External Cephalic Version
External cephalic version
External cephalic version is trying to turn a baby from lying in a breech (bottom first) position to head first by massaging the mother's abdomen. At 37 weeks only 1 in 5 babies will turn head first on their own. If the baby stays breech then it would be usual to plan a caesarean rather than allow the baby to come out normally, although there are exceptions to this (see below). ECV is a relatively simple and straightforward procedure that is sometimes successful in turning the baby from breech to head first. If it is successful then there is the same chance the baby would be· delivered normally, as if it had been he~d first all along. Below are a series of frequently asked questions but do take the opportunity to discuss it with the doctors and midwives in the clinic and also the doctor on the day of the ECV appointment. The Royal College of Obstetricians and Gynaecologists recommend that ECV be performed and should be offered to all eligible women with a breech baby after 37 weeks. If you are still unsure then we would suggest you keep the Thursday morning appointment so at least you can talk it through with one of the two doctors who perform the procedure.
When babies are lying bottom first, the baby's bottom has to be massaged out of the mum's pelvis and then the head is encouraged downwards. It can take anything between 1 minute and 20 minutes to achieve and sometimes more than one attempt is required. There can be discomfort associated with the procedure but if a patient asks for the procedure to be stopped it can be stopped straight away. Sometimes when the womb is massaged it causes a contraction (like a Braxton-Hicks contraction) and usually a small injection is required to prevent the womb contracting. The drug that is used to cause this is the same drug that asthmatics use (called Ventolin). This drug is chemically very similar to adrenalin so that mother frequently experiences some side effects such as a fast pulse and a sensation of the heart beating in the chest. This does wear off within about 15-20 minutes. Provided the mother has no heart or other medical problems, there are no serious side effects from this drug.
Is it Safe?
Many research studies have been performed over the years and show that, provided ECV is attempted after 37 weeks, there is no increased risk to the baby. There is a small risk of needing an emergency caesarean on the day that the ECV is performed, which is why the ECV is only performed in the labour ward and right next to the operating theatre. The chances of this happening are below 1 %, in other words there is a more than 99% chance that an emergency caesarean will not be required. A proper scan in the main department should be performed to check not only that the baby is indeed lying breech but also to check that the growth and wellbeing of the baby are normal. In addition a CTG (heartbeat tracing) is performed before the ECV is undertaken. After the ECV is performed (whether or not it is successful) the heartbeat is checked on the scan machine and with another CTG. Provided all of these are normal there are no extra increased risks to the baby.
The success rate is around 50% for women who have had a baby before and a bit less than this if this is the first baby. This compares with similar rates from other hospitals.
Can the Baby Turn Back?
If we are successful in turning the •baby then 97% of babies will stay head first, in other words only 3 in 100 will turn back. If the baby does turn back it can be discussed whether to try again or whether to go for caesarean section, although this is an unusual occurrence.
What Happens Next?
After your ECV if it is unsuccessful then a caesarean section would usually be •j planned for after 39 weeks. If you happen to labour before then, a decision would be made whether to let the baby come out normally or whether to do a caesarean. Research shows that women who come in in advanced labour with a breech delivery, have a good chance of having a normal uncomplicated delivery, but if there is the opportunity to plan for one or the other, caesarean is usually better. If you happen to labour before the caesarean was planned and the labour was early on it is likely that emergency caesarean could be performed then and there. On the other hand, if the labour was well advanced with the baby nearly out then you may be allowed to continue and deliver the baby normally but bottom first. Obviously this would be discussed with you at the time.
If the ECV is successful you would return to normal care but b~ seen in the clinic within a week or two just to check the baby has stayed head first. If you have any questions or concerns afterwards then you can contact the labour ward directly on extension 2752 at any time.
Are There Any People Who Should Not Have an ECV?
Below is a list of other conditions that usually prevent ECV being attempted.
• Multiple pregnancy
• Significant bleeding in later pregnancy or placenta praevia
• Ruptured membranes (the waters gone)
• Abnormalities of the womb or abnormalities of the baby
Next is a list of things that would make performing ECV more difficult and would lead to a discussion as to whether it was right to try.
• Previous caesarean section
• High blood pressure
• A smaller than expected baby
• Less than average water around the baby
• Obesity in the mother
• A medical condition preventing the use of the drug to relax the womb