ECV - External Cephalic Version - Turning a breech baby (Pregnancy Complications)

Member Name: mumto3

Product:	Pregnancy Complications
Date:	09/11/08 (646 review reads)
Rating:

Advantages: Quick, pain free and simple

Disadvantages: Tiny less than 1% chance of complications

In order to have a complication free pregnancy, labour and birth ideally your baby should turn so that it's head is down (cephalic) from about 38 weeks gestation. Unfortunately some babies have other ideas and will stay in the breech (head up) or transverse (across) position. Unfortunately if the baby is transverse there is no way it's coming out naturally unless you can turn it to the head down position. If a baby is in the breech position you are within your rights to request a vaginal delivery and even to give birth at home. Obviously there are complications with this as the babies body presents first and so the biggest part is left until last. Normally the head comes first and the body and your contractions will help to push the head out but with a breech birth this is not possible.

Over recent years it has been come common practice to perform a caesarean section on all breech and transverse pregnancies. I understand from talking to friends that this trend seems to be turning now and that more people are being offered alternatives.

An alternative to a caesarean is having the baby turned inside the womb. This is known as an ECV or External Cephalic Version or sometimes just External Version. The procedure is very simple and although it will need to be done in hospital it only takes a short time. An obstetrician will perform the procedure and they will usually be assisted by a midwife. The obstetrician will use his hands to manipulate the way the baby is laying inside the womb and hopefully by sliding his hands over your bump be able to push the baby into the correct position for birth. Unfortunately not all pregnancies are deemed suitable for this procedure and the babies size and the amount of amniotic fluid are also deciding factors. Also this procedure may not work and the baby may turn back or refuse to turn at all but I think it is definitely worth a try as the alternative is often a caesarean. The procedure has to be performed in a hospital in case of complications. The baby may become distressed and have to be delivered or your waters may break or the placenta could rupture in which case you would also need to be delivered straight away. Having said that I was advised by my obstetrician that the likelihood of any of these complications occurring is LESS than 1% so I think that these odds are preferable to the discomfort and inconvenience caused by a major operation.

During a routine 38 weeks anti natal appointment in my second pregnancy my midwife became concerned that the baby was laying in the breech position. Where I live there are two hospitals, one runs a weekly anti natal clinic but all complications and deliveries are dealt with at the main county hospital. My midwife immediately rang the county hospital and got me an appointment for a scan the following day. After a sleepless night convinced that I would be facing an elective caesarean (I like to give birth naturally at home) I went for the scan to be told that my baby was in the breech position. The midwife explained that this didn't mean a caesarean and that there were alternatives. She offered me the ECV but suggested I speak to my husband and let my normal midwife know so that it could be arranged. By the time I got home and rang my normal Midwife she had already spoken with the hospital midwife and arranged an appointment for me to have the ECV with the obstertritian at the county hospital the following morning. I spent the rest of the day reading in various books what was involved in the ECV. Some suggested I would be given an epidural, some said gas and air and other stated should just try to relax. The following morning I went to the county hospital not quite knowing what to expect and was taken to a delivery suite. I was scanned to check the babys position and then put on a monitor to check that the baby was ok and not stressed. After about 30 minutes on the monitor the obstetrician arrived to perform the procedure. I lay down flat on the bed to make the space between my hips and ribs as big as possible. The obstetrician scanned the baby again to check the position and explained that he would try turning the baby for one minute and then scan again to check for the position and any signs of stress. He said that if all was well he would try again for another minute and so on until the baby was in the correct position or it was decided that the baby was unwilling to turn. I tried to remain as calm as possible and took some deep breaths that I had learnt from my yoga for pregnancy video. The obstetrician squeezed loads of gel onto my stomach and began to slide his hands over my bump. Meanwhile I was having a conversation with the midwife about how scary Holby City was if you were pregnant because there was always an emergency of some sort. Then the obstertritian said he thought it had been a minute and he was going to see how things were doing with the scanner. The baby had turned already! I hadn't even noticed. I wasn't in any pain or discomfort and I hadn't needed an epidural! It was amazing! I was cleaned up to remove all the gel and put back on to the monitor to make sure that the baby hadn't been upset or any complications had occurred. After about another half an hour on the monitor I was allowed home. My son was born two weeks later at home as I had planned. My midwife had done her homework and prepared for a vaginal breech delivery at home just in case. Apart from feeling a little tender around the bottom of my bump for a couple of days there were no other side effects.

During a routine 36 week appointment in my third pregnancy my midwife became concerned that the baby was breech again. Although 36 weeks is too early for an ECV because the baby can still move around at that time my midwife was going on holiday and would not be back until I was 39 weeks so she booked me in for a scan at my small local hospital just to check the babys position at 38 weeks. When I went for the scan my baby was breech. I told the midwife at the local hospital that I wanted the ECV and she immediately got on the phone to arrange for me to go to the county hospital for the procedure. I asked what would happen if the baby couldn't or wouldn't turn and she said that I would have to have a caesarean! This really upset me because I already had two children and a caesarean felt like the worst senario for me with regards to childcare and recovery time. I was given some tablets to control my stomach acid and told to take them at regular intervals before my appointment and advised not to eat or drink from midnight of the night before. This really worried me as I hadn't had any of this advice on the previous occasion and I felt that they were prepping me for a caesarean. When I got to the hospital a midwife examined me and said that yes the baby was breech. She hooked me up to the monitor and I expected to be left for 30 minutes as before. A short time later a nurse came in and started trying to take a blood sample. I don't have visible veins and I hate needles so this really upset me as she started to dig about looking for a vein. I told her that this hadn't happened before but she said it should have done. She gave up trying to get blood after two failed attempts and went to ask if they needed it. A second nurse then arrived and had another go and started to waggle the needle about inside my arm. I suggested that she stop or I was going to pass out and advised her that I normally had blood taken from my hand. She didn't want to try this and went to get someone else to have a go. All the time the monitor was going mad as I was getting more stressed. A doctor then arrived and after a further two attempts managed to get a small amount of blood which she hoped would be enough. By now I was convinced that I was headed for theatre and was getting very upset. The obstetrician arrived and it was not the one I had seen before. He didn't seem very confident and kept making jokes about he'd better get the ECV right as I'd been here before. To be honest I had no confidence in this mans ability because of all the things that were happening to me and I didn't feel that they had much confidence in him either or why would they be preparing me for a caesarean. He eventually rolled up his sleeves and had a feel of my bump. He seemed a bit confused and asked for the scanner to be brought over. At this point there was a nurse, a midwife, the obstetrician and an intern all standing round my bed and my husband had been pushed out to the other side of the room. The scanner was placed on my bump and the obstetrician had a good look around. I'm not sure what he was looking for because as soon as he placed the scanner on the top of my bump I could see genitals! He eventually announced to the waiting crown that "If this baby is breech it hasn't got a head". I almost cried with relief. I was cleaned up and allowed to go home straight away. If they had scanned me when I first arrived as they had during my first ECV I could have left straight away and not been scared half silly with all their messing around.

After my two very different experiences I'm not sure what the common practice is with an ECV. I expect it depends on who you see at the time. Although I was terrified by my second experience I would still recommend the procedure as a possible alternative to a breech delivery or caesarean.

Summary: You have nothing to lose if you baby is breech