Most babies are in a head-down or vertex position just before birth making a vaginal birth usually safe and possible. Sometimes the baby will be in position with the buttocks or feet first in the mother’s uterus. This is known as a breech baby or breech birth.
Many more complications can occur during a vaginal birth if the baby is breech. The umbilical cord can become pinched or crushed and cause asphyxia or even death of the baby and sometimes, even the mother. Generally breech babies are delivered by cesarean delivery, or c-section.
While risks are involved in cesarean deliveries such as bleeding, infections, added pain and discomfort from the surgical procedure and longer hospital stays for both the mother and the baby, another option may be possible: External Cephalic Version.
External cephalic version is a procedure to try to turn the baby inside the uterus from a breech position to the vertex or head-down position. The doctor will use his hands on the outside of your abdomen and push and roll to attempt repositioning the baby in a head-down position.
Version is generally done at the end of the pregnancy, after the 36th week of gestation, as there is a small risk of inducing labor with the procedure. Also, there is a chance of fetal distress leading to an emergency cesarean delivery. There is a chance, too, that the baby may turn back into the breech position after the external cephalic version procedure is done.
There are several conditions where a woman cannot have external cephalic version. These include the following:
If there has been a premature rupture of the membranes
An external cephalic version is done in the hospital under strict monitoring conditions. Before the procedure, an ultrasound is performed to confirm the baby’s position. Frequently fetal ultrasound is used throughout the version attempt to monitor the baby’s position. A nonstress test is also done to make sure the baby’s heart rate is normal.
Before the version attempt, an injection is given to relax the uterus and prevent contractions. When the uterus is relaxed, the doctor will use both hands on the outside of the abdomen, one on the baby’s head and the other and on the baby’s buttocks. He then tries to push and roll the fetus to a head-down position.
Depending on how sensitive the mother’s abdomen is, some discomfort may be experienced, especially if the procedure causes the uterus to contract. If the fetus has a sudden drop in heart rate which indicates distress, the version is stopped.
Sometimes the doctor will suggest another attempt later using an epidural anesthesia so there is no discomfort and the uterus can totally relax. Studies show that an external cephalic version performed with an epidural anesthesia increases the success of the repeated attempts.
Complications are rare, but an external cephalic version procedure should only be performed in a facility equipped for emergency cesarean delivery. The mother and baby are monitored for a short time after the procedure, then normal activities can be resumed. External cephalic version success rate of about 58% is seen with the following:
The mother has had at least one other pregnancy and birth
A foot or leg has not dropped down into the pelvis (has not engaged)
The baby is surrounded by sufficient amniotic fluid
The version procedure is performed after 36+ completed weeks of pregnancy
About 4% of babies return to a breech position after a successful version.
