How can a baby in a breech position be turned to a head-down position?

Turning a Breech Baby to Head-Down Position

External cephalic version (ECV) is the recommended method for turning a baby from breech to cephalic presentation, with a success rate of about 65% and a strong safety record. 1

External Cephalic Version (ECV)

• ECV should be performed at term (from 36 weeks of gestation) to increase success rates and avoid complications of preterm delivery 2
• The procedure involves externally rotating the fetus from breech to vertex presentation by gently disengaging the fetal head and manipulating the fetus by a forward roll or back flip 1
• ECV is associated with decreased rates of breech presentation at birth and potentially lower cesarean section rates without increasing severe maternal or perinatal morbidity 2
• The procedure should only be performed in a facility equipped for emergency cesarean section 1

Factors affecting ECV success:

• Higher success rates are associated with:
  • Multiparity (having previous pregnancies) 2
  • Absence of maternal obesity 2
• Use of parenteral tocolysis (medications that relax the uterus) during ECV increases:
  • Success rate of the procedure 2
  • Rate of achieved cephalic presentation in labor 2
  • Lower cesarean section rate 2

Safety considerations:

• Cardiotocography (fetal heart rate monitoring) should be performed prior to and for 30 minutes after the procedure 2
• For Rh-negative women, Rh prophylaxis should be administered 2
• ECV has been found to be relatively safe even for women with one previous cesarean delivery 3

Alternative Methods

Postural Therapy

• Lateral positioning based on fetal back orientation shows promising results:
  • Lying on the opposite side of the fetal back for breech presentation 4
  • Lying on the same side as the fetal back after cephalic version to prevent recurrence 4
• This approach has shown an 8% reduction in breech presentation at 37 weeks compared to control groups, though not statistically significant in all analyses 4
• Significantly higher rates of cephalic version after 2 weeks and lower rates of breech recurrence have been observed with this method 4

Other Methods Not Recommended

• Acupuncture, moxibustion, and traditional postural methods have not been proven effective in reducing breech presentation at birth and are not recommended 2

If ECV is Unsuccessful

• If ECV fails, it can be reattempted at a later time 1
• When breech presentation persists, options include:
  • Cesarean delivery (most common approach in many countries) 5
  • Vaginal breech delivery (only if provider has appropriate expertise, no contraindications exist, and facilities for emergency cesarean are available) 5

Potential Complications to Be Aware Of

• Transient fetal heart rate abnormalities may occur during ECV 2
• Impacted fetal head during cesarean delivery can lead to unintentional extension of the uterine incision, hemorrhage, and bladder injuries 5
• Proper technique is crucial as errors in performing breech extractions may increase risk of femoral and humeral fractures 6

ECV is a skill that can be acquired by physicians and should be considered a routine part of obstetric practice for managing breech presentation, potentially producing considerable cost savings 1.