Smartmoms: External Repositioning of the Baby

What is external cephalic version?

External cephalic version is the changing of a baby's position in the uterus by manipulation of the mother's abdomen. Usually it is done to turn a breech baby to a vertex (headfirst) position. A breech baby's bottom or feet are in a position to come out before the head during delivery through the birth canal. Such a delivery may be hazardous. For example, the baby's head may become trapped in the mother's cervix. If the baby is moved to a headfirst position, you may avoid having a vaginal breech delivery or cesarean section.

When is it used?

External cephalic version may be done when your baby is in the breech position near your due date, but not before 37 weeks of pregnancy. Your health care provider may diagnose a breech position by feeling your abdomen and locating the baby's head and bottom. You may also have an ultrasound to check the baby's position.

Women with the following conditions may be advised against having this procedure:

pregnancy with more than one baby
placenta previa (the placenta is near or covering the opening of the uterus)
an anterior placenta (the placenta is attached to the front wall of the uterus)
vaginal bleeding
low level of fluid in the sac around the baby
uterine malformation, such as a double or septate uterus
heart disease
high blood pressure
previous cesarean section
Rh-negative blood type.

External cephalic version may also not be advised if you are already in labor or if your baby has:

an abnormal fetal heart rate pattern
suspected intrauterine growth retardation (slowed growth)
a major fetal anomaly, such as an abnormally large head (hydrocephaly).

How do I prepare for the procedure?

Your doctor or midwife will schedule a date and time for you to go to the Women's Hospital Birth Center for your procedure. You may be called by a nurse in the Birth Center the night before or morning of your procedure to confirm the time of your procedure and to answer any questions you have. You should not eat or drink anything for at least six (6) hours before your scheduled procedure time unless your doctor or midwife instructs you differently. When you get to the hospital, you should go to the 4th floor Triage area to check in.

What happens during the procedure?

Just before the procedure an IV will be started and an ultrasound will be done to confirm the position of the baby and placenta. A nonstress test will be done to make sure the baby's heart rate is normal.

During the procedure, medication is given to relax your uterus. In rare cases epidural anesthesia may be given. The doctor then places his or her hands on your abdomen, locates the baby's parts, and gently pushes the baby's bottom out of your pelvis. The doctor then tries to maneuver the baby so that the head will enter the pelvis. The baby's heart rate is monitored during the procedure.

What happens after the procedure?

After the procedure a nonstress test is done again to check the baby's well-being.

If the procedure is unsuccessful, your doctor will discuss the risks and merits of vaginal delivery compared with cesarean section in your particular case. Even if the procedure is successful, the baby could return to the breech position before you begin labor.

What are the risks associated with this procedure?

Some of the potential complications of this procedure include:

premature labor in about 1% of mothers
premature rupture of the membranes in about 1% of mothers
a small amount of blood loss from you and the baby
the need for an emergency cesarean section because the baby is not getting enough oxygen, usually because of a pinched umbilical cord
damage to the placenta, possibly causing separation of part or all or it.

The likelihood of these complications is small. However, any of these problems can be very serious. For this reason, many doctors prefer not to do external cephalic versions.

When should I call the doctor?

Please call your doctor or midwife at (734) _______________ or Triage at (734) 764-8134 if you notice any of the following:

Bright red vaginal bleeding
Contractions, tightening or cramping of the uterus
A sudden onset of sharp abdominal pain
Leakage of fluid from your vagina
Decreased fetal activity (your baby is not moving as much as usual)

Keep or schedule appointment with your care provider on:______________________(date)

December 2004

How to Tell When Labor Begins

What to take to the Hospital

Pain Relief During Labor

Fetal Heart Rate Monitoring

Post-Date Pregnancy

Preterm Labor

Prostaglandin Gel

Non-stress Test

Amniotic Fluid Index (AFI)

Induction of Labor

VBAC-Vaginal Birth After Cesarean