From the Research
The risks of vaginal breech delivery generally outweigh the benefits for most pregnancies, making planned cesarean section the recommended approach for breech presentation at term. Vaginal breech delivery carries increased risks of birth trauma, cord prolapse, head entrapment, and perinatal mortality compared to cesarean delivery 1. However, cesarean section has its own risks including increased maternal bleeding, infection, longer recovery time, and complications in future pregnancies. In carefully selected cases with specific criteria (frank or complete breech, adequate maternal pelvis, estimated fetal weight between 2500-3800g, flexed fetal head, experienced provider), vaginal breech delivery may be considered after thorough counseling.
Key Considerations
- External cephalic version (ECV) should be offered at 36-38 weeks to eligible women to attempt converting the breech to a head-down position, which has a 40-60% success rate and can reduce the need for cesarean delivery 2.
- The decision between delivery methods should involve informed consent discussions covering immediate and long-term risks and benefits for both mother and baby, taking into account individual circumstances and provider experience.
- Some studies suggest that initiating ECV before term (between 34 to 35 weeks' gestation) may have some benefit in terms of decreasing the rate of non-cephalic presentation and risk of vaginal breech birth, but may also increase the risk of late preterm birth 1.
Tocolysis and ECV
- The use of tocolysis, such as nifedipine, prior to ECV may increase the success rate of the procedure, especially in multiparous women 3.
- However, the routine use of tocolysis prior to ECV is not universally recommended and should be considered on a case-by-case basis.
Provider Experience and Success Rate
- The success rate of ECV is higher when performed by experienced providers, with some studies suggesting a success rate of up to 65% 4.
- Provider experience and volume of procedures performed are important factors in determining the success rate of ECV.