Maybe Breech Babies Can be Turned Earlier in the Pregnancy?

Filed in archive Diagnostics , Studies on June 22, 2007

Fetuses that are in a breech presentation -- with their feet, instead of their heads, towards the pelvis - are the case of about one in every 25 to 30 full-term births that though can be delivered by vaginal birth, most care providers opt to recommend birth by C-section.

In Ontario, Canada, the number of births by caesarean section has been climbing for the past five years and one of the reasons are breech babies.

Now, an international clinical trial is being led by Eileen Hutton (assistant dean of midwifery at McMaster University) to determine if a manual procedure attempting to turn breech babies earlier in a pregnancy than the current practice will mean a higher success rate for the procedure, and ultimately fewer C-sections.

The said procedure, called external cephalic version (ECV), in which a doctor or midwife uses their hands to manipulate the mother's abdomen and help the baby turn in a somersault-like motion, is recommended for women whose babies are in breech position at 37 weeks gestation.

This procedure has been found successful in turning the baby in about 30 per cent of first-time moms, and 58 per cent of subsequent pregnancies.

This kind-a remind me of a procedure used by local village midwifes (I live in a far-flung small Philippine barrio) at a time when home births are more common practice here, but earlier in the pregnancy to turn breech babies around (usually before the 7 month of pregnancy).

According to Eileen Hutton, principal investigator of the trial, which involves about 20 countries and is funded by a $2.8 million grant from the Canadian Institutes for Health Research:

"This is the first trial of its type, in which the timing of ECV is being studied. Although ECV is recommended for breech presentations at full-term, the success rate is not particularly good. We're hoping to determine if performing the procedure earlier, results in better outcomes.

The study began early in 2005, and is expected to be completed in another year. So far, nearly 1,000 women have been recruited to take part, and another 500 are still needed. The trial involves women in countries as diverse as Australia, Chile, Oman, Hungary, Egypt, Israel and Estonia, as well as Canada and the United States.

A 2002 pilot study conducted by Hutton revealed that earlier ECV was about 10 per cent more successful in turning breech babies than later ECV.

In this case I think that medical science has learned a lesson from old birthing practices.

Read the full report.

[Photo Credit: University of Pennsylvania Health System]