Can I avoid C-section with a breech baby? Here’s an alternative procedure that works

“Flipping a bottom-down or breech baby into a head-down through ECV is not new. It has been documented in obstetric textbooks and can play an important role in improving the chances of a vaginal birth. As C-section rates climb – particularly in private hospitals – this empowers women to make their own decision about birth practices,” says Dr Nina Mansukhani, senior obstetrician and gynaecologist at Jehangir Hospital, Pune.

Breech babies account for five per cent of all full-term pregnancies

Most babies turn into a head-down position by the 36th week of pregnancy. But some don’t, either because of multiple pregnancies, excess or less amniotic fluid, uterine fibroids and placenta covering the cervix. Sometimes babies flip when they are preterm or have a birth defect.

Breech babies account for five per cent of all full-term pregnancies and ECV is usually done at 37 weeks of pregnancy. According to the American College of Obstetricians and Gynaecologists(ACOG) and the Royal College of Obstetricians and Gynaecologists (RCOG), this procedure should be the first option for a normal delivery. “Only a moderate amount of pressure is applied on the tummy to rotate the baby to a head-down position. The baby is well cushioned inside so there is no question of trauma,” says Dr Mansukhani.

Why obstetricians opt for elective C-section

Before 2000, ECV was an option offered to pregnant women at teaching hospitals and certain set-ups. In 2000, the Term Breech Trial was published, and its authors recommended caesarean section as the safest mode of delivery for breech-presenting babies and preventing deaths. Obstetricians worldwide soon opted for an elective C-section. “The C-section rates went up from 50 per cent to 80 per cent for a breech presentation,” says Dr Mansukhani.

However, the Term Breech Trial did not ensure uniformity of care. “For instance, in a rural area — given the baby’s weight is within the average range — it would be prudent to opt for a vaginal birth in a breech pregnancy. This can be done by a trained birth attendant rather than shifting the mother to a tertiary health care facility which may not always be feasible,” she explains. Also, C-sections can have their disadvantages like blood loss, operative morbidity and high costs.

Which mothers can opt for ECV?

Not all patients are suitable for the procedure and the doctor can select on a case-by-case basis. Factors like the baby’s weight, position of the placenta, type of breech, the level of fluid inside the womb and scar tissue in the uterus have to be considered. Those not eligible include older pregnant women who have medical conditions like uncontrolled hypertension or diabetes or have undergone in-vitro fertilisation (IVF) treatment. “Counselling the would-be parents is important and the procedure should not be performed if the risk seems high,” says Dr Mansukhani.

What of an emergency during the procedure?

ECV is typically performed near an operating room in case an emergency C-section is needed.

What happens after this procedure?

The mother and the foetus will be monitored to ensure labour doesn’t start prematurely. The mother can go home and resume normal activities. She can keep following up her status after that.