Your care provider may recommend an external version in your last month of pregnancy if your baby is breech and you want to have a vaginal birth instead of a cesarean. The actual medical term you may hear your provider use for this procedure is external cephalic version. What do you need to know about having a version if one is recommended to you?
External Versions Require Using Ultrasound
As an external cephalic version is considered to be a more complicated procedure, obstetricians will be the care provider who will perform this. If you are seeing a certified nurse-midwife for your prenatal care and you opt to have an external version, you will need to be referred to an obstetrician.
If you decide to have an external version, you will need to have it done in the hospital. The reason for this is that your baby will need to be properly monitored using an external fetal monitor. Ultrasound is also used so that your care provider can determine exactly where your baby is in your pelvis before, during and after the version. The obstetrician will also need to use ultrasound to see the placement of your placenta and amount of amniotic fluid.
Medications are Often Used with an External Version
You will also be given a muscle relaxant such as terbutaline to help your uterus stay as relaxed and prevent uterine contractions during the external version. You may consider asking your obstetrician about the possibility of having a spinal during the version. Research shows that having a spinal increases the success rate of turning your baby during an external version by nearly two-fold over mothers who did not have a spinal.
External Versions are Typically Done Around 37 Weeks
It is common to have your care provider schedule an external cephalic version around the 37th week of pregnancy. One of the reasons is to decrease your chances of having a preterm baby should the version cause you to go into labor. Some providers also choose to wait longer so that the baby will be less likely to turn back to a breech position. In some cases, providers may suggest starting a labor induction immediately after turning your baby with an external version in order to use contractions to keep your baby’s head down (also known as vertex.)
External Versions Can Cause Discomfort
Because your provider is manually manipulating the baby from the outside of your abdomen, versions can be uncomfortable or even painful. During the procedure, the obstetrician will try to roll and turn the baby downward by pressing on the baby’s buttocks and then on the baby’s head. If your baby moves immediately back into a breech position, the obstetrician may repeat the version.
You may need to use your breathing exercises that you have learned from childbirth classes during the version to remain relaxed.
External Versions are About 60% Successful
Versions are known to have some failure rate, as in the case of babies who decide to flip right back into a breech position after several attempts. External versions are known to be more successful if you have already had a previous vaginal birth, your baby is not engaged, you have a normal amount of amniotic fluid and the version is scheduled at 36 weeks of pregnancy or later.
There are also things you can do to increase your success rate of a version. One would be to request a spinal (see above) or epidural as both are known to give the mother more comfort during the procedure and increase the rate of success. Another way to make a version more successful is to choose an obstetrician with a higher rate of success.
Ways to Turn Your Baby to Head Down
Even if your obstetrician does not perform this procedure, remember that there are many other ways of turning your baby into a vertex position including doing a breech tilt, doing acupuncture and seeking a chiropractor for a Webster technique. Some obstetricians may also have specific training in vaginal breech births, so be sure to explore all of your options before you schedule a cesarean for a breech baby.