HEDI - Breech Presentation and Turning

Starting in the second trimester, you can usually feel the first movements of pregnancy in your belly. Until about the 36th week of pregnancy, the baby still has enough room to change positions again and again. After that, it gets harder and harder as the baby grows and it gets tighter in your belly. If your baby is not yet head down by this time and has therefore not yet assumed the correct position for birth, this is known as a breech presentation. Your baby's head is on top and their bottom, legs or knees are pointing down towards the cervix. But that's nothing to worry about. On the one hand, sometimes the baby can still be turned with the help of special techniques. On the other hand, a baby can still be born without a c-section, even in this situation.

Turning early

If your doctor or midwife detects that your baby is in a breech presentation during a check-up in the 34th to 36th week of pregnancy, there are several ways to proceed. One exercise you can do under the supervision of your midwife is called the breech tilt exercise. You lie on the floor with your legs bent and lift your pelvis. Often the position of your back during this exercise can cause the baby to assume a different position on its own. Another option is to kneel with your knees and hands on the floor. This can also lead to the baby turning on its own. There are also other methods that can help. It is best to get advice from your midwife and have them show you how to do the exercises properly. Do not do these exercises on your own, but only in consultation with your midwife or doctor.

Turning the baby late in pregnancy

If the gentle methods for turning the baby early have not worked by the 37th week of pregnancy, there is also the option of turning your baby externally. However, you should only have this done by particularly experienced doctors. Seek advice on this from your gynaecologist or midwife. They can tell you the name of a hospital or pregnancy outpatient clinic where they have a lot of experience with this kind of turning. Before the turning, you will be given a medication to prevent possible contractions that could be triggered by the treatment. In addition, the doctors are prepared to perform a caesarean section immediately if complications should arise from the turning procedure. Turning involves using careful, pushing motions to get the baby to turn. During this process, the baby’s heart is monitored with a CTG. After the treatment, the doctors perform an ultrasound to check whether the turning was successful. It succeeds in slightly more than half of cases. Most of the time you will stay on the ward for another night for observation. If your baby's heart sounds good the next day, you can go home.

Delivery from breech presentation

In many cases it is possible to deliver a breech baby naturally. However, the delivery often takes longer. In many cases, doctors will give you an epidural for local anaesthesia. Midwives and doctors usually advise a kneeling birthing position for breech presentation, or more precisely getting on your hands and knees. For a natural birth from the breech presentation, your baby should not be too big or too heavy and your pelvis should not be too narrow. Also, the circumference of the baby's stomach should not be much smaller than the circumference of its head. Doctors use an ultrasound scan to try to assess whether the baby's head will fit through the birth canal. Some clinics specialise in breech deliveries. Your doctor and midwife can tell you which clinics these are and whether a natural delivery is advisable in your case. There are situations in which a natural delivery from the breech presentation is difficult or in which a delivery via caesarean section would be best. If the baby's growth is delayed or if it is your first baby, for example, doctors often make a strong suggestion against a natural birth from a breech presentation. If a delivery without a c-section is particularly important to you, you can get a second opinion before the birth. The decision is always yours.

Breech Presentation and Turning

Turning early

Turning the baby late in pregnancy

Delivery from breech presentation

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