You can usually have a vaginal breech birth if you want to, though it is best to first ensure that there is an obstetrician and/or midwife available who is trained to support you. Your pregnancy may be classified as high risk if you want a breech birth (if it wasn’t already), though this is not always the case, and you may be advised to give birth in a hospital rather than at home or in a midwife-led unit, depending on your medical profile and where you are. The Royal College of Obstetrician and Gynaecologists, for example, says that breech birth in birth centres is safe but only where it is common practice in a particular centre and the staff are experienced. You will never be forced to have surgery, but labour and birth are unpredictable, and you may need to strongly consider it in some circumstances. Being in a hospital can save time in an emergency, though it also increases your risk of medical intervention and having a caesarean, so there’s a lot to factor into your breech birth decision. Having a caesarean deliver a breech baby is also fine; the purpose of this article is to highlight that you have a choice if you want it.

Why do I get a negative vibe from some healthcare professionals about having a vaginal breech birth?

Vaginal breech births are not common practice in this day and age, where women typically have an External Cephalic Version (ECV) offered to them around 36 weeks and take it. ECVs are relatively easy procedures (some women find them uncomfortable, and you can ask to stop or take a break whenever you want) with good success rates. They can also be attempted safely if they are unsuccessful or the baby returns to a cephalic position, though there are limits to this. There are even specific hypnobirthing relaxation techniques that aim to turn your baby naturally, simply because the cephalic position is considered ideal. However, vaginal breech births weren’t always so uncommon, and many older obstetricians will have learnt to deal with them as part of standard training. Things changed because early 2000s research describes caesarean sections for breech births as safer, particularly where babies are in certain kinds of breech position. For example, a baby footling breech, where one or both of the feet are under the baby’s bottom, is trying to find their way down the birth canal foot or feet first, and their risk of getting stuck is increased. As a result, younger obstetricians may have less hands-on experience. However, breech birth-trained professionals should be confident dealing with every sort of breech position. There are charities like Breech Without Borders that aim to make training using models more accessible to professionals and information more widely available to parents. If you don’t feel supported, it’s important to advocate for yourself and change healthcare providers if necessary, as any extra stress or worry you’re feeling will impact the baby.

Why might it be strongly recommended that I do not have a vaginal breech birth?

Most women who are having low-risk pregnancies apart from their baby’s breech presentation are good candidates for vaginal breech births. Problems typically arise where something might obstruct the birth canal, such as large fibroids or cysts, or a placenta praevia. If your baby is especially large for their gestational age, you may also be discouraged from having a vaginal breech birth.

If I’m having twins vaginally, won’t I have to have a breech birth anyway?

It is true that, where you are having twins and one presents as breech, you will not be offered an ECV to “spin” them. Your doctor may recommend a caesarean section, especially if your babies are premature (which is more likely with twins and almost guaranteed with triplets and greater multiples), but you are entitled to have your babies vaginally; you just have to have a trained healthcare team.

Will a vaginal breech birth hurt more than a cephalic birth?

No. Perceptions of pain differ, and there are many factors that influence how much labour and childbirth hurt, from the length of labour to the pain relief you use, whether it’s your first birth, and the baby’s size. Vaginal breech birth will feel different from cephalic birth because of the positioning, but it will not necessarily hurt more.

Will a vaginal breech birth take longer than a cephalic birth?

Yes! Unfortunately, research suggests that vaginal breech birth takes much longer than a cephalic birth. One study suggests that, for a first-time mum, it can take up to three and a half hours longer. If you’ve had a baby before, it won’t take as long, but labour will still be longer than if that same baby was in a cephalic position. Breech babies just need more time.

How late can I decide I want surgery instead?

You can make this decision as late as during labour, and it’s usually perfectly acceptable. Two reasons this wouldn’t be recommended are if labour is progressing quickly or if the baby is too far down in the birth canal to switch to surgery. Your obstetrician should always explain to you why surgery is or isn’t recommended in your specific circumstances, and you can also have a post-birth briefing. The latter could be especially useful if you want more children, as research shows you are more likely to have a baby present as a baby if this happened during a previous pregnancy. Previous pregnancy information is always useful for future pregnancy care.

For more advice on taking care of yourself in pregnancy, labour, and birth, check out Unii’s Antenatal Course, with prenatal video episodes taught by senior NHS midwives, an award-winning obstetrician and gynaecologist, and six other leading healthcare experts. Coming soon to unii.com.

Antenatal Class Questions: What if I want to have a breech birth?

You should be supported in this choice if you want to make it.