Can I Have a VBAC If...My Baby is Breech?

If you're planning a VBAC (vaginal birth after caesarean) and you’ve been told your baby is breech, it’s completely normal to feel a wave of questions and concerns. Let’s break it down so you can feel informed, confident, and in control.

What Is A Breech Baby?

A breech baby is positioned bottom-down instead of head-down. It’s actually really common for babies to be breech during pregnancy and it is not usually a concern up to around 34 weeks of pregnancy.

Most babies will turn head-down on their own before birth, but if your baby is still breech at 36 weeks, the chances of spontaneous turning reduce significantly. Research shows that only about 3–7% of babies will turn head-down after this point. That means roughly 3 in every 100 babies remain breech at term.

Different types of breech presentation

What Are My Options?

External Cephalic Version (ECV)

If your baby is still breech around 36–37 weeks, your maternity team might offer you an ECV—a procedure where a trained clinician uses their hands to manually turn your baby from the outside.

The Royal College of Obstetricians and Gynaecologists (RCOG) recommends that women with a breech baby at term should be offered an ECV, unless there’s a clear reason not to.

Here’s what you need to know about ECV:

• It’s usually offered from 37 weeks (or 36 weeks if it’s your first baby).

• It has a 50% success rate—so it works for about 1 in 2 women.

• If successful, there’s a small chance (about 1 in 100) your baby could turn back.

• It can still be offered later than 37 weeks—there’s no official cut-off date.

  
  

Is ECV an option if I’ve had a previous caesarean?

The role of ECV in the case of previous caesarean section has be controversial. However, the 2017 RCOG Green-Top Guidelines No. 20a state: “Women should be informed that ECV after one caesarean delivery appears to have no greater risk than with an unscarred uterus.”

That means ECV should not automatically be ruled out just because you’ve had a previous caesarean section.

The research reviewed by RCOG compared 70 ECVS performed in women with a previous caesarean section with 387 ECVs performed in multiparous women (2nd+ births) It concluded that ECV was safe and successful in women with one previous caesarean delivery as with multiparous women. In the previous caesarean group they found:

• no complications

• no uterine ruptures

• Similar success rates to those without a previous caesarean

Since the RCOG guidelines were last updated in 2017, there have been a few more recent studies exploring this topic. A 2021 study concluded that "ECV in women with a previous caesarean delivery is a relatively successful and low-risk procedure compared to women without a previous caesarean delivery".

It's also reassuring to note that the American College of Obstetricians and Gynecologists (ACOG) also advise that women with a previous caesarean can be offered an ECV, and the success and safety profile is comparable.

Not everyone is suitable for an ECV. Contraindications may include:

• Placenta praevia (major)

• Multiple pregnancy (twins or more)

• Ongoing or recent vaginal bleeding

• Abnormal fetal heart monitoring

• Ruptured membranes

  
  

If you're unsure, it's worth discussing your individual circumstances with a consultant midwife or obstetrician who is supportive of VBACs.

What about vaginal breech birth after caesarean?

Back in 2006, the RCOG listed a “scarred uterus” (which includes previous caesarean) as a reason not to attempt a breech vaginal birth. But in their 2017 Green-top guidelines No. 20b, this is no longer listed as a contraindication.

That means: a vaginal breech birth after caesarean is not ruled out.

However, the evidence is limited, but what we do have is promising. A small German study involving 37 women with a previous caesarean and a breech baby found:

• No increased risk to mother or baby

• VBAC rates were similar to those with head-down babies

• The researchers concluded that vaginal breech birth is a suitable option for women with a previous caesarean

  
  

What if my current team won’t support breech vaginal birth?

Over the last couple of decades, breech birth has become more and more uncommon. This means that the main risk to attempting a breech birth is a lack of skilled and confident health care professionals. Add a VBAC into the mix and there might be more hesitancy around facilitating a breech birth.

You may wish to explore the Optibreech Care Pathway, which is part of a research programme in the UK offering enhanced support and specialist care for those planning a vaginal breech birth at participating sites.

So… can I have a VBAC if my baby is breech?

Yes, it may still be possible. You have options—and it all depends on your individual situation, your preferences and the support you have around you.

• You may opt for an ECV to encourage baby to turn.

• You may consider a vaginal breech birth, especially with experienced care.

• You might choose to decline intervention and wait, knowing baby might still turn.

• Or you might choose a planned caesarean, if that feels safest for you.

The most important thing? That you’re respected, informed, and supported to make the decision that’s right for you.