Thursday, February 18, 2010

External Version

"If the midwife has determined in the course of the [prenatal] massage that the baby is in a breech (bottom-first) or transverse (side-lying) position, she will do an inversion, an external version of the baby in utero." - Yucutan, Mexico. Brigitte Jordan, Birth in Four Cultures

When I first read that, for some reason my mind went to an image of a traditional midwife making a model of the baby that she would use to "symbolically" turn the baby. Ha, shows how I used to think about the efficacy of a traditional Mexican midwife's practices. yeesh. 

An external version is actually of a turning of the baby inside the mom's tummy! How fantastic is that? 


These days, a breech or transverse baby is usually identified by prenatal ultrasound scans.
External cephalic version was widely performed in the U.S. until the 1950's, and is commonly employed by traditional midwives the world over, as well as by trained midwives and physicians in Europe.  In the US the standard management strategy for breech birth and other malpresentations is the Cesarean section.

"[The Midwife] locates the baby's head and hip and by applying strong, even pressure to these parts, shifts the baby's body into the more favorable head-down position. This procedure is sometimes painful but since the perceived alternative is a Cesarean section in the hospital, the women much prefer to tolerate a few minutes' discomfort at home. [She] will do a version as often as necessary from the eigth month on, up to the time of birth."  - Yucutan, Mexico. Brigitte Jordan, Birth in Four Cultures

Today, in the medical setting, breech external versions are done at the doctor's office. A nonstress test and ultrasound are used to assess the baby's well-being. The mother may be given an injection of terbutaline to relax her uterus. She may also be given an epidural to relax the abdominal muscles and prevent pain from the procedure, but this is time-consuming and expensive. With the guidance of an ultrasound the doctor presses on her abdomen to lift the baby out of the pelvis and turn the baby head-down. This is usually only done after 36 weeks. On the rare occasion that labor begins or the fetus or mother develops a serious problem during version, an emergency cesarean section (C-section) may be done to deliver the fetus.

Versions are successful 60-70% of the time. 


They are most likely to succeed when:
  • The mother has already had at least one pregnancy and childbirth.
  • The fetus, or a foot or leg, has not dropped down into the pelvis (has not engaged).
  • The fetus is surrounded by a normal amount of amniotic fluid.
Potential Risks:
Potential risks of version, for which the fetus and mother are closely monitored, include:
  • Twisting or squeezing of the umbilical cord, reducing blood flow and oxygen to the fetus.
  • The beginning of labor, which can be caused by rupture of the amniotic sac around the fetus (premature rupture of the membranes, or PROM).
  • Placenta abruptio, rupture of the uterus, or damage to the umbilical cord. The potential exists for such complications, but they are very rare.



I was just informed of an alternative form of Breech version that carries fewer risks and a higher success rate - The Webster Breech Version.


Chiropractic Care: The late Larry Webster, D.C., of the International Chiropractic Pediatric Association, developed a technique which enabled chiropractors to release stress on the pregnant woman's pelvis and cause relaxation to the uterus and surrounding ligaments. The relaxed uterus would make it easier for a breech baby to turn naturally. The technique is known as the Webster Breech Technique.

The Journal of Manipulative and Physiological Therapeutics reported in the July/August 2002 issue that 82% of doctors using the Webster Technique reported success. Further, the results from the study suggest that it may be beneficial to perform the Webster Technique in the 8th month of pregnancy.


To add, other than the manual manipulation of the baby there are other ways to promote the turning of a baby, such as visualization, body positions such as the pelvic tilt and knee-chest, using a rebozo, and so on!

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