Q: My baby is breech. Does this mean I must have a Cesarean section?
A: Breech presentation, where the baby is positioned to be born feet or buttocks first, occurs in approximately three to four percent of full term pregnancies. This can create a dangerous situation for the baby, so there is a high Cesarean delivery rate for breech presentation. However, some healthcare providers may offer qualified patients a procedure that could reduce the need for a C-section.
Called external cephalic version (ECV), this procedure involves the physician applying pressure to a woman’s abdomen to turn the fetus in either a forward or backward roll.
This moves the baby to a head-down presentation. If a baby can be moved to a head-down presentation, then the chances for a vaginal delivery increase.
If the baby does not move to a head down position, then it is reasonable to schedule a Cesarean at 39 weeks, or before the mother goes into labor.
Your doctor will evaluate your baby’s presentation between 35 and 36 weeks. If he or she has not turned, your provider might recommend ECV at 37 weeks.
There are some risks with ECV. Adverse events after ECV have included premature separation of the placenta from the uterine wall, umbilical cord prolapse and rupture of membranes; however, all occurred at rates of less than one percent.
Fetal heart rate changes during attempted ECVs are not uncommon, but the heart rate usually stabilizes when the procedure is discontinued. ECV is typically performed in the hospital under fetal monitoring with the ability to perform a C-section if an emergency arises.
The immediate benefit of successful ECV is an increased probability that the baby will be in a head-down presentation for delivery. Babies lying sideways are easier to move to head-down than babies who are breech. The goal is an uncomplicated vaginal delivery.
Results from studies of ECV showed a combined success rate of 58 percent and a complication rate of 6.1 percent. Reports showed a higher success rate if the mother has had a previous pregnancy.
The data does not indicate if the amount of amniotic fluid, location of the placenta or weight of the mother have an effect on the success of ECV.
The results do, however, show lower success rates for moms who are pregnant for the first time and are more than four centimeters dilated. Success rates of ECV were also lower when the projected fetal weight was less than 5.5 pounds; the placenta was on the anterior (front) wall of the uterus; or the baby was low in the pelvis.
Your physician will be monitoring your baby closely during your last weeks of pregnancy. Be sure to discuss your options. Your doctor can tell you if you are an ideal candidate for ECV.
Dr. Joanne Price Williamson is an obstetrician-gynecologist who practices at Provident OB/GYN Associates-Legacy Center in Okatie.