Breech Birth - Do you really have a choice?

Finding out that your baby is breech can suddenly make your birth plans feel much less certain.

A breech baby is positioned bottom or feet first rather than head first. Breech presentation is common earlier in pregnancy, but by the end of pregnancy only around 3 to 4% of babies remain breech.

If your baby is still breech towards the end of pregnancy, you should be able to have an informed discussion about your options. These may include:

• attempting an external cephalic version (ECV) to turn your baby head down

• planning a caesarean birth

• planning a vaginal breech birth

Both NICE and the Royal College of Obstetricians and Gynaecologists recognise planned vaginal breech birth as an option alongside planned caesarean birth. RCOG guidance also says that someone choosing vaginal breech birth should be cared for by a team trained and experienced in supporting breech birth.

And this is where things can become complicated.

Vaginal breech birth may be an option, but is experienced support available?

Being told that you can choose a vaginal breech birth is not quite the same as having genuine access to one.

For much of the twentieth century, attending vaginal breech births was a normal part of maternity care. As caesarean birth became more common for breech presentation, the number of vaginal breech births fell.

That also meant fewer doctors and midwives were regularly attending them.

Over time, fewer breech births meant fewer opportunities to develop and maintain breech birth skills. Less experience can lead to less professional confidence, and this can make vaginal breech birth even harder for families to access.

So when you are deciding how you want to give birth to a breech baby, one of the most useful questions may not simply be:

“Can I have a vaginal breech birth?”

It may be:

“Who will actually be there to support me if I choose one?”

Why confidence in your breech birth team matters

Decisions around breech birth are often discussed in terms of statistics.

But numbers are only one part of informed decision making.

You may also want to know:

• How many vaginal breech births does this hospital support?

• Is there a specialist breech midwife or obstetrician?

• Who has practical experience of physiological vaginal breech birth?

• Will someone experienced actually be available when I go into labour?

• What happens if the breech specialist is not working that day?

• Does the maternity unit regularly practise breech birth skills?

• How does the team approach spontaneous pushing, maternal position and hands off breech birth?

• Can I meet the breech team before labour?

• Can I transfer my maternity care if another hospital offers more experienced breech support?

Those questions can have a huge impact on how safe and confident you feel about your options.

My full AIMS Journal article explores this issue through the experiences of women who had to decide between vaginal breech birth and planned caesarean birth.

Their decisions were not simply based on whether vaginal breech birth existed as an option on paper. The availability of experienced and confident support played a major role in whether that option actually felt possible.

What is OptiBreech?

OptiBreech is a UK project focused on improving care and options for women and birthing people whose babies are breech at term.

One of the important aspects of the OptiBreech approach is developing specialist breech services and teams with specific training and experience in supporting vaginal breech birth.

This matters because having a hospital willing to discuss breech birth is different from having clinicians who regularly train in and attend vaginal breech births.

Some OptiBreech services have a breech specialist midwife, consultant midwife or breech lead obstetrician, with a wider team working to maintain the skills needed to support these births.

How do I find an OptiBreech centre near me?

The easiest place to start is the OptiBreech Participating Sites page.

OptiBreech currently lists participating services around the UK and, for a number of centres, provides direct contact details for the breech team and information about self referral.

This is particularly useful because you do not necessarily need to assume that the maternity unit closest to you is your only option.

Some OptiBreech centres accept people transferring their care specifically because they want to plan a vaginal breech birth.

Hospitals currently listed by OptiBreech include services in London, Surrey, Birmingham, Greater Manchester, Cornwall and other parts of the UK.

The list changes as services develop, so I would always check the OptiBreech website rather than relying on an older list.

Find participating OptiBreech centres here:OptiBreech Participating Sites

If there is no OptiBreech centre particularly close to you, it may still be worth contacting the nearest service. Ask whether they accept self referrals or transfers of care for people planning a vaginal breech birth.

You can also ask your own maternity service whether they have a:

• breech clinic

• breech specialist midwife

• breech lead obstetrician

• consultant midwife with experience of vaginal breech birth

• dedicated team trained in physiological breech birth

What if my nearest hospital does not routinely support vaginal breech birth?

You can ask for an individualised discussion about your birth options.

You may also want to explore whether another NHS Trust has greater experience with vaginal breech birth.

This can sometimes mean travelling further for appointments or transferring your maternity care. That is not practical or desirable for everyone, but knowing what exists can help you make a genuinely informed decision.

Some families may also choose to speak to an independent midwife or another professional experienced in breech birth to understand their options more fully.

The aim is not to convince everyone with a breech baby to choose vaginal birth.

A planned caesarean may absolutely be the right choice for you.

But an informed choice should ideally mean being able to consider the benefits, risks and practical realities of both planned caesarean birth and vaginal breech birth, rather than discovering that one option is almost impossible to access because experienced support is unavailable.

Learn about breech birth before making your decision

If you have just discovered that your baby is breech, it can feel like you suddenly have a lot of information and some big decisions to make in a very short space of time.

One of the most useful things you can do is learn about breech presentation and vaginal breech birth yourself.

Understanding what physiological breech birth actually looks like, how a breech baby moves through the pelvis, when assistance may be needed and what the evidence says about vaginal breech birth versus planned caesarean birth can make conversations with your maternity team much more meaningful.

Breech Without Borders is a non profit organisation focused specifically on breech education, training and advocacy.

Their Breech 101 online course has been created specifically for parents, doulas and childbirth educators who want to understand breech birth in more detail.

They also have a large collection of free breech resources covering the mechanics of breech birth, breech birth videos, manoeuvres, research, risks and benefits, international breech guidelines and advocacy.

They maintain a directory where parents can search for midwives, doctors and other professionals with an interest in breech pregnancy and birth. It is important to know that Breech Without Borders does not vet the people listed, so you will still need to ask about an individual practitioner's qualifications, training and experience.

What if my local maternity service does not have experienced breech staff?

This is also where we can think beyond our own individual birth.

One of the biggest problems surrounding vaginal breech birth in the UK is the loss of skills and confidence that has happened as fewer vaginal breech births have taken place.

But those skills can be rebuilt.

If your experience highlights a lack of breech birth training within your local maternity service, you can ask what is being done to improve it.

You could contact your hospital's Patient Advice and Liaison Service, or PALS, and ask for your feedback to be passed to the Consultant Midwife, Head or Director of Midwifery, Clinical Director or obstetric lead responsible for maternity services.

You might ask:

• What training do midwives and obstetricians currently receive in physiological vaginal breech birth?

• How often is practical breech birth simulation training undertaken?

• Does the Trust have clinicians who regularly maintain their vaginal breech birth skills?

• What happens when someone chooses a planned vaginal breech birth?

• Is the Trust considering developing a dedicated breech service or pathway?

• Would the maternity service consider additional multidisciplinary breech training?

You can also point them towards Breech Without Borders.

They do not only educate parents. They provide professional vaginal breech training and have a specific hospital breech training programme designed for maternity teams.

Their hospital programme combines online learning with hands on simulation training and ongoing education. They also offer training for obstetric and family medicine residents and hospital staff.

You do not need to be a healthcare professional to ask your maternity service whether its staff could receive more training.

If enough parents ask why vaginal breech birth is unavailable locally and request investment in skills and training, it helps demonstrate that this is something families actually want access to.

Because improving breech birth choices is not simply about telling women that vaginal breech birth is an option.

It requires maternity services to invest in the skills, experience and confidence needed to make that option genuinely available.

Want to read more about vaginal breech birth and informed choice?

I explored this in much more depth for the AIMS Journal in:

When choice isn’t really a choice: Finding confident support for vaginal breech birth.

The full article looks at why vaginal breech birth skills declined, how the availability of experienced clinicians influences decision making and, importantly, shares the experiences of three women navigating a breech diagnosis and trying to work out what their choices really were.

Their stories show just how different having a theoretical choice can feel from having a maternity service you genuinely trust to support it.

Read the full AIMS article here:https://www.aims.org.uk/journal/item/doula-support-breech