During the latter stages of your pregnancy, your midwife or doctor will feel your bump to see what position your baby is lying in. The different position in pregnancy and/or labour are:
- Head pointing down (cephalic presentation)
- Head pointing down with baby facing mum’s back (occipito anterior) – this is the best and usual position for the baby to be in when you give birth
- Head pointing down with baby facing forwards (occipito-posterior)
- Sideways (transverse position)
- Head pointing up and bottom/feet facing down (breech position)
In pregnancy, the baby’s position does not matter too much and will often change. However, the closer you get to your due date, the more important it becomes. Babies are often head down by around 32 weeks. However, there is still time for them to move if they are not. Once you reach 36 weeks, it is less likely a breech baby will change position by themselves.
What if my baby is still breech/the wrong way up at 36 weeks?
If an ultrasound scan confirms your baby is still breech at 36 weeks, your doctor should give you the option of them manually trying to turn your baby so they are head down. This is called external cephalic version (ECV) and will involve the doctor pushing on your bump. You may also be offered this if your baby is lying sideways. This is safe for both mum and baby, although your baby should be monitored to check that they don’t become distressed during the procedure. It can be uncomfortable so you may be given medication to help the muscles in your womb relax first. According to the NHS, ECV has a 50% success rate for changing a baby’s position.
If your baby does turn, and stays head down, you should be able to have a vaginal birth if you want to.
If your baby does not turn or turns but changes position again before you go into labour, your doctor may try ECV again. However, they should also discuss your birth options with you and the risks/benefits of each option so that you can make an informed decision. These options should be a caesarean section or a vaginal birth.
The doctor may recommend a caesarean section if they believe this is safest for you and your baby.
They will consider things such as:
- Your baby’s feet are below their bottom (a footling breech)
- Your baby is bigger or smaller than expected for their age
- Your placenta is low/covering your cervix
- You/your baby has a medical condition such as pre-eclampsia
If you choose to have a caesarean section but go into labour before your surgery date, your doctor will assess you and advise whether a caesarean section can still be performed. This should include performing a scan. However, if you are already pushing/your baby is very close to being born, there may not be time and it may not be safe to perform a caesarean section.
If you decide to give birth vaginally, it is important that the doctor and/or midwife who helps during your labour, has the skill and experience to deliver a breech baby, as this will be more complex than a baby who is head down. They may also recommend that your baby’s heart rate is continuously monitored.
What happens if my baby isn’t in the best position when I go into labour?
My baby is head down but facing forwards
If your baby is head down but facing forwards, this can increase the pain you feel during labour and this will usually be focused on your back.
It is possible that your contractions will help your baby turn so that when you are ready to start pushing, they are already in the best position (facing your back). If this doesn’t happen, your doctor may be able to help your baby turn, and they may use forceps (these look a bit like large tongs which are curved to fit around your baby’s head) to help deliver your baby.
My baby is lying sideways
If your baby is lying sideways close to your due date or when your labour starts, you will likely be advised to have a caesarean section.
If your doctor knows that your baby is lying sideways in the week or two leading up to your due date, you may be recommended to stay in hospital until you go into labour or a caesarean section is performed. This is because if you go into labour, there is a small risk it could become a medical emergency quickly if your baby’s cord comes out before your baby is born.
How Enable Law can help you?
We have acted for mums who did not receive the right care during their pregnancy, including a failure to recognise that their baby was breech or a failure to explain to mum her various options once it was known that her baby was breech. These failures are very serious and, in many cases, have caused their babies to sadly pass away.
A medical negligence claim is an opportunity for parents and their families to make sure the same mistakes aren’t made again. If you have any worries or concerns about whether your baby’s injury or death occurred because something went wrong with your care, Enable Law can work with you to help you get the answers you deserve.
We understand the difficulties having a child with additional needs pose for a family and are here to help you and your family to have the best possible outcomes for you.
We also know the devastating impact that losing a baby has. If this has happened to your family, we will work with you to determine what happened, whether the care provided was appropriate and help you get the answers you need. If you require advice, contact us today.
Please note: This article has been written based on the current RCOG (Royal College of Obstetricians & Gynaecologists) Green-top Guideline No. 20b: Management of Breech Presentation (wiley.com), published March 2017 and NHS guidance as at January 2023.
