the attempt feels like it’s not worth it. You may decide that scheduling a C-section is the best choice for you and your baby at this juncture. But if you clicked a “how to flip a breech baby” article looking for every possible exercise you can try, then read on.
Turning a breech baby with a doctor’s help
If your baby isn’t head down by 36 weeks or so, your doctor may offer you an “ECV” (external cephalic version). Often involving two doctors, and always with careful monitoring and in easy reach of an operating room in case something were to go wrong, the goal is to physically, externally maneuver your baby to rotate (“version”) his head (“cephalic”) into that vertex position.
This procedure can range from uncomfortable to painful. Some women find it trivial, others find it more traumatic. I underwent an unsuccessful and pretty painful ECV with my first baby, but honestly, if I had another breech baby, I would still be willing to try an ECV again if one was offered. For me, the potential benefits of a vaginal birth outweighed everything else. Your own calculations might lead you in another direction.
ACOG cites a roughly 50% success rate for ECV, influenced by a number of factors. You can estimate your odds with this calculator. For example, odds go up if this isn’t your first pregnancy, and go down if you have an anterior placenta. A 2024 meta-analysis found that anesthesia can increase this success rate further, though with an increased risk of maternal hypotension [1]. Other risks to consider in the ECV decision include complications like premature rupture of membranes (PROM), placental abruption, preterm labor, or fetal heart rate concerns, all of which could, with various degrees of urgency, require your baby to be born that day.
This is one of the reasons why ECVs are done in a hospital setting with an OB ready to take care of you and your baby if anything goes wrong, and why you will be monitored before and afterwards to make sure your baby is tolerating everything well. Thirty six to thirty seven weeks is generally considered the safest timing of an ECV to maximize success without unnecessarily increasing the risks of a premature baby.
You should also know that even successful ECVs can reverse themselves, and the baby can flip back into a breech position. Sometimes there’s a good anatomical reason (like uterine abnormalities, cord length, or placental location) for your baby to be breech, but sometimes we don’t know why babies like being head up; maybe he’s just comfortable in there!
You should also know that even successful ECVs can reverse themselves, and the baby can flip back into a breech position. Sometimes there’s a good anatomical reason (like uterine abnormalities, cord length, or placental location) for your baby to be breech, but sometimes we don’t know why babies like being head up; maybe he’s just comfortable in there!
Trying to flip a baby at home
If your ECV is unsuccessful, or if you opt not to try one, you still have some options to try before resigning yourself to a C-section.
Change up your posture, sleep position, and exercise
As much as you’re going to hate me for telling you this, at 8 months pregnant, it’s possible that your posture has been a problem. Slouching, reclining, or crossing your legs can all be risk factors for breech presentation. These positions can constrict the pelvis, and push baby into your spine instead of giving him room to move around. Whenever possible, do your best to sit with your knees lower than your hips, legs wide apart, upright or leaning slightly forward. And of course, don’t sit too much; get plenty of movement in your day as well.
You can also tweak your sleeping position to give your baby the best chance to flip. In your third trimester, you should be sleeping on your side anyway. Try adding a pillow between your legs to open your pelvis, and roll slightly forward to give your baby room to lift out and readjust.
When you’re up and about, include gentle exercises like walking, squats, or hip circles on a yoga ball. Once you’ve allowed the baby to get unwedged from your pelvis, these movements should help him to re-settle in the right direction.
Finally, it’s possible that muscle or ligament tightness caused by postural changes or habitual movements could be contributing to a difficult environment for the baby to position properly. If you suspect this could be the case, физиотерапия тазового дна or chiropractic care might be worth looking into. If you seek chiropractic care, look for a professional trained in the Webster technique for adjustments during pregnancy. The goal here is to release anything that could be holding your baby too tightly in the pelvis to allow him to turn.
Consider acupuncture / alternative medicine
You can also look into moxibustion, a Chinese medicine technique that involves burning mugwort near an acupuncture point on the little toe called BL67. This is sometimes complemented with classic acupuncture to the same site. There are a surprising number of research papers studying this topic, some of which found positive results [2]. The technique has very few negative risks, so it might be worth looking into if you get particularly desperate to flip your baby.
Look into the Spinning Babies program
Last, but most certainly not least, spend some time perusing SpinningBabies.com, specifically their article “Flip a Breech.” Spinning Babies has paid courses as well as plenty of free information, including lots of advice for trying to flip a breech baby. Following their advice involves lying upside down and other funny positions, but many swear by them.
If your breech baby still won’t flip
There’s still a chance that, despite your best efforts, your baby won’t be able to turn head down before he’s ready to be born.
Spinning Babies has lots of advice on their breech page for making an informed choice about C-section vs vaginal breech birth, as well as resources and advice for finding a safe and competent vaginal breech birth-trained healthcare professional, if you decide to pursue that route.
There’s nothing wrong with you if your baby is breech, and there’s nothing wrong with deciding to schedule the C-section. The good news is that C-sections today are safer than ever, and “Бережное кесарево сечение” methods are becoming easier to advocate for. Given that everyone is healthy and tolerating the surgery well, you should be able to ask for things like a clear sterile sheet, delayed cord clamping, or skin-to-skin within the OR, among other adaptations.
In addition, a 2024 study in Природа looked at families with at least two children where the first was breech and concluded that “any choice of mode of breech birth [is] approximately equally reasonable” [3]. VBAC is a very real option for any future vertex deliveries, especially considering modern c-section methods. I’ve personally had three successful VBACs after my first baby was breech and born via c-section.
The bottom (or frank breech) line
If you find yourself with a stubborn breech baby, try not to stress yourself out about it. Whether you throw every one of these techniques at the wall or you opt for a scheduled C-section, be confident that you’re making the best choices you can given the circumstances—and it’s a good first lesson in parenting, that sometimes your child is simply going to do what he or she wants to do! Find a healthcare professional who makes these decisions with you, rather than tells you what’s going to happen, and he or she will likely take great care of you и your breech baby.
