Breech Baby Breech!

Recently one of our members has been through the heartache and struggle of trying to negotiate the type of birth she believes is safe for her, after researching thoroughly it's appropriateness for her. She is a motivated and intelligent woman, who initially thought she had a choice when it came to the way in which she would birth. Out of this has come a greater awareness of the options women in Adelaide actually have when they face a baby who is breech and when a vbac. Fortunately, for our member she found an obstetrician who would agree to a vaginal birth, but could not guarantee that he would be available to attend, however he had no doubt that her wishes would be respected by those staff on at the time. Experience will tell us time and time again, that this respect may also not be available when you go into labour. Our member visited the specialist obstetrician who gave her the time and care to thoroughly assess her situation (over 1 hour to discuss her options). During this consultation he successfully turned the baby (ECV) into a vertex (head down) position in approximately 90 seconds without using any muscle relaxant drugs (which have some side effects like most interventions and drugs, and our member was unhappy to risk these).

External Cepahlic Version (ECV) is a practice which is becoming less common today, even when research clearly shows that it reduces the caesarean section rate dramatically. Having a successful ECV does not guarantee a vaginal birth, however, it increases your chances dramatically. Many women are also not aware that a breech positioned baby can be turned in most cases, and if not successful the first time then it is worthwhile having a repeat ECV. This is always dependent on the woman and her choice and circumstances, but as is common today women are not aware they have choices.

If a woman who is well informed of her choices, and the risks and benefits of these, then chooses to have a caesarean section for her baby's birth, then she deserves 100% support from those around her, physically and emotionally. If the woman finds a supportive health professional who will agree to vaginal birth for a breech, she will also need much support as her situation is quite unique today and she may be inundated with other's fears of vaginal birth with a breech. She may decide not to reveal what position her baby is in, to protect herself from any negativity. As we all know negativity is as conducive to birth as Roundup is to flowers.

Of 3 studies into ECV the following results were found, however, most professionals decisions are now based on the Term Breech Trial, purportedly a definitve trial on the safety of breech vaginal or caesarean delivery. This trial was a randomised study to compare the safety of planned caesarean with planned vaginal birth for breech presentation. The findings were that planned caesarean was better for the baby, but for women serious complications were similar between groups. Only 2088 women were studied between 121 birth places and 26 countries. A feature was high intervention during the labours, which is not recommended by leading experts in breech birth such as Michel Odent and Maggie Banks. The trial is not devoid of problems in the quality of research, for example the lack of experience in some clinicians is of great concern. The sad result of this trial is that women now will most commonly only be given the one choice; to birth by caesarean if their child is breech, as it has been accepted as definitve by many in the obstetric community (not all). For inspiration it has been highly recommended that the book by Maggie Banks, Breech Birth Woman Wise is a must read for any woman with a breech baby. If you wish to read the trial and Maggie Banks summisation of it please contact Carolyn:

Eurpoean Journal of Obstetrics & Gynecology and Reproductive Biology 81 (1998) 65-68
External Cephalic Version after previous cesarean section: a series of 38 cases
de Meeus, Ellia, Magnin.
Version attempts were successful in 25 of 38 women (65.8%). Seventy-six percent of the successful version women went on to have vaginal birth after cesarean section. The vaginal delivery rate was increased after successful ECV in patients previously vaginally delivered, but this difference was not statisitically significant. Not maternal of neonatal complications occurred. Conclusion: ECV is acceptable and effective in women with prior low transverse uterine scar, when safety criteria are observed.

Int J Gynecolo Obstet 45 (1994) 17-20
External cephalic version after previous cesarean section-a clinical dilemma
Schacter, Kogan, Blickstein
Method: Eleven parturients after previous cesarean delivery underwent external version after 36 gestational weeks, utilizing tocolysis and ritodrin, after excluding cases of low-lying placenta, severe oligohydramnion or ruptured membranes. Patient were then followed until delivery and scar examination was carried out after vaginal delivery, or at re-cesarean section, according to mode of delivery. Results: All 11 attempted versions were successful. Six patients subsequently delivered vaginally and five by re-cesarean section. None of the uterine scars showed any signs of dehiscence. Three of the five infants delievered by re-cesaren section weighed over 4000g, whereas all of the vaginally-delivered infants weighed under 3500g. Conclusions: External cephalic version to vertex presentation after previous cesarean section was successful in all 11 carefully successful patients. No untoward effects were noted, and no signs of scar dehiscence were found. The safety and efficacy of this procedure after previous cesarean delivery should be examined further.

Aust NZ J Obstet Gynaecolo 2001 41: 4:395
Introducing external cephalic version to clinical practice
Karantanis, Alcock, Phelan, Homer, Davis
A service offering external cephalic version to all women with breech presentation at 36-38 weeks gestation was introduced at St George Hospital in July 1997. This paper describes how this service was established and reports the clinical outcomes over the first three years; 116 external cephalic versions were attempted on 114 women and success was achieved in 58 women (51%). Of the 58 women, 43 (74%) subsequently had vaginal delieveries. There were no fetal deaths, immediate Caesarean sections, or placental abruptions as a result of the ECV procedure. There were two (2%) episodes of transient fetal bradycardia following ECV, both of which returned to normal with a subsequent normal neonatal outcome. Pre and post-ECV Kleihauer levels (tests the levels of maternal and fetal transfusion by examining DNA in the mothers blood) were collected with no increase in levels as a result of the ECV. ECV is a procedure that can , and should, be provided as part of a public hospital service.