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    Find out what other moms-to-be are asking. Join in the discussion with Henci Goer, whose expertise is determining what the research tells us best promotes safe, healthy birth. If you would like to contact Henci outside of the Ask Henci forum, send an email to Goersitemail@aol.com.

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    Apr 13
    2009

    External Version for Breech Baby

    Archived User

    Just before my 36th week appointment, my baby turned breech.  The Midwife truly thought she felt him head down, but couldn't find his heartbeat until she went really high.   This is my fourth child and I have never had a baby in a breech position before, so I never even considered this option.  My next appointment is Wednesday and I will be 37.5 weeks.  The Dr. will confirm (probably through ultrasound) the position of the baby.  If the baby is still breech, she will probably either offer to schedule a section or do an external version, which is required to be done at the hospital. 

    I have heard that, because of the higher risks of an emergency c section vs a planned one, an external version is not always best.  I have also had a slightly low lying placenta and am not sure how an external version will effect this.  Delivering a baby breech is not an option my Dr. would consider, especially considering that my labors have always been induced and very, very slow to progress. 

    Does anyone have any thoughts on this - what is the likelihood of getting a baby to turn at almost 38 weeks (they would probably try the version on Friday) and are the risks and pains of a version (which they say doesn't usually work) worth it? 

     

     

    Henci Goer

    Sorry that I didn't reply sooner. I've been under the weather. By all means go ahead with the external cephalic version (ECV). Done properly, that is, with care and not forcing a baby who is resistant to turning, it is safe and effective. Added bonus: since you have had babies before, ECV is more likely to work for you. You can also try two different alternative medicine techniques. Neither will do you or the baby any harm as neither involves manipulating the baby. You can find a chiropractor who knows the Webster technique, or try moxibustion, or, better yet, both.

    If the baby doesn't turn, you may wish to consider whether you want to schedule a cesarean. This is not so straightforward a choice as your obstetrician may have presented it. Cesarean surgery has its risks too, some of them serious, especially if you are planning to have more children, and vaginal breech birth has gotten a bad rap. In suitable candidates--frank breech (buttocks down), normally-formed average-size baby, head tucked--breech birth outcomes are just as good as with planned cesarean. (See below.) Having had children before makes you a more favorable candidate for vaginal breech birth as well as ECV. The catch is, though, in the conclusion of the study summary. The problem in the U.S., at least, is finding a practitioner who knows how to assist at a breech birth. Obstetricians are squarely to blame for their failure to acquire those skills. You can always learn something you want to learn, and these days, simulation models make it possible to learn delivery skills without needing to practice on a live mother and baby. Nonetheless, U.S. obs rarely have the skills, and the last thing you want is a panicked doctor who doesn't know what he or she is doing. You may wish to see if someone in your community has the skills. If none exist or you prefer to go ahead and plan the cesarean, here are a couple of suggestions that are not necessarily standard practice that will make cesarean surgery safer:

    • Do not schedule surgery until 39 completed weeks of pregnancy. This minimizes the chance of your baby having potentially serious respiratory problems after delivery. In fact, since you have a history of slow labors, you may wish to await labor onset. The best way of telling when a baby is ready to be born is by allowing labor to start spontaneously.
    • Insist on double-layer uterine suturing. Single-layer suturing appears to increase the risk of scar rupture in future labors, and while there is some disagreement in the research on this point, why take the chance when we know the results with double-layer are good. 

    Beyond that, consider and plan with your doctor for a positive cesarean experience. Also, deciding that a cesarean is best and safest for your baby doesn't mean you have to like it. Allow yourself to experience whatever feelings you need to. 

    -- Henci 

    Goffinet F, Carayol M, Foidart JM, et al. Is planned vaginal delivery for breech presentation at term still an option? Results of an observational prospective survey in France and Belgium. Am J Obstet Gynecol 2006;194(4):1002-11.

    OBJECTIVE: A large trial published in 2000 concluded that planned vaginal delivery of term breech births is associated with high neonatal risks. Because the obstetric practices in that study differed from those in countries where planned vaginal delivery is still common, we conducted an observational prospective study to describe neonatal outcome according to the planned mode of delivery for term breech births in 2 such countries. STUDY DESIGN: Observational prospective study with an intent-to-treat analysis to compare the groups for which cesarean and vaginal deliveries were planned. Associations between the outcome and planned mode of delivery were controlled for confounding by multivariate analysis. The main outcome measure was a variable that combined fetal and neonatal mortality and severe neonatal morbidity. The study population consisted of 8105 pregnant women delivering singleton fetuses in breech presentation at term in 138 French and 36 Belgian maternity units. RESULTS: Cesarean delivery was planned for 5579 women (68.8%) and vaginal delivery for 2526 (31.2%). Of the women with planned vaginal deliveries, 1796 delivered vaginally (71.0%). The rate of the combined neonatal outcome measure was low in the overall population (1.59%; 95% CI [1.33-1.89]) and in the planned vaginal delivery group (1.60%; 95% CI [1.14-2.17]). It did not differ significantly between the planned vaginal and cesarean delivery groups (unadjusted odds ratio = 1.10, 95% CI [0.75-1.61]), even after controlling for confounding variables (adjusted odds ratio = 1.40, 95% CI [0.89-2.23]). CONCLUSION: In places where planned vaginal delivery is a common practice and when strict criteria are met before and during labor, planned vaginal delivery of singleton fetuses in breech presentation at term remains a safe option that can be offered to women.


    All Times America/New_York

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