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Breech presentation & External Version

Most babies are positioned head down in the womb. This is so they can come out of the birth canal (vagina) head first. Sometimes, the baby is positioned so the feet or buttocks will come out first during childbirth. This is called a breech presentation.

Why are some babies breech?

Often, there is no obvious reason why a baby is breech. It may simply be that your baby is most comfortable in this position. Some factors that may influence why a baby might be in breech position are: premature labour (earlier than 37 weeks), too much or too little of the liquid (amniotic fluid) around the baby in the womb, more than one fetus in the womb, the length of the umbilical cord, the size of the uterus, an irregularly shaped uterus or uterine fibroids (non-cancerous growths on the wall of the uterus), or certain physical abnormalities in the baby.

How are breech babies delivered?

There are a few options depending on your circumstances…

If your baby is breech, and you are past your 36th week of pregnancy, there is the option of attempting to turn the baby around so its head is down near the birth canal. A technique called version is used to gently roll the baby around so the head is in the best position for labour and delivery. The obstetrician will place his or her hands on your abdomen, then push or lift. You may be given a medication to relax the uterus and make the version procedure easier. The success of the procedure is approximately 30-50% and depends both on how many babies a woman has already had as well as the practitioner’s experience.

During the procedure, your baby’s heart rate will be monitored and ultrasound will be used to check the baby’s position. Very rarely, version may cause problems with the baby’s heart rate or lead to early labour. Your doctor will be ready to deliver your baby if necessary, vaginally or by C-section. External cephalic version is rarely associated with serious complications. In a large study of more than 12000 women, emergency cesarean delivery occurred 0.35% of the time. Other serious risks were: placental abruption and stillbirth 0.24%.

Sometimes, the baby will move back into breech position after this process. If you believe your baby has switched positions again, discuss this at your next prenatal check-up. Your doctor may try version again, but as the baby grows in the final weeks of pregnancy, there is less room for movement in the womb.

Not everyone is a candidate for version. Absolute contraindications include the following: any contraindications to labour, e.g. placenta previa, or congenital abnormality. Relative contraindications include: severe oligohydramnios (little amniotic fluid), hyperextension of the fetal head, two or more previous cesarean sections, morbid obesity, or active labour. There is no evidence to suggest that ECV is unsafe after one low transverse uterine incision or cesarean section.

Some chiropractors with special training can perform the Webster maneuver to attempt to help the baby turn. It consists of trigger point therapy on tender lower abdominal ligaments and adjustments of the pelvis.

Some chiropractors have special training in moxibustion which is similar to acupuncture, but with the addition of a special herb called mugwort applied at trigger points in the feet. This can be done for 15-20 minutes twice daily for 5-7 days at 34-36 weeks of pregnancy. This has been proven effective to reduce needing version. 


ALARM 2014

obstet gynecol 2007;110(6):1343-50

Grootscholten K, Kok M, Oei SG, Mol BW, van der Post JA. External cephalic version-related risks: A meta-analysis. Obstet Gynecol 2008;112(5):1143-1151.

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