Turn, baby, turn

February 8, 2011

(PhysOrg.com) -- Turning a breech baby earlier in pregnancy results in fewer babies being in a breech position, but does not decrease the chance of a caesarean birth, an international study led by McMaster University researchers has found.

The manual procedure to turn the baby, called external cephalic version (ECV), has been recommended for breech positions - when the feet, rather than head, are toward the pelvis - at full-term of between 37 and 42 weeks gestation. However, the study looked to determine if performing this procedure between 34 and 35 weeks would result in better outcomes.

Beginning ECV early did decrease the likelihood of a breech presentation at birth. However, researchers found that beginning the procedure earlier does not translate into a reduction in the use of caesarean or surgical birth and may increase the rate of preterm birth, a concern because of its association with and poorer long-term outcomes.

"We believe that it's important for a woman with a breech presenting baby who is interested in ECV to prevent a caesarean, to know the results of this study so that she will be able to make the best possible decision about timing of ECV," said principal investigator Eileen Hutton, assistant dean of the midwifery education program at McMaster.

The study is available in the online edition of BJOG, An International Journal of Obstetrics and Gynaecology.

The study follows a pilot study by Hutton in 2002 which showed that earlier ECV was about 10 per cent more successful in turning breech that later ECV.

A fetus is in breech position in about one in every 25 to 30 full-term births. Although breech babies can be delivered by vaginal birth, most care providers recommend caesarean birth, which is the type of birth for one in four babies born in Ontario.

In the ECV procedure, a doctor or midwife uses their hands to manipulate the mother's abdomen and help the baby turn in a somersault-like motion. The procedure is successful in turning the baby in about 30 per cent of first-time moms, and 58 per cent of subsequent pregnancies.

The new study, funded by the Canadian Institutes of Health Research, involved more than 1,500 women from 68 centres in 21 countries.

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