Tag Archives: breech version

Turning a Breech is a Safe Option for Women with a Prior Cesarean

5 Mar

Breech presentation occurs in 3-4% of all term pregnancies and is the third most common reason for performing a cesarean in the U.S. More than 90% of breech babies are delivered by planned cesarean section. External Cephalic Version (ECV), a procedure that helps to turn a fetus from a breech presentation to a cephalic presentation has been shown to decrease the incidence of breech presentation at term for women without a cesarean scar thereby reducing the need for a cesarean section.  However, a study published in the January 2014 issue of  the British Journal of Obstetrics and Gynaecology   suggests it is safe for women with a prior cesarean to have an external cephalic version (ECV) in a medical center. This allows women to labor for a VBAC and reduce exposure to complications from a repeat cesarean.

The researchers in Spain compared a group of 70 low risk women with a prior cesarean with 387 low risk women with a prior vaginal birth who had an external version at or after 37 weeks of gestation.  happy mother with newborn babyAll women were expecting one baby. Physicians were successful in turning a breech in 67.1% of women with a cesarean scar and 66.1% of women with a prior vaginal birth. There were no complications in the group of women with a prior cesarean. Of the women with a prior cesarean 52.8% had a vaginal birth (VBAC). More than half of the women avoided a repeat cesarean section. Of the group of women without a prior cesarean 79.4% had a vaginal birth.

The authors of the study concluded that in addition to the 270 documented cases of uncomplicated ECVs for women with a prior cesarean, their data on 70 additional women that underwent the procedure without a uterine rupture or fetal mortality indicates that ECV is a safe option for women with a prior cesarean who want to labor for a VBAC.

Concern from the medical community for the complications of cesarean section and its impact on mothers and babies is mounting. Recently the American College of Obstetricians and Gynecologists and the Society For Maternal-Fetal Medicine issued Obstetric Care Consensus Statement: Safe Prevention of the Primary Cesarean Delivery which called for physician restraint in performing cesarean sections. The guidelines offered safe directives for preventing the first cesarean including offering a breech version to women to reduce the odds for a cesarean section.

This study on the safety of external cephalic version for women with a prior cesarean adds to the existing evidence and may encourage clinicians to also offer the procedure to women with a prior cesarean who may want to labor for a VBAC.

Resources for Mothers

American Academy of Family Physicians

What Can I Do If My Baby is Breech?

Royal College of Obstetricians and Gynaecologists, U.K.,

Turning A Breech Baby In The Womb

 

 

A Breech Version May Avoid A First Cesarean Or Lead To A VBAC

12 Nov

A breech is one of the main reasons why women have a cesarean.  Yet it is also one of the most preventable.

With a prior cesarean and a low-transverse uterine scar (bikini incision),  an expectant mother with a breech who wants to have a VBAC  can ask her care provider about the option of an external version.

The current ACOG guidelines for VBAC state that an external cephalic version (ECV) is an option for low risk women with a low transverse uterine scar. If the ECV is successful women can labor for a VBAC rather than schedule a repeat cesarean.

Towards the end of pregnancy, most babies will align themselves in the uterus into a head down position, the safest position for birth. However, in approximately 3-4% percent of pregnancies, the baby will present as a breech, with its feet or buttocks positioned close to the birth canal.

External cephalic version (ECV), also known as a breech version, is a procedure in which external manipulation is used to change a fetus from a breech presentation to a vertex (head down) presentation.

External version is a relatively safe and successful procedure for most women when performed by experienced caregivers. About 65% of breech versions are successful. Complications from ECV are rare.

ECVs are more successful with an experienced care provider. Other factors such as the position of the baby and the level of amniotic fluid also play a role.

According to U.S.  birth data, in 2006 about 73 percent of ECVs were reported as successful. Women who had a successful ECV were more likely to have a vaginal delivery (77.7 percent) than women with a failed ECV (10.4 percent).

Preparing For  ECV

Before doing an ECV most care providers will want to do an ultrasound exam to see the position of the baby, locate the umbilical cord and placenta, and determine the amount of amniotic fluid.  Ultrasound is often used during the procedure. An electronic fetal heart monitor is used to measure the baby’s heart rate before and during the procedure. To make sure the baby’s heart rate has stabilized monitoring usually continues for about 30 minutes after. It is normal for the baby’s heart rate to increase while it is being moved. If the baby does not tolerate the procedure it will be stopped.

Care providers sometimes offer the mother a drug such as terbutaline to relax the uterine muscles, reduce contractions, and facilitate the breech version. Tocolytic drugs do have side effects for both mother and baby and women should find out what they are.

Mothers may be offered the option of having epidural anesthesia and should ask about the benefits and risks of an epidural for this procedure. If a woman has Rh-negative blood she will be offered Rh immune globulin to prevent incompatibility should her blood and her baby’s come into contact during the version. This happens in about 4.1% of external versions.

How A Breech Is Turned

To facilitate the movements of his hands over the mother’s abdomen, her care provider will rub a lubricant on her belly. With both hands on her abdomen, he will place one hand on her belly where her baby’s head would be and the other on the baby’s bottom. He will lift the baby’s bottom with one hand and gently push the head down with the other, backward or forward.

If the procedure is successful the expectant mother will likely go home. It is possible to have this procedure done again if the baby could not be moved into a head-down position. Some women find this procedure uncomfortable and sometimes painful.  Although complications are rare, after the procedure, her care provider should give her information about possible complications that may develop such as vaginal bleeding, going into labor, or the early rupturing of the bag of waters.

Studies show that with a breech version mothers are more likely to have a vaginal birth.

There are specific techniques through fetal positioning to help a baby in utero turn from a breech to a cephalic position (head down). Sometimes this method works and mothers can avoid an ECV.

Few hospital-based care providers today are skilled at attending a breech vaginal birth and many worry about malpractice liability. There is a growing interest, however in supporting women who choose to have a breech vaginal birth given that the evidence supports breech vaginal birth in specific circumstances.

Resources

American Academy of  Family Physicians. What Can I Do If My Baby is Breech?

Dr. Tucker performing an ECV. Youtube Video.

Coalition For Breech Birth

Cochrane Reviews.  Cephalic version by postural management for breech presentation

Henci Goer. When Research is Flawed, Vaginal Breech Birth.

Royal College of Obstetricians and Gynaecologists, U.K. Turning A Breech Baby In The Womb

Society of Obstetricians and Gynecologists of  Canada. No More Automatic C-section For Breech.

Spinning Babies.

Wellpath Center. Using the Webster’s Technique (chiropractic) to turn a breech. Youtube Video.


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