External cephalic version (ECV) to turn a breech baby
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Uploaded on Aug 30, 2009
This video shows an ECV to turn a breech baby to head-first. It is offered to women at 36-37 weeks and reduces the chance of needing caesarean section. It is a safe procedure and is successful about 40-50% of the time. On this occasion I used a drug to help relax the womb first. While most women find it uncomfortable, it isn't usually painful. If you have a tender uterus anyway, it is more likely to hurt.
The baby in this video had a reassuring fetal monitoring right before I started the procedure and the fetal heart was checked afterwards. If a longer attempt at ECV was carried out then we check half way through too with the ultrasound. Transient changes in the baby's heart rate are not uncommon and usually settle after a few minutes. Very occasionally they don't settle and a caesarean section needs to be done.
For the ECV shown, the baby does a forward somersault anticlockwise. The first step is to lift the baby's bottom out from your pelvis and move her to lying transversely. Often that is the most difficult part. Overall, it normally takes between 1 and 2 minutes to do the turn - any longer than that and the chance of success goes down. It is more likely to succeed in the following situations:
- if you have had a baby before
- if there is a normal amount of water around the baby
- if your baby has his knees bent
- if his or her bottom isn't engaged in your pelvis
- if the baby's head is not right up against the placenta
During an ECV uterine contractions can occur and we generally just wait until they pass.
Is it safe? One of the best quality research on safety comes from Oxford in the UK (incidentally, where I trained to do them) and they looked at just over 800 consecutive ECVs. The chance of needing emergency CS during or just after the ECV was 1 in 200. The risk of the placenta coming away (abruption) was 0.1% and no babies died due to the procedure. These figures are similar to other research that is available and confirm the safety of ECV. Approximately 3% of babies turn back to breech after successful ECV and 3% of unsuccessful ECVs turn spontaneously to head-first afterwards. This is the research study:
Thanks to the mother here who kindly gave her consent to the video being published for educational purposes.
Oh, and sorry for the music - it was the only 'baby' result in my iTunes library!
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