Choosing Between a C-section and External Cephalic Version

My first pregnancy was relatively uneventful. I suffered from the usual morning sickness throughout the first trimester and sailed through the second and third trimesters. It was not until my first vaginal exam during my 37^th week that the doctor suspected there might be a problem. My daughter was very high up in my uterus. Not only was her head not yet engaged in my pelvis, which was not in itself a problem, but the doctor was concerned that he could not feel a nose on what should have been her face.

I was immediately sent into the next room for an ultrasound. The good news was that the baby was happy, healthy, and had a full head of hair. The bad news was that her head was wedged under my ribs. She was breech.

The doctor gave me two options. He could either attempt an external cephalic version (ECV) at the hospital in two days, or he could schedule me for a c-section in a week. According to my doctor, not all mothers are good candidates for ECV. For example, mothers whose babies are expected to be very large or who have insufficient fluid surrounding the baby are not generally recommended the procedure. However, the doctor felt that the procedure could safely be performed on me.

Nevertheless, the risks of the ECV concerned me. The doctor explained that the ECV could put the baby in distress, resulting in an emergency c-section. He also said that the procedure would likely be very painful for me and only had about a 50 percent success rate. Even if the procedure worked, there was no guarantee that the baby would not revert to a breech presentation. When I left the doctor's office that day, I still had not made up my mind.

I was wary of attempting the ECV, and later conversations with a friend of mine confirmed my worry. She had attempted an ECV in her pregnancy because her baby was also breech. She went into labor the next day and had an emergency c-section when her baby went into distress. She also confirmed what the doctor had told me. The ECV had been very painful for her and had not been successful. Given my friend's experience, and after talking to my husband, we decided to schedule the c-section rather than attempting the ECV.

I was frightened of undergoing major surgery, but even more frightened to put my baby at risk by undergoing the ECV. To me, the risks of the c-section were largely risks that I would bear. The risks of the ECV would be risks that my baby would bear. The pain of surgery and subsequent recovery were tolerable if I had reasonable assurance that my baby would be born healthy.

After I consented to the surgery, the c-section was scheduled for the next week. My baby remained in the same breech position, which was confirmed by an ultrasound just prior to the delivery. When my daughter was born, she had a line across her forehead from where it was pressed into my rib, so it was very unlikely that she would have successfully turned either on her own or with assistance. While the c-section was difficult for me, it was well worth the pain and recovery to have a healthy child.

Each woman will weigh the benefits and risks of ECV differently, and should research every available option before deciding how to proceed. The American Academy of Family Physicians has published some good information regarding ECV that may be helpful to mothers with babies presenting in the breech position at http://www.aafp.org/afp/980901ap/coco.html. Asking questions about the procedure and talking to other mothers who have been in the same circumstance will also be invaluable to making an informed decision. As I learned, only you will have to live with the option you choose, so choose wisely.