Checking for breech baby

A
 Second pregnancy. But I know I never had an ultrasound at the end of first my pregnancy to see if baby was breeched or not. The last ultrasound I had was 17 weeks, gender ultrasound.
He wasn't breeched and came vaginally. I'm assuming that when my Dr checked me for dilation during my appointments that he could tell the direction of the baby?
This pregnancy, the most recent ultrasound I had was at I think 27 weeks and she wasn't head down. I'm sure that she still isn't right now. But anyway.
Question is do Drs NEED an ultrasound to determine position? Obviously it's it only way to know 100% but what do they do when you're insurance doesn't cover extra ultrasounds.