ECV When Baby Is Breech: Understanding External Cephalic Version
Late in the last trimester of pregnancy, the developing baby should be in a head-down position ("vertex" presentation) so that she'll be born head first, but that's not always the case. About 4 percent of babies during this stage present as breech, meaning the bottom or feet are closest to the mother's cervix.
Vaginal delivery of a breech baby is dangerous because newborns' heads are typically wider than their bodies. According to the American College of Obstetricians and Gynecologists (ACOG), when a baby is born feet first, his body may not stretch the cervix enough, and the baby's head or shoulders could get stuck inside the birth canal. Another potential complication is a prolapsed umbilical cord. If the umbilical cord moves into the vagina ahead of the baby, it could become pinched or pressured in a way that impedes oxygen flow to the baby.
If your unborn baby is in breech position at 36 or 37 weeks—which your doctor can assess by feeling specific points of your abdomen and confirm with an ultrasound or pelvic exam—your doctor should offer external cephalic version, also known as a "version" or ECV, the medical abbreviation.
What Is ECV?
External cephalic version (EVC) is a procedure performed at 36 or 37 weeks to turn a baby who's breech or lying on her side to the optimal head-down position prior to labor. To perform an ECV procedure, a doctor, usually with the help of another healthcare professional, uses her hands to apply pressure to the mother's abdomen to guide the baby into a head-first position. Successful ECV makes it possible to attempt a vaginal birth.
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What to Expect During an ECV Procedure
If you're an expectant receiving ECV for your breech baby, you can expect your doctor to administer a mild sedative and local anesthesia before the procedure. Drugs commonly used during an ECV procedure include nitrous oxide (aka "laughing gas"), terbutaline (a tocolytic used to prevent early labor), calcium channel blockers, and an epidural, says Marsha Granese, M.D., OB-GYN with Mission Hospital in Mission Viejo, California. "I use an epidural and a lot of abdominal lubrication, and have given tocolytic injections to help stop the uterus from contracting and allow for the most relaxed uterus," she says.
ECV patients who receive an epidural can expect to feel moderate to intense pressure. "If the mother's not using an epidural, there can be an extreme amount of pressure with pain and she may feel short-winded," says Dr. Granese. Both mom and baby are monitored throughout the procedure and ECV is stopped immediately if any signs of fetal distress occur. It may take doctors several attempts using ultrasound to guide their turns to perform a successful version
Not every breech pregnancy is eligible for a version. Some of the contraindications, or scenarios when doctors wouldn't perform ECV, include if the baby is smaller than she should be (growth restricted) or unusually large (macrosomic), there isn't enough amniotic fluid, or if the mother has other high-risk implications that would cause fetal stress.
ECV risks include placental separation (abruption), internal bleeding, rupture of membranes, fetal distress, and preterm labor. Doctors usually perform ECV near a delivery room so, if problems arise, they can perform a C-section quickly. There's also the possibility that ECV won't work: The overall success rate for ECV procedures is 58 percent, according to the National Institutes of Health. And even if the version does work, there's a chance your baby could return to breech position before labor.
What If ECV Isn't Successful?
If your ECV doesn't have the intended outcome, there are alternative methods Dr. Granese recommends that can help encourage your baby to get into vertex presentation, including acupuncture with moxibustion (burning dried mugwort at select points of the body), and a chiropractic adjustment called the Webster technique, which balances the pelvic muscles to allows the baby to move easier. Expectant moms who meet certain criteria may also attempt a vaginal breech delivery.
"I don't like moms to feel disappointed if ECV fails," says Dr. Granese. "Statistics say the baby is far safer during cesarean delivery than in a vaginal breech delivery. There's no long-term morbidity with a vaginal breech delivery, but in the immediate delivery, statistics have shown a cesarean can be quite safe. And she can try to have vaginal birth with her next pregnancy, especially if the reason for her first cesarean was because of a breech presentation."