If you find yourself at the end of pregnancy with a baby who is still head up, you may want to try to encourage baby to turn head down.
There are three ways to help a breech baby go head-down:
- At Home
There are multiple ways to try helping your breech baby turn virtually risk-free at home using exercises and common household items. - With Help
Chiropractors, acupuncturists, hypnotherapists, and other alternative practitioners sometimes have experience helping turn breech babies. There are few—if any—risks. - In Hospital
Good doctors offer and are skilled at performing external cephalic version (ECV). Great doctors, incidentally, offer and are skilled at vaginal breech birth. If you choose an ECV, the doctor will turn the baby manually from outside your belly. This process can be risky, but rarely.
Your choices with a breech baby:
If a baby is still head up at term, you will have 3 choices.
1. Scheduling a cesarean
2. Turning your baby and having a head-first birth
3. Finding a provider who offers vaginal breech birth
People have had success turning their breech babies with all sorts of methods. You can look into most of the ways people flip breech babies here.
In the average American OB office, an ECV will be the only option presented to you for turning a breech baby. No one will mention the safety of vaginal breech birth.
What is an ECV?
An external cephalic version is a used when a baby presents butt or feet first in the pelvis (breech). After about 32 weeks, most babies have gone head-down in preparation for delivery.
Many of the exercises and activities you can do to help make room for baby to turn work best before 36 weeks. Always ask for baby’s position to be checked shortly after 32 weeks.
When a baby is still breech at 36 weeks, the doctor should offer to schedule an ECV. Some providers like to wait until 37 or 38 weeks.
During an ECV, the doctor will use her hands on your lubed-up belly to turn the baby while watching an ultrasound monitor and/or heart-rate monitor.
Some doctors will only perform them in a labor and delivery unit, or only with a tocolytic drug (to relax your muscles), or only with an epidural.
What are the risks of turning a breech baby with ECV?
ECV Risk 1: Old Timey Fear
ECV has been performed since Hippocrates and became popular in the early 20th century. It lost popularity in the 60s and 70s when there were circulating reports of maternal and fetal complications.
During most of the last century, physicians were trained and experienced in vaginal breech delivery. So when a few rough (or unlucky) practitioners and their patients saw negative outcomes and word got around, ECV gained a sheen of folk anxiety. Why do that when the baby can come out perfectly fine butt-first?
ECV was also more regularly done early in gestation, when the baby still had lots of room to flip back to breech. So it didn’t seem that useful to parents or obstetricians.
I’ve encountered quite a few mothers of a certain age who thought of ECV as horribly dangerous.
ECV Risk 2: Baby May Flip Back to Breech
Even if the ECV is successful and you go home with a head-down baby, there is always a chance he will flip again.
Reversion is more likely if there is imbalance in your pelvis and baby is breech because that’s the comfiest position in your uterus right now. A chiropractor and some easy exercises at home can help rectify this.
ECV Risk 3: It Might Fail
The national success rate for ECV is 65% (Zhang). Individual practitioners have success rates varying from 35-86%.
If this is not your first baby, there is a better likelihood of success.
The location of the placenta, maternal weight, and size and position of baby are all factors as well.
ECV Risk 4: Baby’s Heart Rate May Change
The most common complication with ECV is a temporary abnormal heart rate. This is called transient fetal heart rate abnormalities or transient abnormal cardiotocography, and will mean some extra observation after the procedure. When baby’s heart rate is stable again, you can go home.
Risk of transient fetal heart rate abnormalities varies in studies from 2-9%. The biggest review of ECV studies we have (Collaris & Oei, 2004) showed that 5.7% of babies had temporary heart rate concerns. Many of these babies are likely responding to the weirdness of being shoved around and settle down quickly. Your baby has a greater than 90% chance of not being bothered by the procedure at all.
If the heart rate abnormalities are concerning enough or don’t resolve, a caesarean will be recommended. This happens very rarely. For Thinking Woman’s Guide to a Better Birth, Henci Goer studied 3,700 ECVs in twenty-six studies. There were only complications leading to cesarean in two cases.
ECV Risk 5: It Might Hurt
You might have heard that an ECV hurts. It can. In one study, the median pain score reported after the procedure was 5.7 out of 10 (Fok et al., 2005). Less pain seems to be experienced when the procedure is successful or turning easily achieved. Though the same study reports that in the subjects with a pain score of 8.5 or more, 80% of the versions were successful.
ECV Risk 6: An ECV Can (Rarely) Be Dangerous
Sometimes, bad things do happen. With ECV, it’s very unlikely. The risk of placental abruption, emergency cesarean section, vaginal bleeding, and perinatal mortality combined were less than 1 percent (Collaris & Oei, 2004).
There are also risks with the drugs sometimes used for ECV. Epidural risks for mom and baby are well documented. The muscle relaxant drugs regularly used (tocolytics such as terbutaline) also can have side effects. Ask your doctor how she does ECV and what drugs and options you have.
Remember that Henci Goer studied 3,700 ECVs and there were only two cesareans after complications. No babies or mothers were lost in those 3,700 cases.
Is ECV Safe?
There are risks for an ECV. There are other ways you can try to turn the baby first or in addition. But remember that statistically, ECV is very safe and a cesarean is a much more invasive and risky procedure.
