Breech Birth ~ The Conundrum
I recently spoke with a rural woman, devastated by the news that her only local option for her first birth was a cesarean. She was healthy, her baby was healthy. The only difference? Her baby was bum down at 38 weeks.
She had already tried an ECV (where they attempt to turn the baby externally), but her little one stayed put. And that’s perfectly okay. Sometimes there’s a reason, unknown to us, why a baby chooses a certain position.
How Common is Breech?
Around 3–4% of babies are breech at term. Yet the only option most women are presented with is major abdominal surgery. It’s worth remembering that the risks of an unnecessary cesarean may actually outweigh the risks of a planned vaginal breech birth.
Before we get into the numbers, let’s talk about the providers themselves.
The Loss of Breech Skills
Obstetricians are increasingly de-skilling in breech birth. It is now treated as a medical emergency, and very few hospitals will ‘allow’ a planned breech birth. That means 4% of women automatically fall outside the skillset of the most highly trained obstetricians.
This issue also flows into twin births, where a breech baby is very common. Vaginal twin births are becoming more and more rare, not because women cannot birth in this way, but because providers aren’t confident or trained to support them.
Whether it’s due to hospital culture, liability concerns, or lack of opportunity, many obstetricians have turned away from breech birth altogether. It’s almost like a birth professional saying “ oh no, I dont do shoulder dystocia's". We can't! It's a core skill for our profession.
Midwives Rising in Breech Care
As obstetric skills fade, midwives, particularly homebirth midwives, are stepping up. Passionate about women’s choices, they are actively building knowledge and experience in breech birth, ensuring that women continue to have real options.
Let’s be clear though: a skilled and experienced provider is absolutely essential for a safe vaginal breech birth.
Breaking Down the Stats
The biggest concern around breech birth is the risk of adverse outcomes for babies. Here’s what the numbers show per 1000 births:
Cesarean birth: 0.5 babies with poor outcomes
Normal vaginal (head-down) birth: 1 baby with poor outcomes
Vaginal breech birth: 2 babies with poor outcomes
Yes, breech carries a slightly higher risk. Babies born breech are also more likely to need resuscitation at birth. However, studies show that by age two, outcomes are similar, with no long-term differences.
So, is the small increase in risk enough to warrant major abdominal surgery for every woman? For some, yes. But not all women will agree, and that choice should always remain theirs.
Considering Future Pregnancies
A first cesarean also increases risks in subsequent pregnancies, such as uterine rupture, placental complications, postpartum hemorrhage, and other health conditions.
If you compare the numbers, the risk of uterine rupture in a woman’s next pregnancy after cesarean may even surpass the mortality risk of a first-time vaginal breech birth. Cesareans are not automatically saving lives in the context of breech birth, they are simply shifting risks into future pregnancies.
Breech at Home
With hospitals largely closed to the option, breech birth at home is slowly becoming more common. While long-term research is still limited, we do know that outcomes are safest when women are supported by skilled providers who are trained, equipped, and confident.
Key factors for safety include:
A midwife experienced in breech birth
Neonatal resuscitation equipment available
Clear transfer plans if needed
Informed decision-making as the foundation of care
For many women, simply knowing this is an option is deeply empowering.
Finding a Breech Provider
If you’re searching for a provider, a great starting place is the Breech Without Borders online directory. You can also connect with your local homebirth midwives, who may guide you in the right direction.
The Bigger Picture
It is heartbreaking that women, especially in regional areas, are left feeling as though their bodies are broken or their babies are being ‘stubborn.’ This is simply not the case.
Midwives are keeping breech skills alive, teaching, learning, and sharing with each other, while holding space for women who want to birth their babies vaginally. My hope is that one day, the wider medical system will open its eyes and restore breech birth as a safe, supported option.
Until then, we keep the torch lit.
Hannah x
