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Management of Breech Presentation (Green-top Guideline No. 20b)

Published: 16/03/2017

You can also access this guideline in PDF.

New evidence and guidance in this field were reviewed at the February 2020 Guidelines Committee meeting and it was decided that revision of this guideline would be deferred for 3 years (May 2023). The version available on the website and app will remain valid until replaced.

This is the fourth edition of this guideline, first published in 1999 and revised in 2001 and 2006 under the same title.

The aim of this guideline is to aid decision making regarding the route of delivery and choice of various techniques used during delivery. It does not include antenatal or postnatal care. Information regarding external cephalic version is the topic of the separate Royal College of Obstetricians and Gynaecologists Green-top Guideline No. 20a, External Cephalic Version and Reducing the Incidence of Term Breech Presentation.

Breech presentation occurs in 3–4% of term deliveries and is more common in preterm deliveries and nulliparous women. Breech presentation is associated with uterine and congenital abnormalities, and has a significant recurrence risk. Term babies presenting by the breech have worse outcomes than cephalic presenting babies, irrespective of the mode of delivery.

A large reduction in the incidence of planned vaginal breech birth followed publication of the Term Breech Trial. Nevertheless, due to various circumstances vaginal breech births will continue. Lack of experience has led to a loss of skills essential for these deliveries. Conversely, caesarean section can has serious long-term consequences.

Declaration of interests:

Mr M Griffiths FRCOG, Eaton Bray is a member of Doctors for a Woman's right to Choose on Abortion. He is an unpaid member of a Quality Standards Advisory Committee at NICE, for which he does receive expenses for related travel, accommodation and meals.

Mr LWM Impey FRCOG, Oxford is Director of Oxford Fetal Medicine Ltd. and a member of the International Society of Ultrasound in Obstetrics and Gynecology. He also holds patents related to ultrasound processing, which are of no relevance to the Breech guidelines.

Professor DJ Murphy FRCOG, Dublin provides medicolegal expert opinions in Scotland and Ireland for which she is remunerated.

Dr LK Penna FRCOG, London: None declared.

Patient information

Information for women about breech baby at the end of pregnancy