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| |    Turning a Breech Baby: External Cephalic Version by Marjorie Greenfield, M.D. reviewed by Laura Jana, M.D., F.A.A.P. External cephalic version (ECV) is a procedure to change a baby from breech or other non-headfirst presentation to headfirst (cephalic). The physician pushes on the baby through the mother's abdomen, either creating a forward roll like a somersault or a back flip. For details about the procedure itself, see "The External Cephalic Version Protocol." Why do external cephalic version? Since all transverse babies and most breech babies are born by caesarean, moving the baby to cephalic presentation increases the chance of having a vaginal birth. Research has shown that offering ECV to all mothers with breech babies at 36 weeks gestation decreases the caesarean rate for that group of women. The success rate for rotating a baby to headfirst position is quoted as anywhere between 35 and 86 percent. The procedure is more successful in women who have had other children, since the baby can move around more easily, than it is for a first-time mom whose baby sits low in her pelvis. The risks involved Often the baby's heart rate will slow during or immediately after the version, especially when it is successful. The heart rate usually comes back to normal within a few moments, and there is no evidence that these short-lived heart-rate changes harm the baby in any way. In very rare situations, the heart rate stays slow long enough that practitioners will start the initial preparations for a possible emergency caesarean section. Although preparation is sometimes necessary, emergency C-sections are extremely rare under these circumstances. While it's rare to have a serious complication of ECV, it may be uncomfortable or even moderately painful. You always have the right to stop the procedure for any reason. (Remember, it's your body!) If you can keep your abdominal muscles relaxed, you might be more comfortable and the procedure may be more likely to succeed. You may feel sore for a few days. Ideally, you will want a support person with you during the version, and you'll need someone to drive you home afterward. Who should have an ECV? If a woman reaches 36 weeks and her baby is breech, external cephalic version is probably a good idea. Most babies who are going to flip to headfirst on their own will have done so by that time. If you wait well beyond 36 weeks, especially in first-time moms, the breech baby is more likely to have deeply engaged in her pelvis and the version will not succeed. The procedure usually is not done earlier than 36 weeks, since there is a remote possibility that the baby will need an emergency delivery as a result of the procedure--and you don't want to risk the baby being born that early if possible. Who should not have ECV? There is some controversy over whether it's OK to do an external version on a woman who has had a prior caesarean, but studies have not shown an increased rate of complications in this group. The only real argument not to try a version is if you know you will need a C-section for some other reason.
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