PREGNANCY

If your baby is in the breech position (head up, buttocks down) as your due date ap-proaches, your caregiver may recommend a procedure known as external cephalic version (ECV), a manoeuvre used to move a baby into a head-down position. Eileen Hutton is a midwife and clinical researcher at the University of Toronto who has studied and performed ECV extensively. She notes that the procedure “is being looked at with new interest” these days. A recent Canadian trial which assessed the risks and benefits of breech birth versus Caesarean section was stopped midway, when it became evident that vaginal deliveries carried more risks than C-section for breech babies. Hutton recently released the results of a survey that showed very few doctors are comfortable with vaginal breech birth. So for women with a breech baby who wish to avoid a C-section, getting the baby to turn before labour commences may be the best option.

How is ECV done?
A midwife or doctor uses her hands to “lift” the baby’s buttocks out of the pelvis so that the baby is “floating.” This is often the most difficult part of the procedure since the baby’s buttocks may have settled well down into the pelvis. Pressure is applied to the baby’s head to get him to “somersault” forward into a head-down position. The baby’s heart rate is monitored during ECV, and sometimes women are given a drug to help relax the muscles of the uterus.

What does it feel like?
Hutton says most women don’t find the procedure unduly painful. “There is a digging sensation over the bladder when the baby’s buttocks are palpated and that can be uncomfortable,” she says, adding that some women describe the sensation of the baby somersaulting forward as “weird.” But when asked to rate the pain level associated with ECV, Hutton found the average rating was four out of ten, with ten being most painful and one no pain.

When should ECV be done?
Traditionally ECV has been done at 37 weeks. By then, most babies who would have settled into the head-down position on their own will have done so. This timing also means that should ECV trigger the onset of labour (which is very unlikely), the baby can safely be delivered. But a recent study undertaken by Hutton found that when ECV is done earlier, between 34 and 36 weeks, there is a trend toward lower rates of breech presentation compared to ECV at 37 weeks. This has prompted Hutton and her colleagues to launch a second trial to assess the impact of earlier ECV on preterm labour and C-section rates, and also to determine if that trend is statistically significant.

Are there any reasons why ECV shouldn’t be attempted?
Women who are candidates for a C-section for reasons other than a breech presentation or who have high blood pressure, a uterine anomaly (oddly shaped uterus) or a low volume of amniotic fluid should not have an ECV.

Are there things women can do on their own to encourage a baby to turn?
According to Hutton, none of the research that’s been done on positioning or pelvic tilting has shown these techniques to be effective. There’s also no evidence to show that shining a bright light in the pelvic area or playing music to lure the baby into the head-down position work either. However, there is one study of a traditional Chinese remedy called moxibustion (where heat is applied to a pressure point in the small toe) that showed it increased the effectiveness of ECV (compared to ECV alone).

Originally published in Pregnancy & Birth, Autumn 2003