Understanding Why Some Babies Don’t Turn
By Nadia Raafat
There are few moments in pregnancy that come as more of a shock than hearing the words, “Your baby’s breech.”
I know, because that’s exactly what happened to me.
At 36 weeks pregnant with my first baby, I went into hospital after experiencing a small bleed. Throughout my pregnancy I had been reassured that my baby was head down, so I wasn’t expecting any surprises. Instead, I was told that my baby was in breech position, and that I was already one centimetre dilated. They kept me in that night for observation, and I prayed that I would not go into labour. I was not yet ready to give birth.
I knew nothing about breech presentation. Suddenly I found myself facing conversations about turning my baby, possible caesarean birth and the uncertainty of what would happen next.
New Year was pending; I was discharged with an appointment for an External Cephalic Version (ECV) ten days later.
I never made it to that appointment.
Emergency caesarean delivery
A few days later I travelled alone to a New Year retreat I had booked before Christmas. I went for a long countryside walk – not knowing that walking brings babies deeper into the pelvis. I practised a few alleged breech-turning exercises I had found in a pregnancy book. In hindsight, I can see they would not have worked.
The following dawn, at just 37 weeks, I went into labour.
I was too far from home, and in too much discomfort to travel so I made my way to the nearest hospital in Portsmouth where I laboured for twelve hours before giving birth by emergency caesarean section.
Although it wasn’t the birth I had imagined, it taught me so much about what birth could be and about myself.
It taught me that a breech labour is still labour. My contractions were normal. My cervix opened beautifully to 5cms. My body knew exactly what to do. The only difference was my baby’s position and the fear surrounding this breech labour.
It also taught me that breech babies deserve respect.
Over the years, as I have supported hundreds of women through pregnancy and birth, I have come to believe that a baby who remains breech is not simply a problem to be fixed. Sometimes there is a clear physical reason. Sometimes there isn’t. Either way, I believe a breech baby invites us to become curious rather than frightened.
What is a Breech Presentation?
During most pregnancies, babies settle into a head-down position during the final weeks before birth. This allows the head—the largest part of the baby’s body—to be born first.
A breech baby is one whose bottom or feet are positioned to be born first instead.
At around 28 weeks, many babies are still breech. They continue to move freely as they grow, and most will turn naturally as pregnancy progresses.
By 36–37 weeks, however, only around 3–4% of singleton babies remain breech.
There are several different types of breech presentation.
Frank breech is the most common. The baby’s bottom is down with both legs stretched upwards, feet near the face.
Complete breech means the baby is sitting cross-legged with knees bent.
Footling breech is where one or both feet sit below the bottom and would be born first.
More rarely, a baby may be kneeling.
The type of breech presentation is important because it influences the options available for birth.
Why Do Some Babies Remain Breech?
This is one of the questions I am asked most often.
The truthful answer is that there isn’t always one explanation.
Sometimes there is a clear physical reason why a baby has remained breech.
These include:
- the shape of the uterus
- a low-lying placenta or placenta praevia
- uterine fibroids
- unusually high or low levels of amniotic fluid
- multiple pregnancy
- prematurity
- occasionally, differences in the baby’s development.
Sometimes babies simply seem comfortable where they are.
And sometimes there is no obvious mechanical explanation at all.
My own experience fell into this final category.
There was no physical reason why my first baby remained breech. I later went on to have three more pregnancies, and each of those babies settled naturally into a head-down position.
That has always made me wonder whether there was something more to my first pregnancy than anatomy alone.
Pregnancy is More Than a Physical Process
One of the things I have learned through many years as a doula, yoga teacher and counsellor is that birth is never purely mechanical.
Pregnancy is a profound physiological process, but it is also an emotional, psychological and relational one.
A mother’s emotional world affects her breathing, muscle tone, hormones, posture, sleep, nervous system and sense of safety. These are not separate from pregnancy—they are pregnancy.
When I look back at my first pregnancy, I remember a great deal of uncertainty.
My pregnancy was unplanned. I was adjusting to the reality of becoming a mother before I had expected to. My relationship felt insecure, and I carried much of that insecurity in my body.
For me, these things mattered.
I cannot prove that they influenced my baby’s breech position. But I believe they did.
Since then, I have worked with many women whose babies have arrived during pregnancies marked by grief, trauma, relationship instability, ambivalence, significant life change or deep anxiety. These issues do not mean a baby will present breech, and often times, they have not – but occasionally they do. Equally, I have cared for women whose breech babies had entirely physical explanations. Every pregnancy has its own story.
I don’t believe it serves women to insist that breech presentation is either entirely mechanical or entirely emotional.
Rather, I believe pregnancy is holistic.
Holistic pregnancy
Our babies develop within our bodies, but they also develop within our physiology, our relationships and our emotional lives.
Traditional midwives have recognised this for generations.
Dr Christiane Northrup has written about the symbolic and emotional dimensions of pregnancy and birth, inviting women to explore whether unresolved fears or life transitions might sometimes be reflected in the body.
Similarly, Mexican traditional midwife Naolí Vinaver encourages us to see babies as active participants in pregnancy rather than passive passengers. Rather than asking only, “How do we turn this baby?”, she invites us to ask, “What might this baby be communicating?”
Recently, a client came to see me at 37 weeks with a breech baby, and together we explored every possible reason why her baby might not have turned. As we talked, one theme kept emerging. She described her baby as exceptionally alert, aware and responsive.
Intuitive babies
During pregnancy, whenever she read stories aloud with her older son resting against her bump, the baby would turn towards the familiar voices. When she travelled to hospital on her moped for scans, she noticed the baby would move away from the vibration and sensation of the journey. She instinctively felt she was carrying a baby who was deeply engaged with the world beyond the womb.
In her case, there was also a large volume of amniotic fluid, and this was her second pregnancy, giving her baby plenty of room to move. Perhaps the explanation was partly mechanical, perhaps partly a reflection of this baby’s unusually responsive nature. We can’t know for certain. But experiences like these remind me that every breech baby has its own story, and that listening carefully to both mother and baby can sometimes reveal insights that anatomy alone cannot.
This is perhaps one of the greatest lessons breech babies have taught me over the years. There is rarely a single explanation. Sometimes the answer lies in anatomy. Sometimes it lies in physiology. Sometimes it lies in the emotional landscape of the pregnancy. More often than not, it is a combination of many different factors, each playing its part.
Can You Have a Vaginal Breech Birth?
For many years, breech presentation was considered an automatic indication for caesarean delivery. Today, the picture is more nuanced.
Research and clinical experience have shown that, in carefully selected circumstances and with an experienced breech team, many women can safely give birth vaginally to a breech baby.
Whether this is appropriate depends on several factors, including the type of breech presentation, the size and wellbeing of the baby, the shape of the mother’s pelvis, how labour progresses and, importantly, the experience and confidence of the clinicians caring for her.
A frank breech, where the baby’s bottom presents first with the legs extended upwards, is generally considered the most favourable position for a planned vaginal breech birth. Footling breech, where one or both feet present first, carries a greater risk of cord prolapse and is less commonly recommended for vaginal birth.
Previous vaginal birth
Another important consideration is whether this is your first baby or whether you have previously given birth vaginally.
For women who have already had one or more straightforward vaginal births, the pelvis and soft tissues have already accommodated the passage of a baby. As a result, a planned vaginal breech birth, particularly with a frank or complete breech baby, is often more straightforward than it would be for a first-time mother, provided all the other clinical criteria are favourable.
For a first baby, the situation requires more careful assessment. This doesn’t mean a vaginal breech birth isn’t possible, but labour is less predictable and clinicians are understandably more cautious. The type of breech, the estimated size of the baby, the mother’s pelvis, how labour progresses and the experience of the birth team all become especially important.
Whatever your circumstances, the most important factor is being cared for by clinicians who are experienced in supporting breech birth and who can help you make an informed decision based on your individual situation, rather than breech presentation alone. Unfortunately, access to experienced breech teams varies considerably, meaning that your options may depend upon where you plan to give birth.
A Breech Baby Is Not an Emergency
In most pregnancies, discovering a breech baby at 36 or 37 weeks is not an emergency. It is information.
It is an invitation to pause, gather good information, explore your options and decide what feels right for you and your baby.
For some women, that will mean waiting a little longer to see whether baby turns naturally. For others, it may involve trying techniques to encourage baby into a head-down position.
For some, an External Cephalic Version (ECV) will feel like the right next step.
And for others still, after careful consideration, planning a vaginal breech birth or a caesarean delivery may feel like the safest and most appropriate path.
There is no single ‘right’ decision.
There is only the decision that is right for you, your baby and your circumstances.
Looking Ahead
If your baby is breech in the final weeks of pregnancy, there is still much that can be done to encourage them to turn. In my next article I’ll explore the approaches I have found most helpful over many years of supporting women through pregnancy and birth.
We’ll look at gentle positional techniques, moxibustion, the Webster Technique, emotional preparation, homeopathy, External Cephalic Version (ECV), and why I believe creating the right conditions for your baby is often more powerful than trying to force a particular outcome.
The question isn’t simply, “How do I turn my breech baby?”
The better question is,
“What might my baby need in order to turn?”
If you’d like support to help your baby turn, book a breech support session with Nadia, please email info@nadiaraafat.com
Head to the Becoming Mother news and information section to read the latest articles about perinatal yoga and mindfulness teacher training and online sessions, birthing and birth doula support.
- What does it mean if my baby is breech at 36 or 37 weeks?
A breech baby is one positioned bottom or feet first rather than head down. By 36–37 weeks, only around 3–4% of babies remain breech. It’s not an emergency, it’s information that gives you time to explore your options and decide what feels right for you and your baby. - What are the different types of breech presentation?
The main types are frank breech (bottom down, legs extended upward), complete breech (baby sitting cross-legged), and footling breech (one or both feet positioned to be born first). The type matters because it affects which birth options are available to you. - Why do some babies stay breech?
There isn’t always a clear explanation. Physical causes can include the shape of the uterus, placenta position, fibroids, amniotic fluid levels or multiple pregnancy. But sometimes there’s no obvious mechanical reason at all. A holistic view also considers the emotional and relational landscape of the pregnancy alongside anatomy. - Can you have a vaginal birth with a breech baby?
Yes, in carefully selected circumstances with an experienced breech team. A frank breech is generally considered the most favourable position for a planned vaginal breech birth, while footling breech carries greater risk and is less commonly recommended. Whether a previous vaginal birth has been experienced is also an important factor. - What can I do if my baby is breech in late pregnancy?
There are several gentle approaches that may encourage a baby to turn, including positional techniques, moxibustion, the Webster Technique, and External Cephalic Version (ECV). Nadia offers 1:1 breech support sessions if you’d like to chat to her about the options.
