Understanding Breech Presentation
Your Options for a Safer Delivery — A Patient Guide
You are not alone. About 3–4% of babies are in a breech position at term. You have safe options, and we will work together to find the best plan for you and your baby.
Atlanta Perinatal Associates • Maternal-Fetal Medicine • 2025
What Does "Breech" Mean?
In a normal pregnancy, the baby turns head-down before birth. When the baby is positioned bottom-down or feet-down instead, this is called a breech presentation.
Most babies turn on their own by 36 weeks. When they don't, it is called a term breech.
Good news: Breech position does not mean anything is wrong with your baby. Some babies simply prefer this position.
The Three Types of Breech Presentation
Complete Breech
Baby sits cross-legged, bottom-down. Best position for a successful version.
Incomplete (Footling) Breech
One or both feet point down. Risk of cord prolapse — ECV is contraindicated.
Frank Breech
Legs straight up toward the head. ECV can be attempted but is more challenging.
Why Incomplete Breech Is a Contraindication
In an incomplete (footling) breech, the umbilical cord can slip down through the cervix before the baby — a condition called cord prolapse. This cuts off the baby’s oxygen supply and is an obstetric emergency.
This is why we do not perform ECV in an incomplete breech. The risk of cord prolapse during the procedure makes it unsafe.
Your Delivery Options with a Breech Baby
External Cephalic Version (ECV) → Vaginal Delivery
We attempt to turn the baby head-down. If successful, you may proceed with a normal labor and delivery.
Planned Cesarean Delivery (C-Section)
Scheduling a C-section is a common and safe choice for breech babies. This is always an option.
Cesarean After a Failed ECV
If we attempt an ECV and the baby does not turn, a C-section will be performed.
Vaginal Breech Delivery (Rarely Performed)
Delivering a breech baby vaginally carries risks, including head entrapment. Most physicians do not offer this option.
What Is an External Cephalic Version (ECV)?
An ECV is a safe, non-surgical procedure in which your physician uses their hands on the outside of your abdomen to gently guide your baby from a breech position to a head-down (cephalic) position.
The procedure is always performed under continuous ultrasound guidance and with fetal heart rate monitoring to ensure the baby's safety throughout.
Where it is done: ECV is performed in a hospital setting (Rockdale) where emergency delivery is immediately available if needed.
The ECV Process: Step by Step
Confirm Breech
Ultrasound confirms the baby's position and checks fluid levels.
Relax Uterus
Medication (tocolytic) may be given to relax the uterine muscle.
Turn to Transverse
Gentle external pressure guides the baby sideways.
Turn Head-Down
The baby is guided to the cephalic (head-down) position.
Monitor & Confirm
Continuous monitoring confirms the baby is doing well.
The procedure itself typically takes 5–10 minutes. You will be monitored before and after for approximately 1–2 hours.
Criteria for Performing an ECV
To be a candidate for ECV, the following conditions should be met:
✓ Required Conditions
Gestational age ≥ 37 weeks
Intact membranes (water not broken)
Normal (adequate) amniotic fluid
No contraindications to vaginal delivery
Baby not yet deeply engaged in the pelvis
✗ Contraindications
Incomplete (footling) breech
Low amniotic fluid (oligohydramnios)
Fetal growth restriction
Placenta previa
Significant hypertension or diabetes
Abnormal fetal heart rate or active labor
Predicting Success: The Version Score
Before attempting an ECV, we calculate a Version Score to estimate the likelihood of success. This score is based on five clinical factors.
A higher score means a higher probability of successfully turning the baby. We generally do not recommend ECV if the score is 4 or less, as the procedure is unlikely to succeed and risks are not justified.
Clinical Guidance: "Women scoring ≤4 may simply not be candidates for external cephalic version. Appropriate delivery plans should be made and a costly and futile attempt at version avoided."
American Journal of Obstetrics & Gynecology, 169(2):245–250, 1993
The Modified Version Score: How It Is Calculated
| Factor | 2 Points | 1 Point | 0 Points |
|---|---|---|---|
| Parity (prior deliveries) | > 1 delivery | 1 delivery | No prior deliveries |
| Cervical Dilation | > 3 cm | 1–2 cm | Closed (0 cm) |
| Estimated Fetal Weight | < 2,500 g | 2,500–3,000 g | > 3,000 g |
| Placental Location | Posterior | Anterior / Lateral | Fundal (top) |
| Amniotic Fluid Index (AFI) | > 10 cm | 7–10 cm | < 7 cm |
Maximum Score: 10 • Source: AJOG 169(2):245–250, 1993
ECV Success Rate by Version Score
Important: A score of ≤ 4 suggests ECV is unlikely to succeed. A score of ≥ 8 indicates an excellent chance of success.
AJOG 169(2):245–250, 1993 • Success rates are estimates; individual results vary
Understanding the Risks of ECV
Reassurance first: Serious complications are rare, occurring in approximately 1–2% of cases. We perform ECV in the hospital where we can respond immediately to any concern.
Failed version — The most common outcome when ECV does not succeed. A C-section is then planned.
Reversion to breech — After a successful turn, the baby may turn back in 5–10% of cases.
Maternal discomfort — The procedure can be uncomfortable. We will stop if you request it.
Fetal heart rate changes — Monitored continuously; we stop immediately if any concern arises.
Rare serious risks (<1%) — Placental abruption, premature rupture of membranes, umbilical cord entanglement, or need for urgent delivery.
Alternative Methods to Turn the Baby
Some patients explore non-medical approaches to encourage the baby to turn on its own.
Common Methods
Postural methods: Knee-chest position, pelvic tilts, passive bridge
Acupuncture: Stimulation of specific points (e.g., BL 67 on the fifth toe)
Moxibustion: Burning herbs near acupuncture points; some evidence of benefit
Chiropractic care: Webster technique; Hypnosis
What the Evidence Says
Scientific evidence for these methods is limited. Some studies suggest moxibustion may increase the rate of spontaneous turning, but results are mixed.
Please discuss any alternative methods with your provider before trying them.
When Is ECV Performed?
At Atlanta Perinatal Associates, we perform ECV at 37–39 weeks of gestation.
This timing ensures the baby is mature enough for delivery if needed, while there is still sufficient room and amniotic fluid to make turning possible.
Before 37 Weeks
Too early. The baby may turn on its own. Risks of early delivery are not justified.
37–39 Weeks
Optimal window. The baby is term. We can deliver safely if needed.
Note: If you are currently 36 weeks, your appointment would be scheduled for approximately one week from now.
Your ECV Appointment at Rockdale
Before Your Appointment
Bring prenatal records from your OB/GYN. Arrange for someone to drive you home. Eat a light meal 2–3 hours before.
During the Procedure
Ultrasound exam, IV placement, and possible medication to relax the uterus. The turning attempt takes about 5–10 minutes.
After the Procedure
You will be monitored for 1–2 hours. A final ultrasound confirms the baby's position before you go home.
Important: If your OB/GYN does not deliver at Rockdale, you will need to arrange backup OB coverage in case delivery is needed on the day of your procedure.
A Shared Decision: Your Voice Matters
The decision to attempt an ECV or to schedule a planned C-section is yours to make. Our role is to provide you with complete, honest information and to support whatever path you choose.
Reasons to Consider ECV
You prefer a vaginal delivery. Your Version Score is favorable. You understand and accept the small risk of complications.
Reasons to Choose C-Section
You prefer a predictable, scheduled delivery. Your Version Score is low. You have personal or medical concerns about the procedure.
Remember: It is also possible the baby will turn on its own, especially if you are multiparous (have had prior deliveries) and are still a few weeks from your due date.
Summary & Your Next Steps
Breech is common — About 3–4% of term babies are in breech position.
You have safe options — ECV, planned C-section, or watchful waiting if you are not yet 37 weeks.
ECV success depends on your score — We use the Version Score to estimate your individual chance of success.
Timing matters — ECV is performed at 37–39 weeks at Rockdale Medical Center.
Your safety comes first — We monitor closely and stop immediately if there is any concern.
Next Appointment: We will see you in one week to re-evaluate the baby's position and finalize your delivery plan together.
Questions to Ask at Your Next Visit
About Your Situation
What is my final Version Score?
What type of breech is my baby in now?
Are there any new reasons I should not try ECV?
About the Plan
If ECV works, what is my birth plan?
If ECV fails, when will my C-section be scheduled?
What if the baby turns back to breech after a successful ECV?
There are no silly questions. We are partners in your care. Please bring a list of anything on your mind.
We Are Here for You
Atlanta Perinatal Associates
Maternal-Fetal Medicine • Rockdale Medical Center
To schedule your ECV or ask questions, please call our office. Have your prenatal records from your OB/GYN ready when you call.
Emergency: If you experience decreased fetal movement, vaginal bleeding, leaking fluid, or severe pain, call us immediately or go directly to Labor & Delivery.
Additional resource: Watch an ECV animation →
ACOG Practice Bulletin • SMFM Guidelines • AJOG 1993 • Updated 2025