“Like a Version”……..External Cephalic Version!

Say What

Even in utero, babies do EXACTLY what they want to do…….So just what do you do if you are about full term and baby isn’t in the right position; i.e., BREECH?!?!?!?

Pump your brakes, slow down Sally, don’t avail yourself to a c-section JUST yet…….

Aside from options ranging from manipulation from Chiropractors that are supposed to make baby flip, to certain “exercises” that are supposed to coerce baby into assuming the correct position(I’m still not convinced that any of the aforementioned actually works but hey, I’m open it…..), here’s what you need to know about External Cephalic Version…….

Like a Version………Touched for the very first time(In my BEST Madonna voice…..gotta love Madge)

Speaking of touching…….versions are typically performed by your OB/GYN. They are typically performed in a hospital setting.

Find out what the protocol is for versions at your particular institution……Is anesthesia involved? Some folks utilize it, others don’t .There typically will be some sort of fetal monitoring before hand, to ensure that baby’s status is reassuring, and afterwards, again, to ensure that baby is doing ok….after all, if you had just been flipped around in your dwelling place wouldn’t you want us to make sure you were doing ok; i.e., no obvious signs of distress, labor, bleeding, etc?

There should be a bedside ultrasound that will monitor baby throughout the procedure to ensure that baby is moving in the right direction and that the heart rate remains stable………What sort of flip are we doing here anyway? Front or back? These are ALL things you need to know.

If you are RH negative; you will likely, or should, receive a dose of rhogam…versions, after all, can be a bit traumatic, specifically when you consider that we are turning baby inside the uterus.

What makes you a good candidate for a version?

  • Being mulitparous…translation…..this isn’t your first baby
  • Having an adequate amount of amniotic fluid
  • The baby is not engaged in the pelvis

What makes you a poor candidate for a version?

  • This is NOT a singleton pregnancy….Versions should be done on single intrauterine pregnancies
  • Low Amniotic Fluid Level
  • Placental abnormalities, whether it be placental insufficiency, previa, abruption, etc.
  • Any uterine malformation or fetal anomaly

While being obese certainly is not a contraindication, it certainly may make the version technically more difficult. The size of the baby, location of the placenta, as well as the location of the fetal back are other factors that impact success.

Most versions are done at the 37 week mark. If successful, there is a 3% chance of reversion. Success rates have been quoted anywhere from just over 50% to around 63%. It’s probably worth asking your clinician what their success rate is.

While the whole purpose of an external cephalic version is to avoid a c-section, risks associated with it include things like: the fetus reverting to breech presentation, ensuing labor, premature rupture of membranes, fetal distress/bleeding or any other “thing” that might necessitate an emergency delivery.

For those of you not comfortable with taking the risks associated with an attempted version, a c-section for mal presentation can always be scheduled at 39 weeks. Just make sure that you review the pros and cons so that you can make an informed decision.

Hoping this blog post adds value to your day!

Until Next Time,

Look Better. Feel Better. Be Better.

Dr. Angela




About Dr. Angela

Wife, mother, Midwesterner, and award-winning OB/GYN, Dr. Angela is equal parts best girlfriend and bold professional, supporting women’s health with innovative approaches to care and heavy doses of humor. Dr. Angela has done more than launch a successful practice, she has defined herself as a voice for a new generation of womanhood, established her ASK DR. ANGELA brand committed to authenticity, and built a community rooted in trust, candor, and compassion.

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