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Breech presentation at or near term
Successful external cephalic version reduces the chance of a Cesarean section.
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About 4% of babies are not "head first" by 36-37 weeks of pregnancy. If a baby is breech, it can make labour more complicated. For this reason, most women in Australia with a breech baby will have a planned Cesarean birth.
External cephalic version
Turning the baby around by lifting the baby's bottom out of a woman's pelvis and encouraging the baby to do a "somersault" is called an "external cephalic version" or ECV. This procedure is successful approximately 50% of the time and has been shown to be a safe and effective method to reduce the rate of breech birth and Cesarean section.
Our ECV service is based in the Fetal Monitoring Unit in the Department of Perinatal medicine. The ECVs are performed by maternal fetal medicine specialists after performing an ultrasound to check the baby's growth, position and well-being. The baby will have heart rate monitoring (cardiotocography, CTG) before and after the procedure. If you have a negative blood group ("Rhesus negative") you will also need an injection of anti-D after the procedure.
What causes a baby to be in the breech presentation?
We do not always know why some babies are breech at the end of pregnancy. Sometimes the shape of the mother's uterus or the movements of the baby may affect the way the baby lies. Most of the time we don't have a explanation.
How common is breech presentation?
About four per cent of babies (4 out of 100) are in breech presentation at 36 weeks gestation. By 40 weeks (your due date), about three per cent of babies (3 out of 100) are still in breech presentation.
Could my baby turn naturally to a head first (cephalic) position before labour?
About 1 in 4 babies that are breech at 36 weeks will turn naturally by 40 weeks. We usually can't predict which babies will turn on their own.
Is there anything I can do to encourage the baby to turn?
External cephalic version (ECV) successfully turns about 50 per cent of breech babies to the head down position when performed after 36 weeks gestation.
Breech exercises (putting your head down and bottom up for periods of time during the day) or acupuncture are thought to be safe things to try, but have never been proven to actually help.
What is an ECV?
External cephalic version is a procedure where an obstetrician applies pressure with his or her hands on a pregnant woman's abdomen to encourage the baby to do a somersault into the head first (cephalic) presentation.
What is the success rate of ECV?
The success rate for ECVs at Mercy Perinatal is about 50 (about half of all attempts). An ECV is more likely to be successful if: (i) you have had a baby before, (ii) there is plenty of fluid around your baby, (iii) your baby's bottom has yet to engage in your pelvis, and (iv) your uterine muscles are relaxed.
What are the chances of a normal birth after a successful ECV?
If your baby turns to head first and all is well, you have more than 80 per cent chance of a natural birth. However, even after a successful ECV, some labours do not progress smoothly and you may still require a caesarean.
What are the chances of the baby turning back to breech after a successful ECV?
The chance of your baby turning back to breech after a successful ECV is about 2-3% (very low).
How safe is an ECV?
An ECV is a safe procedure if certain precautions are taken. The chance of causing a problem for your baby during an ECV is low. Less than 1% of women need an emergency delivery within 24 hours after an ECV.
We always perform fetal heart rate monitoring (CTG) before and after the ECV. We also perform an ultrasound to check the amount of fluid around the baby, the size of your baby and the umbilical cord position and blood flow before deciding whether it is safe to proceed with the ECV.
What happens if the baby remains in the breech position?
An appointment will be made with your obstetrician to discuss how to continue to manage your pregnancy. There is about nine per cent chance that your baby will turn to head first at some time after an unsuccessful ECV.
If your baby remains in breech position, you will be informed about the advantages and possible complications of vaginal and caesarean breech delivery. You can then make an informed decision on how you prefer to birth your baby.
If you experience labour pains or break your waters you should call the hospital immediately. It is very important that you inform the midwife when you call that your baby is in the breech position.
Information about breech presentation
From the Royal Australian College of Obstetricians and Gynaecologists
Mercy Perinatal ECV service
Baby In Breech Position
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