So…your baby is breech (bottom, or feet, down)…what happens next?
First of all, it can be perfectly normal for your bub to be breech, especially earlier in your pregnancy. You can imagine, when they’re small, they can flip and flop around in their lovely warm pool, into any position they like. As you get closer to your due date, however, most babies will settle in to a head down position (called cephalic). Once you get to “term” (about 37 weeks, or 3 weeks before your due date), only about5% of babies will be in the breech position.
If you are one of these mums, one of the options your care provider should discuss with you is an ECV. This stands for external cephalic version, and basically means encouraging your baby into the head down position (cephalic), by manipulation on the outside of your tummy (external).
The reason we offer this is that it is generally accepted that a head first vaginal birth is safer for babies than a breech vaginal birth. Many breech babies are born via Caesarean section for this reason, so if we can encourage breech babies to turn to head first, we can avoid a Caesarean section.
Sooo, easy decision right? Let’s turn that baby! Well, that’s pretty much the way I feel, but like most things in life, there’s a little more to it. Although it is a very safe procedure, like anything in life it comes with a small chance of complications.
Most importantly, not all babies will turn, and a small percentage of those that do turn, will turn themselves back to breech again. Overall, chances are about 50/50 of your baby turning and staying in the head down position, although there are definitely personal factors that will influence that number up or down for you. Serious complications are rare, but the very worst case scenario (exceedingly rare) would be a complication (such as bleeding, or a persistent change in the baby’s heart rate) meaning that your baby would need to be delivered sooner rather than later, often by Caesarean section. As a guide, in my career, I have only seen one woman have a complication like that – some bleeding, but not severe, which meant that we induced her labour that evening – all went well and mum and baby were both healthy. It is for this reason, though, that most caregivers offering ECV will do it sometime in your 37th week of pregnancy, so if the baby does need to come, he or she is mature enough to be born healthy.
The actual procedure of an ECV is pretty cool. First, you will have a heart rate monitor applied to make sure your baby is happy and healthy prior to the turning. You may be given some medication to relax your uterus, and this can sometimes make your heart race a bit (a normal side effect, and a good indication that the medication is working). Then, your doctor will run the ultrasound over you to get a feel for how your baby is lying. Some doctors use talcum powder, or ultrasound goo, on your tummy to make it easier to turn the baby. Then, they put a hand over the baby’s head, and a hand on the bottom, and gently encourage your baby to do a forward, or backward, somersault. How cool is that!
The turning feels weird, but shouldn’t be painful. However, your uterus is designed for your baby to lie in an up and down position (either head or bottom first), and so you can imagine that as they pass the middle point of the somersault (where they are lying sideways in your uterus) that can be pretty uncomfortable! Luckily this part doesn’t last long, and if you are feeling uncomfortable, it is probably a sign that the turning is going well. Bottom line is to keep in constant communication with your caregiver, and if at any time you are too uncomfortable, let them know.
So if you are in the position where your baby is breech at term, speak to your caregivers about ECV. There are a few conditions that mean that ECV is not a good idea, so of course you should take their individualized advice, but hopefully this post will have helped you to know a bit more about your options and what to expect from ECV.
Dr Bianca Bryce
(This article contains general information only and is not intended to replace advice from a qualified health professional. All information is written from the experience and knowledge of the person writing the post).
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