Ice Packs for Breech Version: Not Recommended
Ice packs are not effective for turning a breech baby to cephalic presentation and should not be used for this purpose. There is no evidence supporting the use of cryotherapy (ice application) to influence fetal position in breech presentation 1, 2, 3.
Evidence-Based Approaches for Breech Version
External Cephalic Version (ECV) - The Recommended Intervention
ECV is the only proven method to reduce breech presentation at birth and should be offered to all women with breech presentation at term 1.
ECV decreases the rate of breech presentation at birth and potentially lowers cesarean section rates without increasing severe maternal or perinatal morbidity 1.
ECV should be performed from 36 weeks gestation onward, with immediate access to an operating room for emergency cesarean section 1.
ECV before 37 weeks increases the rate of cephalic presentation at birth compared to ECV after 37 weeks, though with a small increased risk of moderate prematurity 1.
Factors That Improve ECV Success
Multiparity and absence of maternal obesity are the main factors associated with successful ECV 1.
Parenteral tocolysis (beta-mimetics or atosiban) increases ECV success rates, cephalic presentation in labor, and reduces cesarean section rates 1, 4.
Regional analgesia combined with tocolysis is more effective than tocolysis alone for increasing successful versions 4.
Monitoring Requirements
Cardiotocography should be performed before and for 30 minutes after the ECV procedure due to increased risk of transient fetal heart rate abnormalities 1.
RH-negative women require systematic RH prophylaxis, but routine Kleihauer testing is not recommended as the risk of significant fetomaternal hemorrhage is very low (<0.1%) 1.
Ineffective Alternative Methods
What Does NOT Work
Acupuncture, moxibustion, and postural methods (including knee-chest position and pelvic elevation) are not effective in reducing breech presentation at birth 1, 2, 3.
Postural management techniques show no difference in non-cephalic births, cesarean section rates, or Apgar scores compared to no intervention 3.
Moxibustion alone does not reduce non-cephalic presentations at birth compared to no treatment 2.
Why Ice Packs Don't Work for Breech
The concept of using ice packs for breech version appears to be based on a misunderstanding of cryotherapy applications. The available evidence on cryotherapy relates only to nasal blood flow and epistaxis management in adults, not fetal positioning 5.
Current evidence does not support cryotherapy recommendations even for nasal conditions, with inconsistent application methods and mixed results 5.
There is no physiological mechanism by which external ice application would influence fetal position within the uterus 5.
Common Pitfalls to Avoid
Do not delay offering ECV while attempting unproven methods like ice packs, postural techniques, or moxibustion 1, 3.
Do not perform ECV without immediate access to emergency cesarean section capabilities 1.
Do not attempt ECV without considering parenteral tocolysis, as this significantly improves success rates 1, 4.
Inadequate preparation, including failure to have appropriate equipment and a multidisciplinary team available, can lead to worse outcomes 6.