BREECH BABIES AND EXTERNAL CEPHALIC VERSION

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1 BREECH BABIES AND EXTERNAL CEPHALIC VERSION Information Leaflet Your Health. Our Priority.

2 Page 2 of 6 What does breech mean? In the last few weeks before birth, from about 36 weeks of pregnancy, most babies move into a head-down position in the womb. However, about 3 in 100 babies are not born head-first. Instead, the part of the baby that is coming first is its bottom or feet. When a baby is in this position we call it breech. There are three types of breech position: The commonest (65%) is the extended breech. The baby's bottom comes first and its legs are straight, with the feet near the face. About one quarter (25%) of breeches are flexed, with their legs tucked in at the knees. The remaining 10% of breech babies have their foot or feet below the bottom. The baby may also be curled up with the knee presenting first Early on in the pregnancy many more babies are breech but most of them turn by themselves to the head-first position before birth. So, babies born prematurely (before 37 weeks) are more likely to be breech than those born after 37 weeks. Other reasons for a breech presentation: If you are expecting twins, you are more likely to have one or both babies in a breech position. It does not usually matter which way the second twin is presenting until after the birth of the first baby. A lot of fluid around the baby may allow the baby to move a lot, making it breech. Less fluid around the baby may prevent it from moving from breech to a head first position. Sometimes the placenta might lie at the bottom of the womb and this can stop the head from moving down and causes the baby to be breech. By examining your abdomen (tummy) the midwife or doctor might notice that your baby is breech. If it is getting close to your due date s/he will arrange a scan to: check the position of the baby find out what type of breech it is look for any reasons why it may be breech

3 Page 3 of 6 What do I do if my baby is breech? If you are over 36 weeks and the scan confirms that your baby is breech, the doctor will discuss options with you: If it is a flexed or extended breech the doctor will talk to you about ways of trying to turn your baby, and how your baby should be delivered. If it is a footling breech, twin pregnancy, the placenta is low-lying in the womb, or there is another reason preventing it from coming in the head-first position you will be offered a Caesarean Section. You can discuss your individual circumstances and preferences with your consultant obstetrician. Can I do anything to help if my baby is breech? To try and avoid you having a Caesarean Section we may offer to help to turn the baby. This is called external cephalic version or ECV: If this procedure is successful and the baby stays head down, a normal vaginal birth is more likely. What are the benefits of external cephalic version and how is ECV performed? External cephalic version is a procedure to turn a baby from breech position to head-first while it's still in the womb. This is done once you have reached 36 weeks of pregnancy, as there is less chance of the baby turning back. You are welcome to bring your partner / other support person with you. First you will have a scan to check the position of the baby. If it is breech (and there are no other reasons for a Caesarean Section) we will give you an injection to prevent contractions and then monitor the baby's heart for 20 minutes to make sure that it is fine. The doctor will then feel your abdomen. With you awake, the doctor will flex the baby's head (from the outside, gently move the head, so the chin is tucked onto the baby s chest) and lift its bottom at the same time. The doctor will then make the baby do a forward or backward roll so that the head comes first. Right hand lifts breech out of pelvis. Left hand makes head follow nose. Flexion of head and back maintained throughout. Flexion is continued. Left hand brings head downwards. Right hand pushes breech upward. Pressure is exerted on head and breech simultaneously until head is lying at the pelvic brim.

4 Page 4 of 6 ECV will be done on the Antenatal Day Unit. If you have a rhesus negative blood group you will need a blood test and an injection before you leave. After the procedure we scan the baby again and will also monitor its heart for about half an hour. You will then go home. The overall success rate of ECV is 30% - 80%. The success rate of ECV depends on several factors, including the following: How close you are to your due date How many pregnancies you've had How much fluid is around the baby How much your baby weighs How the placenta is positioned How your baby is positioned Although the procedure may feel uncomfortable, especially when the baby is lying across the womb, it should not hurt. If it does hurt the doctor will stop. If the ECV does not work we would offer a repeat ECV one week later, then recommend a Caesarean Section at 39 weeks or sooner if you go into labour. When is an ECV not done? If you need a Caesarean for any other reason You had a vaginal bleed during the previous week The baby s heart trace is abnormal Your womb is not the usual pear shape Your waters have broken You are expecting twins What are the risks of external cephalic version? External cephalic version is a safe procedure. The incidence of the following risks is very rare: Premature labour or rupture of membranes A small blood loss due to bleeding from the placenta. Fetal distress leading to an emergency Caesarean Section can occur in 0.5% cases. The baby might turn back to the breech position after the ECV is done (5%). There is usually a follow up appointment to check the position of the baby the following week. Can a breech baby be delivered vaginally? Some breech babies can be safely delivered vaginally. However, more complications can occur if the baby is breech compared to head-first. A large world-wide study has looked at over 2000 women in 26 countries whose babies were breech at term (i.e. 37+ weeks of pregnancy). The findings of the study lead us to advise most women with a term breech baby that it is safer for

5 Page 5 of 6 the baby to be delivered by Caesarean Section rather than vaginally. Although there are some risks to mothers with a Caesarean Section (like bleeding, infection, blood clots and a longer stay in hospital), these risks are out-weighed by the benefits to the baby of planning a Caesarean. Supervisors of Midwives Need extra information, support or advice? Contact a Supervisor of Midwives by ringing the main switchboard at Stepping Hill Hospital: A Supervisor of Midwives is available 24 hours a day. Supervisors are concerned with ensuring the safety and well-being of mother and baby and with the provision of high quality midwifery care. Contact us Antenatal Clinic Triage Department Useful website addresses NHS choices website Royal College of Obstetricians and Gynaecologists (RCOG)

6 Page 6 of 6 If you would like this leaflet in a different format, for example, in large print, or on audiotape, or for people with learning disabilities, please contact: Patient and Customer Services, Poplar Suite, Stepping Hill Hospital. Tel: Our smoke free policy Smoking is not allowed anywhere on our sites. Please read our leaflet 'Policy on Smoke Free NHS Premises' to find out more. Leaflet number MAT49 Publication date January 2016 Review date January 2018 Department Antenatal Clinic, Women s Unit Location Stepping Hill Hospital

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