Has your baby turned to the birth position, ready for a normal delivery?

By: - 27th February 2019

Children are the ultimate treasure for parents. Whether it is your first child or not does not matter. This is why mothers are extremely cautious during the pregnancy. During this time, everyone in the family will be giving their utmost support. Everything is done to ensure that the child is brought to life safely. However, no matter how careful you are, there will be instances of complications that could impede a normal delivery. One such situation is when the baby has not turned upside down to the birth position also known as breech presentation.

Usually, 95% of babies gradually turn head down by the completion of the 36th week inside the womb. But 5% of them will not. However, this not taking place prior to the week 36 is nothing to be concerned about in a complication free pregnancy. If the situation does not change after week 36, it is considered to be problematic. The placenta lying low in the uterus, fibroid growths inside the uterus and various abnormalities in the uterus and the fetus are the conditions that cause the baby to remain unturned. Also, there are babies who do not turn even without any of the above reasons. When it has been early-identified, considering a normal delivery can be tricky, as there is a risk of various complications for both mother and baby. In such situations, doctors will attempt to flip the baby using external pressure on the mother’s abdomen. This process is called ECV.

Mothers for whom the ECV procedure is successful can be directed to a normal delivery (if there are no other complications), whereas for those who the ECV did not work, caesarian surgery will be recommended. Mothers who object to an ECV will also be directed to a caesarian surgery. However, mothers who underwent a caesarian on a previous delivery are usually not subjected to this procedure.

What we aim to do here is to give you some information about External Cephalic Version.

Before a mother undergoes ECV procedure, she would have to do a scan test. After investigating any complications related to the baby, if the conditions are normal, the mother will be given a date and a time to be hospitalized for ECV. If it is a first pregnancy, ECV will be conducted between week 36 and 37. For second or third pregnancy, it will be done between week 37 and 38. While monitoring through a scan test, external pressure is induced on the mother’s abdomen to nudge the baby to the correct position. The mother may feel some discomfort as this procedure is done without anesthesia. Upon a successful completion of ECV, the mother will get the opportunity for a normal childbirth. However, another scan test will be conducted to check the fetal position before delivery, as occasionally, there are instances in which the position could have changed again. Once the ECV is done, the mother will be directed to a CTG scan and if the result has no reason for concern, the mother will be released from the hospital.

Also, there are mothers who are willing to undergo a normal delivery even if the baby is in breech, and due to the various possible complications, this must be done by a thoroughly experienced doctor. Moreover, mother’s utmost patience and support is required for a successful childbirth of this manner. It is essential that the mother get admitted to the hospital as soon as she starts experiencing labor pains

The mothers who do not agree for ECV or those for whom the process was unsuccessful, caesarian surgery will be recommended. If the baby has turned to a position appropriate for delivery, the mother will be advised to have a normal childbirth. Regardless of whether it was a caesarian surgery or a normal deliver, the child will be thoroughly inspected. The mothers who have already undergone this experience need to inform the doctor when the next pregnancy occurs.

An article prepared in consultation with Professor of University of Kelaniya, Dr. Tiran Dias, Gynecologist of Colombo North Teaching Hospital

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