External Version

From WikiParenting

If your baby is in a breech presentation, your healthcare provider may attempt an external cephalic version. This is a procedure where they try to rotate the baby manually, by using pressure on the mother’s abdomen from the outside.

For the majority of your pregnancy your baby is able to move freely within the uterus. Around week 32 of your pregnancy, it becomes more difficult for the baby to move around because there is little room left to turn in. A baby that is not in the head down position is considered breech. Babies that are in a breech position near term are unlikely to be able to turn on their own.

[edit] Why would one be performed?

Since the head down position is the safest position for birth, an external version is attempted to try to turn the baby from a breech position to a head down position prior to delivery. If the version is successful the mother may avoid a cesarean section or breech birth.

[edit] When is it done?

The procedure is usually performed after 37 weeks. It is put off until then to see if the baby will turn by itself, and to ensure that the baby is fully developed in case an emergency cesarean section needs to be performed.

[edit] What are the risks?

The procedure does have risks associated with it, but they are rare. Risks include:

• Premature labor
• Premature rupture of membranes (PROM)
• Blood loss
• Fetal distress that necessitates a cesarean section
• Reversion to breech position after the version
• Placental detachment

[edit] What is the success rate?

The procedure has an overall success rate of about 65 percent with the best success rate in babies that lie in a transverse position – 90 percent. Keep in mind that not all babies will turn, and some go back to the breech position after successfully being turned. Various factors that influence whether the procedure will succeed are:

• If there is enough, but not too much, amniotic fluid
• If the baby is big enough to not turn back on his own
• If you are close to term
• If this is your second or higher gestation

[edit] Who should not have an external version?

Most women with normal pregnancies can have an external version performed. You should not have one if:

• You are carrying multiples
• You have too little amniotic fluid
• You have placenta previa
• Your baby is abnormally small
• You have experienced vaginal bleeding
• The baby has an abnormal heart rate

[edit] How is it performed?

The procedure is done in a hospital. The baby will be checked with an ultrasound to confirm the breech position and his heart rate will be assessed. You will be administered medicine to relax your uterus. Lubricant will be placed on your abdomen, and the doctor will then use his hands to begin manually turning the baby. The procedure may take only a few minutes, or it can take longer, depending upon the ease at which your baby turns. The procedure will be halted if your baby shows signs of distress. The baby should be monitored at all times during the procedure by ultrasound.

[edit] Does it hurt?

Women who have had the procedure done relate that it is anywhere from mildly to extremely uncomfortable; but keep in mind that the discomfort stops when the procedure is over, and you may avoid the extended recuperation time and pain associated with a cesarean section.

[edit] After the procedure

When the external version is finished, your baby will again be checked for distress. If the baby turned and is fine, you will be sent home. If the baby refused to turn or was in distress, your doctor will probably talk to you about having a cesarean section performed.

[edit] Other techniques to try

Other techniques that you can try to encourage the baby to turn on his own are:

• Moxibustion. This is an acupressure technique that uses smoldering herbs to stimulate acupressure points to encourage the baby to turn on his own. Clear it with your doctor and then call your state’s acupuncture or Chinese medical associations for names of licensed practitioners.
• Positioning. Get onto your hands and knees, and then straighten out your elbows and slide your hands forward so that your bottom is higher than your head. Try this twice a day, but stop if you feel uncomfortable.
• Hypnosis. Try hypnosis; ask your doctor if they can refer you to a skilled hypnotherapist.