What it is
About 3–4% of babies are still breech at term. There are three main paths once breech is confirmed around 36–37 weeks: external cephalic version (ECV) is a procedure where a provider tries to turn the baby by pressing on the belly, with success rates around 50–60%; planned cesarean is the most common approach in North America; vaginal breech birth is offered in a smaller number of settings, usually with strict selection criteria (frank breech, appropriate size, experienced provider, informed consent).
Evidence review links
Each link opens the full review on the publisher's site in a new tab.
- ACOG Committee Opinion 745: Mode of Term Singleton Breech DeliveryACOG
- Cephalic version by postural management for breech presentation (Cochrane Review)Cochrane
- Planned caesarean section versus planned vaginal birth for breech presentation at term (Term Breech Trial)The Lancet
- SOGC Clinical Practice Guideline: Vaginal Delivery of Breech PresentationSociety of Obstetricians and Gynaecologists of Canada
- Moxibustion for correcting breech presentation (Cochrane Review)Cochrane
- Evidence on: Breech Version and Breech BirthEvidence Based Birth
Possible benefits
- ECV, when successful, avoids a cesarean and its recovery[ACOG↗][Cochrane↗]
- Planned cesarean lowers the risk of birth injury for breech babies compared with unplanned vaginal breech birth[ACOG↗]
- Vaginal breech birth avoids abdominal surgery and preserves future birth options when performed with experienced providers and appropriate criteria[Society of Obstetricians and Gynaecologists of Canada↗][Evidence Based Birth↗]
Possible risks
- ECV has a small risk (~1–2%) of temporary heart-rate changes; rare risk of emergency cesarean the same day[ACOG↗]
- Cesarean has surgical risks and affects future pregnancies (VBAC considerations, placenta placement)[ACOG↗]
- Vaginal breech birth carries higher risk of birth injury and low APGAR in some settings, especially without a trained provider[The Lancet↗]
- Availability of vaginal breech birth is limited — many hospitals no longer offer it[Society of Obstetricians and Gynaecologists of Canada↗]
Alternatives
- Spinning Babies® / Webster chiropractic / moxibustion / positioning: evidence is limited but some parents try before ECV[Cochrane↗][Evidence Based Birth↗]
- Wait-and-see: some breech babies still turn on their own before labor[ACOG↗]
- Second opinion at a hospital that offers vaginal breech birth, if that matches your goals[Society of Obstetricians and Gynaecologists of Canada↗]
Current evidence
ACOG Committee Opinion 745 supports offering ECV to nearly all appropriate candidates. The 2000 Term Breech Trial led most North American hospitals to move to planned cesarean; later analyses (SOGC, PREMODA) show that with careful selection and skilled providers, planned vaginal breech birth can be a reasonable option. Availability varies widely.
Where the evidence is clear · where people may choose differently
For most topics, guidelines from ACOG, WHO, and other major bodies broadly agree on the core safety points (when to act in an emergency, informed-consent standards, monitoring baselines). Where reasonable people — and even guidelines — differ tends to be around thresholds (when to start or stop something), preferences (comfort, environment, support), and values (how you weigh small risks against benefits). Use the questions below to explore those pieces with your care team.
Educational only. Your care team can help you weigh what applies to your specific situation.
Related evidence topics
Questions to ask your care team
- ?When and how will you check the baby's position — and confirm with ultrasound?
- ?Do you offer ECV, what is your success rate, and what are the risks?
- ?If ECV doesn't work or isn't offered, what are my options here?
- ?Is planned vaginal breech birth offered locally, and would I be a candidate?
- ?How will a breech diagnosis affect timing of birth and the birth plan?
Universal questions (works for any decision)
A short BRAIN-style set you can bring to any conversation about interventions, monitoring, or care decisions.
- ?Why are you recommending this now — is it urgent, routine, or optional?
- ?What happens if we wait an hour (or longer) before deciding?
- ?What signs would tell us this is working — or that we need to change course?
- ?What are the alternatives, including doing nothing?
- ?What would you recommend if this were your family?
- ?What would change your recommendation?
Sources & provenance
Tap a source to open the original guideline or review in a new tab.
- ACOG Committee Opinion 745: Mode of Term Singleton Breech Delivery — ACOG
- Cephalic version by postural management for breech presentation (Cochrane Review) — Cochrane
- Planned caesarean section versus planned vaginal birth for breech presentation at term (Term Breech Trial) — The Lancet
- SOGC Clinical Practice Guideline: Vaginal Delivery of Breech Presentation — Society of Obstetricians and Gynaecologists of Canada
- Moxibustion for correcting breech presentation (Cochrane Review) — Cochrane
- Evidence on: Breech Version and Breech Birth — Evidence Based Birth
Plain-language paraphrase. Re-verify before publish.
Last reviewed: 2026-07-03
Further reading — canonical references
Read the source material directly. Each link opens the publisher's own current guidance in a new tab — cross-check what we summarize against what they say.
Tier 1 · Clinical guidelines
Tier 2 · Systematic reviews
Educational only. Guidelines evolve — the linked publisher pages will reflect newer guidance than any static snapshot.
Version history — v1.0.0
v1.0.0 · 2026-07-03 · LlaMamma editors
Initial breech-birth topic (ECV, planned cesarean, vaginal breech).
New guidance from ACOG, WHO, Evidence Based Birth, or other listed sources is recorded here and can be updated remotely without a new app release.