External Cephalic Version for Breech Position

Treatment Overview

At the end of most pregnancies, the baby's head is near the birth canal (vagina). But sometimes a baby's rear end or feet are near the birth canal. This position is called breech.

If your baby stays in this breech position, you will probably need a cesarean section (C-section). Most breech babies are healthy and don't have problems after birth.

Your doctor may try to turn your baby. To do this, the doctor presses on certain places on your belly. Sometimes this causes the baby to turn. The medical name for this process is external cephalic version.

During the process of trying to turn your baby, your doctor will carefully watch your uterus. There's a chance that the pressure and movement might start contractions. There's also a chance that the umbilical cord will twist or get damaged.

If your baby turns, your doctor may send you home. But the doctor will check you often until your labor starts. If your baby's head stays down, you may be able to have a vaginal delivery. But a small number of babies move back into a breech position.

What To Expect

You and the baby may be closely watched for a short time after the doctor tries to turn your baby. You can do your normal activities after the procedure is over.

Why It Is Done

You might choose to have your baby turned if you'd like to have a vaginal delivery.

Doctors may try to turn a baby when:

• The mother is 36 to 42 weeks pregnant. Before 36 weeks, the baby is likely to turn back into a head-down position on its own. But turning the baby may be more successful if it is done as early as possible after 36 weeks. That's because the baby is smaller and is surrounded by more amniotic fluid and space to move in the uterus.
• The mother is pregnant with only one baby.
• The baby has not dropped into the pelvis (has not engaged). A baby that has engaged is very hard to move.
• There is enough amniotic fluid surrounding the baby for turning the baby. If the amount of amniotic fluid is below normal (oligohydramnios), the baby is more likely to be injured during a version attempt.
• The mother has been pregnant before. A previous pregnancy usually means that the wall of the belly is more flexible and can stretch when the doctor tries to turn the baby. But version may also be tried if the mother hasn't been pregnant before.
• The baby is in the frank, complete breech, or footling breech position.

Version is usually not done when:

• The bag of waters (amniotic sac) has ruptured.
• The mother has a condition (such as a heart problem) that prevents her from receiving certain tocolytic medicines to prevent uterine contractions.
• A cesarean delivery is needed. This can happen when the placenta partially or completely covers the cervix (placenta previa) or has separated from the wall of the uterus (placenta abruptio).
• Fetal monitoring shows that the baby may not be doing well.
• The baby has a hyperextended head. This means that the neck is straight, rather than bending the head forward with the chin tucked into the chest.
• The baby is known or suspected to have a birth defect.
• The mother is pregnant with more than one baby (twins, triplets, or more).
• The mother's uterus does not have a normal shape.

Version may pose a slight risk of opening a previous C-section scar. Limited research has shown that women with a cesarean scar have had no such problems. But larger studies are needed to fully assess the risk.^{footnote 1}

In some cases, a doctor will choose not to try a version when there is less amniotic fluid than normal around the baby.

How Well It Works

Turning a breech baby has an average success rate of 58%.^{footnote 1} It's most likely to succeed when:^{footnote 2}

• The mother has already had at least one pregnancy and childbirth.
• The baby, or a foot or leg, has not dropped down into the pelvis (has not engaged).
• The baby is surrounded by a normal amount of amniotic fluid.
• The procedure is done near term (36 or more completed weeks of pregnancy), before labor starts.

Turning the baby is least likely to succeed when:^{footnote 2}

• The baby is engaged down in the mother's pelvis.
• The doctor can't grasp the baby's head.
• The uterus is hard or tense to the touch.

Compared to the first attempt, repeat attempts to turn the baby are less likely to be successful.

Risks

When the mother and baby are closely watched, the risks of turning a breech baby are low.

Possible risks include:

• Twisting or squeezing of the umbilical cord. This can reduce blood flow and oxygen to your baby.
• The start of labor. Labor can start if the amniotic sac around the baby ruptures. (This is called premature rupture of the membranes, or PROM).
• Placenta abruptio, rupture of the uterus, or damage to the umbilical cord. These problems are possible, but they are very rare.

In the rare case that labor starts or your baby or you develop a serious problem during version, you may have an emergency C-section to deliver the baby.

Version has a very small risk of causing bleeding that could lead to mixing of the blood of the mother and the baby. So if you have Rh-negative blood, you'll get an Rh immunoglobulin injection (such as RhoGAM). This is done to prevent Rh sensitization, which can cause problems in future pregnancies.