It’s a little-discussed fact of pregnancy that not every baby is content to flip head-down by the final weeks. In about 3–4% of full-term births, the fetus settles into a breech position, with the buttocks or feet poised to emerge first. Traditionally, this finding prompts a discussion about delivery by cesarean section. But recent reconsiderations—supported by both anecdotal experience and emerging research—suggest that, in the right circumstances and with an experienced health care professional, a breech baby can be delivered vaginally with good outcomes.
We don’t always know exactly why a fetus ends up breech. Prior pregnancies can be a factor, as can having twins or more, or having too much or too little amniotic fluid. Sometimes the shape of the uterus or the presence of fibroids plays a role. Even placental position, like placenta previa (when the placenta covers part or all of the cervical opening), can make breech positioning more likely. Regardless, many breech babies are otherwise healthy and simply prefer this topsy-turvy orientation.
If you do find out your baby is breech—often confirmed by a physical exam and an ultrasound—your care team may offer an external cephalic version (ECV). This procedure involves applying firm pressure on your abdomen and guiding the fetus to rotate head-down. Most ECVs happen after 36 weeks of pregnancy, and although a bit uncomfortable, more than half succeed in repositioning the baby. But ECV isn’t for everyone. If you’re carrying multiples, dealing with placenta previa, or there are concerns about fetal well-being, your practitioner might skip it and go straight to discussing delivery options.
Historically, scheduled cesarean delivery has been the norm for breech babies, and it does carry its own measure of safety. That said, a planned breech vaginal birth under the care of a skilled provider can be a good option for some families. The main challenge is that the baby’s head, which is widest, emerges last. This can complicate the delivery process if the body doesn’t adequately stretch the birth canal, leading to the possibility that the head becomes trapped or that the umbilical cord gets compressed. Each scenario demands careful management and, in some cases, an urgent shift to a cesarean if problems arise.
Crucially, research and clinical experience show that with a provider trained in breech vaginal deliveries, the overall risk can be minimized. A recent Wall Street Journal article, “Breech Delivery Process Is Reconsidered,” points out how more physicians are revisiting the art of breech delivery, emphasizing proper screening for candidates and extensive experience in these techniques. It’s not simply a matter of letting nature run its course—it’s about having the knowledge, the right tools at the ready, and the preparedness to intervene if necessary.
In other words, we shouldn’t think of a breech baby as a foregone conclusion of surgery. We should think of it as a puzzle that requires collaboration, planning, and a willingness to tailor each birth plan to each specific pregnancy. ECV can shift the odds in favor of a vaginal birth, but if that doesn’t work, a conversation about breech vaginal delivery—together with an honest appraisal of the risks—might still be on the table.
Ultimately, it comes down to context and expertise. If you have a breech baby, it’s essential to find a health care professional who’s experienced, comfortable, and prepared for all contingencies. What matters most is that the birth is safe, whether your little one chooses to flip head-down or come into the world feet first. If the provider has the training and you have the right support, a vaginal breech birth is far from impossible—it can be a healthy and empowering choice.
At Maternal Resources, we’ve been at the forefront of safe breech deliveries for more than 20 years, refining our techniques and ensuring that every candidate for a vaginal breech birth receives thorough screening, comprehensive counseling, and expert care. Our longstanding commitment to evidence-based practices, coupled with hands-on experience, allows us to provide patients with individualized plans—often making what seems like a challenging situation into a fulfilling and secure birth experience.