What is a breech birth?
Before birth, most babies are in a head down position in the mother’s uterus and therefore are born head first. Sometimes the baby’s buttocks and legs come first. This is called a breech birth or breech baby.
Many babies are breech early in pregnancy, but most of them turn to the headfirst or vertex position towards the end of pregnancy. The incidence of breech presentation beyond 38 weeks of pregnancy is 3-4%
When a breech presentation is confirmed after 34 weeks a plan is made to review you at 36 weeks.
At 36 weeks an ultrasound scan is performed to check your baby is healthy and that the environment (fluid volume, maturity of the afterbirth, movement of the baby etc) is suitable for offering an ECV. For those who are suitable an ECV, this will be performed at 37-38 weeks.
What is External Cephalic Version?
ECV is a way to try to turn a baby manually from breech position to a vertex (head down) position while its still in the mother’s uterus. ECV significantly reduces the risk of Caesarean Section delivery without increasing the risk to the baby.
Why leave the ECV until 37-38 weeks?
If any complications arise the baby can be successfully delivered and is regarded as mature.
The evidence suggests that ECV prior to 36 weeks is not effective in reducing breech presentation later in the pregnancy.
Approx 65% of babies will be turned successfully.
Of the successfully turned group the rate of vaginal delivery is practically the same as the rest of the pregnant population with 75% delivering vaginally.
ECV is performed as a day procedure in the Day Obstetric Unit.
What are the risks of ECV?
Very Small risk of the following
• Premature labour
• Premature rupture of the membranes
• A small blood loss for either the baby or the mother
• Fetal distress leading to an emergency Caesearean Section
The baby might turn back to the breech position
Can a Breech baby be delivered without a Caesarean Section?
Yes. Some breech babies can be delivered vaginally. However, more complications can occur if the baby is breech, and studies confirm that a vaginal delivery of a breech has a two fold increased risk of death or serious disability than a normal head first delivery. Caesarean section is now performed for nearly all babies presenting as breech in a woman’s first pregnancy. Women who have had prior normal vaginal deliveries may be considered for a breech vaginal delivery after individual assessment and counselling. The weight of the baby being a major consideration, and also the mother’s previous obstetric history.
'Posh' versus 'Push' Childbirth - Article from The Telegraph 18/7/2011