August 15, 2012
This is a dilemma that pregnant women face on a daily basis. Up until 36 weeks, the position of the baby can vary from feet first (breech), buttocks first (frank breech), head first (cephalic) or transverse lie (the baby is lying in a horizontal position). However, after 36 weeks, the position of the baby normally doesn’t change because there is not enough room for the maneuver.
This becomes a significant challenge for first-time moms who have what we call, an “untried pelvis” meaning there’s never been a birth so it’s not certain whether the pelvis could accommodate a breech presentation. Delivering a breech baby takes a tremendous amount of skill because the baby’s head is the last part of the delivery and could theoretically get “stuck,” something we want to avoid. This is why most first-time pregnant moms have c-sections if their baby is in a breech position.
Some physicians will attempt to do an external cephalic version, commonly known as an “external version” if they think they can manually turn the baby from a breech to a head down position. This is usually done by an obstetrician or family practice physician in rare instances. The procedure is successful in 65% of cases but here are a few things one should be aware of in order to make an informed decision.
- An ultrasound should be done prior to the procedure to make sure they are no fetal anomalies
- There should be enough fluid around the baby but not over 20 centimeters
- The baby should weigh at least 4.5 pounds but not more than 8.5 pounds
- The baby should be in a “back up” position, meaning it’s back is facing the front of the abdomen
- RhoGham should be given if the patient is Rh negative
- The procedure should be done in a hospital in the event of complications
- The procedures should be done preferably by a high-risk specialist (maternal fetal medicine specialist) or someone who has done at least 30 procedures hopefully with a success rate
- The baby should not be in a footling breech position because the umbilical cord could become injured during the procedure
- No more than 3 attempts should be made
- The procedure should be done under ultrasound guidance
- Terbutaline is usually given to relax the uterine muscles before the procedures starts
- The baby should be monitored for 30 minutes after the procedure is finished
Should your provider suggest an external version, you now have the facts. If the procedure is not successful, do not worry. Better safe than sorry. A c-section does not mean failure. It means all options were taken and it is the safest way to have a healthy baby.