breech - allowing labour to begin on its own before c-section?

Archived User

breech - allowing labour to begin on its own before c-section?

HI Henci,

I am wondering if you can point me in the direction of any evidence, regarding a friends  upcoming c-section. Her baby is breech, and doctor wants to do an ECV at 36 weeks (he says that is full-term). She is very interested in having as normal a birth as possible, and would much rather wait until 37 weeks, just in case the ECV sends her into labour. SHe is hopeful that they will be able to resolve that issue at her next appt. However her bigger concern is this: if the version is not successful, what are the risks of allowing her body/baby to go into labour naturally, and THEN go to the hospital for the c-section? This is her first pregnancy and she is otherwise very fit and healthy.


Henci Goer

RE: breech - allowing labour to begin on its own before c-section?
(in response to Archived User)

Attempting an ECV is more likely to be successful earlier than later because there is more amniotic fluid and the presenting part is less likely to be engaged. Also, as pregnancy advances, the likelihood of labor beginning rises, and the woman may miss her opportunity. (See below for evidence.) Usually, women are given a uterine relaxant (tocolytic) as part of the procedure to prevent the uterus from tightening in response to the manipulation, so I don't think she need worry about triggering labor. I will add that it has become the fashion in recent years to perform ECV under an epidural, and, at least when done at 37 w or later, to induce labor immediately after on grounds of delivering the baby while head down--although this latter policy may have changed with the current recognition of the risks of excess respiratory problems when delivering before 39 weeks. Still, few babies flip back to breech once turned, if they do, the procedure can be repeated, and inducing with an unfavorable cervix greatly increases chances of the induction ending in a c/section regardless of use of cervical ripening agents. Also, doing them under an epidural removes an element of safety. Excessive pain during the procedure is a sign to stop.

As for going into labor naturally, it remains true that the best way to tell when the baby is ready to be born is to await spontaneous labor. Also, labor stimulates the baby in ways that prepare it to be in the outside world, notably, catecholamines work to dry out the lungs. I think the question she has for her doctor is why not await labor onset? The only reason I can think of is doctor's convenience of scheduling and the issue of possibly needing to assemble a surgery team at night, but any hospital I would want to be at ought to be able to handle this contingency. Still, there may be others.

-- Henci

Excerpt from Thinking Woman's Guide to a Better Birth (c) 1999 by Henci Goer

Two [studies] reported success rates in three-quarters or more of attempts made before 37 weeks, dropping to half of attempts in one study and two-thirds of attempts in the other when done later (Scaling 1988; Kornman, Kimball, and Reeves 1995).

Kornman MT, Kimball KT, and Reeves KO. Preterm external cephalic version in an outpatient environment. Am J Obstet Gynecol 1995;172(6):1734-41.

Scaling ST. External cephalic version without tocolysis. Am J Obstet Gynecol 1988;158(6 Pt 1):1424-1430.


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