7800 Wolf Trail Cove, Germantown, TN 38138 • (901) 682-9222 • Open Weekdays 8:00 - 5:00
EXTERNAL CEPHALIC VERSION
Q. What is external cephalic version (version)?
A. External cephalic version, or just plain version, is a procedure that is performed on an expectant mother to rotate her baby that has positioned itself in a breech position (buttock first presentation). The procedure is performed by applying pressure on the outside of the mothers' abdomen in hopes that the baby will be rotated into a head down position which is best for a normal vaginal delivery.
Q. Why rotate the baby?
A. A breech vaginal birth carries more risks to both the mother and the baby. The time and difficulty of a birth is often defined by the size of the baby's head compared to size of the mother's pelvic width. When a baby's head is large compared to the pelvic width, then the third stage of labor (the pushing stage) is often lengthened. When the third stage does not progress, and it is determined that the stress to the baby and the mother is too great, then a decision to perform a C-section will be made. In a breech vaginal delivery, the buttocks and torso are delivered first and the head last. Problems arise when the baby's head is too large to easily pass through the birth canal after the buttocks and torso have already progressed down the birth canal. This can cause undo stress on the baby and the mother.
Q. When is it best to have the version performed?
A. The likelihood of a baby rotating on its own diminishes as the due date approaches. After 36 weeks, the chance of the baby rotating on its own is less than 25%. Many obstetricians will schedule an external cephalic version between the 37th and 38th week. The success rate of a version performed after the 36th week is somewhere between 40% and 70%. The large range is due to many different factors: how big the baby is, the amount of amniotic fluid present, fetal and maternal tolerance to the procedure, and the timing of the version. If the version is performed too early, the baby may flip back into the breech position before the due date. If the version is performed too late, there may not be enough room left in the uterus for the baby to move.
Q. What does an external cephalic version involve?
A. The procedure is usually performed in a hospital in or near the labor and delivery unit where an ultrasound and fetal monitor is available. An ultrasound is performed to determine that the baby is in fact breech and where exactly the head and buttocks are positioned. A fetal monitor is placed on the mother's abdomen to monitor the fetal heart rate throughout the procedure.
Before the procedure, medication is often given to relax the uterine muscles for easier manipulation. The mother is placed in a lying position. The doctor will than begin to push on the mothers abdomen attempting to push the head down and the buttocks up.
Q. What are the risks?
A. The likelihood of complications is small, but the following is a list of risks that may arise during or after the procedure:
- Premature labor and delivery if the procedure is performed before 37 weeks
- Rupturing of the membranes
- Blood loss
- Emergency C-section due to fetal distress
- Separation of the placenta from the uterus
Due to the risks involved, many women and their doctors forego the procedure and choose to go ahead and schedule a C-section without any attempts to turn the baby.
Q. Are there alternatives to an external cephalic version?
A. Currently, no medical statistics are available to back up alternatives to a version; however, the following have been used and recommended by many doctors and nurse-midwives:
- Breech tilt--lying on her back, pillows are placed under a women's pelvis so that her abdomen is raised several inches above her head. This procedure should be performed several times a day and last between 15 to 30 minutes in length.
- Ironing board exercise--this is the same idea as the breech tilt but with an ironing board propped securely on a couch or low chair instead of the using pillows.
- Knee/chest exercises--this involves laying her head, shoulders, and chest on a bed while kneeling beside the bed and flexing her hips toward the floor or bed.
All procedures are performed with the intention that gravity will help coax the baby to turn naturally within the uterus. It is recommended that the mother be as relaxed as possible using breathing techniques, soothing music, and visualizations to help promote the turning.
Frank W. Ling, MD
Dr. Ling is Clinical Professor, Department of Obstetrics and Gynecology at Vanderbilt University, Nashville, Tennessee.
Date Published: 2000-09-21
7800 Wolf Trail Cove, Germantown, TN 38138
Phone: (901) 682-9222; Fax: (901) 682-9505