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Turning a breech baby

If you find out that your baby is breech, it can often be 'turned around' so that it's in a better position for labour, but how is this done?

Posted: 7 July 2009
by Laura Lee Davies

In the weeks running up to the birth, your baby is likely to move into the 'head down' position. This is completely comfortable for your baby, who is floating in amniotic fluid, and the position is the best possible way in which a baby will be born vaginally, head coming first down from the uterus (womb). If a baby positions itself so that the bottom or feet are likely to come out first, this is known as a breech position.
Between 37 weeks and full term, most babies will turn 'head down', some will do this even earlier. The midwife team will keep an eye on when/if this happens by monitoring your bump at your regular antenatal appointments.

Why turn a 'breech baby'?
Historically, if a baby was breech the mother just had to get on with it and deal with the consequences, which might or might not be favourable for the mother and/or child. Nowadays, although many medical professionals may be concerned about a breech birth, it is not the worst problem to deal with if the midwife present is experienced and other conditions make for a smooth and efficient labour.
However, it is preferable that the head come down first, because the skull is the hardest, largest part of the body and if it comes first then the rest of the body will usually efficiently flow through after its delivery, while the baby is already exposed to air. If another body part comes down, there can be a danger that physiological injury occurs to the baby's body, and most importantly, there is a risk that the baby's air supply will be limited, or that other birth-related trauma may occur if the head comes out last.

Turning a breech baby by ECV
ECV stands for external cephalic version. This can be done in the weeks before the birth, but usually not earlier than 36 weeks. (Before then, a 'watch and wait' policy is more likely, as some babies will leave it quite late to get into the 'right' position!)
It involves gentle manipulation of your tummy so that the baby is encouraged to move into the head-down position. It can be done as close to the due date as is seen safe and fit to do so.
Where your midwife and/or consultant believe this can be done safely, it is an option which may be preferred over having to go for a caesarean, which is often advised if a baby is breech.
It is only successful in about half of the attempts made, so your doctor, consultant and/or midwife will advise you if the outcome is any more or less likely in your case.

What does an external cephalic version (ECV) entail?
In most cases, an ECV means attending a normal antenatal clinic session rather than checking into hospital as an inpatient. (As it is very unlikely to bring on labour, this will be a daytime appointment.)
You will usually be given medication to help relax your muscles, but this is completely safe for your baby. Then your midwife will manipulate your bump with the aim of moving your baby into a head-down position. It can be a little uncomfortable but should not be extremely painful.
You will be advised to be vigilant about bleeding afterwards as, in about one in 200 cases, the baby will require delivery by emergency caesarean after an ECV. However, the baby's heart beat is always monitored before and after an ECV to make sure that he or she has not been put under any dangerous stress.
Following the treatment, you will be advised about aftercare, in order to ensure that bleeding or discomfort do not signal any danger for you and your child. However, in most cases a mother will go home and safely await the normal labour and birth procedure which may follow even weeks later.
If the baby goes breech again, a further ECV may be attempted but it is unlikely that a third procedurte would be suggested if the baby is still not head down. At that point your consultant may suggest an elective caesarean.

When an ECV is not advised
If you do not have a regular-shaped womb, or there is another medical reason why a caesarean has already been advised, then you will not be offered an ECV.
If you have experienced recent bleeding, it is unlikely that this procedure will be suggested. Also, if upon monitoring your baby's heart rate it is found to be uneven or fast, then an ECV will not be carried out.
If you are expecting more than one child it is unlikely that this procedure will be carried out, unless this is the last child to be delivered and the other (or others) has been delivered safely before this last baby needs to be turned.

If you feel that you need this procedure but it has not been suggested by your midwife and/or consultant, feel free to discuss the issue with them as there may be ongoing medical reasons why they do not feel it is advisable in your case.
However, where possible and where it is safe, the medical profession now believes that a normal vaginal birth is always preferable to a caesarean.

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