• External Cephalic Version May Be Able to Turn a Breech Baby Into the Correct Position for a Vaginal Birth

    Through a pregnancy, the baby may change position several times. However, towards the end of the pregnancy the baby's head normally moves downward to prepare for head-first delivery. If the baby's feet and buttocks are in the position to exit first, then the baby is in a breech position. This position is associated with more complications during delivery.
    Often babies in breech position are delivered via cesarean section to decrease the risk of complications during delivery. There are some options, however, to try to turn the baby so the baby is in a head-down position before labor. One procedure, called external cephalic version, is done by applying gentle pressure to the mother's abdomen to try to coax the baby into the correct position.
    Researchers from the Cochrane database reviewed several past studies to assess the benefits or risks of external cephalic version. The review, published in the Cochrane Database, found that external cephalic version done on full-term or near-term women with a baby in breech position led to fewer breech births and cesarean sections.

    About the Study

    The systematic review included seven previous trials with 1,245 women. The trials compared birth outcomes in women with a breech position baby who received external cephalic version or no intervention. Women that received external cephalic version at or near term had:
    • 54% reduction in birth with a breech presentation
    • 37% reduction in cesarean section
    Although the benefits seem clear, there are a number of significant differences between the studies. There were no significant differences in health outcomes for the infant. But, there may not have been enough information to draw clear conclusions on infant safety.

    How Does This Affect You?

    A systematic review combines smaller sometimes conflicting studies to provide clearer more reliable results. The quality of the studies included in the review and the compatibility of the individual study's results can influence the reliability of results. In this case, there was a problem with the combination of statistical results, which may overestimate or understate the benefit of external cephalic version. The statistics on outcomes for the infant were also too varied to get an absolute idea on safety issues, but it is generally considered a safe procedure.
    Your doctor will help to determine if your baby is in a breech position. While cesarean section is an option for breech delivery, it has some risks of its own. External cephalic version appears to be a low risk option to try to maneuver the baby into the correct position for a vaginal birth. Talk to your doctor if you have a pregnancy where the baby is in breech position to see if external cephalic version is a good option for you.

    RESOURCES

    The American Congress of Obstetricians and Gynecologists http://www.acog.org/publications/patient%5Feducation/

    Family Doctor.org http://familydoctor.org/

    References

    Hofmeyr GJ, Kulier R. External cephalic version for breech presentation at term. Cochrane Database of Systematic Reviews 1996, Issue 1.

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