UBC Reports | Vol. 51 | No. 4 | Apr. 7, 2005

Prof Turns Breech Baby Problem on its Head

By Hilary Thomson

It’s a new approach to a traditional procedure and it may save thousands of mothers the risks and recuperation associated with Caesarean section surgery.

Called external cephalic version (ECV), the current procedure is used to re-position a fetus in breech (bottom down) presentation. Also known as “turning the baby,” the manual, external procedure manoeuvres the baby by applying pressure on the mother’s abdomen, causing the baby to somersault into a head-down position. ECV is traditionally employed in the last two weeks of a normal 40-week pregnancy, and enables a vaginal delivery in 30-50 per cent of cases.

Eileen Hutton, of UBC’s division of midwifery, wants to boost the success rate by performing ECV as early as 34 weeks.

In the first study of its kind in the world, Hutton’s research team will recruit 1,460 mothers-to-be whose babies are in breech position. In the five-year international randomized trial funded by $2.8 million from the Canadian Institutes for Health Research, some women will have an ECV at 34-35 weeks and others at 37 weeks and researchers will compare differences in outcomes at birth and in the one-month period following delivery.

Women will be recruited from more than 80 centres in countries that include Canada, the U.S., Argentina, Chile, Netherlands, Israel and Jordan.

Researchers will look at the impact of early ECVs on the rate of C-sections performed as well as rates of premature births associated with the procedure. Investigators will do a cost-analysis as part of the study and will compare costs associated with earlier and late ECVs. They’ll look at costs of complications at the time of C-section, such as infection, which can require extended hospitalization, specialist attention and home care.

At full term, about three to four per cent of all babies will present in breech position, says Hutton, adding that the rate is constant internationally. The cause for breech presentation is not known.

“We know that most physicians now recommend C-sections for breech pregnancies, however, women who have this surgery have more problems compared to mothers who have vaginal births,” says Hutton, pointing out that C-sections are the largest contributing factor to maternal deaths and serious illness associated with birth. In addition, the scar resulting from the surgery complicates all subsequent pregnancies.

When Velda McAlduff-Low discovered the baby she was expecting was in breech presentation, she didn’t hesitate in choosing ECV in the hopes of avoiding a C-section.

“I knew that the six-week recovery time needed for the surgery would make it next to impossible to care for my baby and my toddler at home,” says the 44-year-old Delta resident, who last month successfully delivered a baby girl without surgery.

The procedure takes about five minutes and is usually performed without anaesthetic, although considerable pressure is applied to the abdomen. One obstetrician pushes her fingers against the mother’s belly to lift the fetus’ buttocks up. In a co-ordinated movement, another specialist pushes the head downward. The entire procedure is guided by ultrasound imaging.

“After several attempts, the team was successful in turning the baby,” says McAlduff-Low. “The procedure was painful but well worth it I am absolutely glad I had it done.”

“We want to reduce adverse outcomes for women with breech babies. If early ECVs are effective, they represent a low-tech, safe alternative to surgery,” says Hutton, who is also a midwife and mother of three, none of whom required turning.

The study has started recruitment at BC Women’s Hospital as the first site, under the leadership of Dr. Marie-France Delisle. Women wishing to be involved in the study must be pregnant with a single fetus with gestational age 33-35 weeks, in breech presentation.

For more information, contact BC Women’s Hospital & Health Centre at 604.875.2253.

The study is co-ordinated through the Centre for Healthcare Innovation and Improvement at the B.C. Research Institute for Children’s and Women’s Health (BCRICWH) and the Maternal, Infant and Reproductive Health Research Unit at Sunnybrook and Women’s Health Sciences centre in Toronto.

As part of Children’s & Women’s Health Centre of British Columbia, BC Women’s Hospital & Health Centre is the only facility in B.C. devoted exclusively to the health of women, newborns and families.

BCRICWH operates in partnership with UBC and the Children’s & Women’s Health Centre of British Columbia, an agency of the Provincial Health Services Authority.

For more information on the study, visit http://www.utoronto.ca/miru/eecv2.