Breech Baby & An ECV: External Cephalic Version

This pregnancy hasn’t been an easy one; I had hyperemesis gravidarum (an extreme form of morning sickness), erythema multi-forma (a body covering rash with no known cause), a complete placenta previa (that resolved around 33 weeks), and a very stubborn breech baby. We’ve been blessed enough that our daughter appears to be very healthy, despite my pregnancy complications. I really didn’t want a c-section and after trying everything suggested by the Spinning Babies website and my nurse midwife, our only hope for a routine delivery was a procedure called an external cephalic version (ECV). Today I’m sharing my experience with having an ECV and what I think you should know before you go. Remember that I’m not a medical professional and nothing in this post should be construed as actual medical advice; you should always consult your medical professional before making any medical decisions.

I thoroughly researched the risks of external cephalic version before I scheduled the procedure, and I decided that the benefits from a successful ECV far outweighed the few risks. The majority of external cephalic version procedures are performed outpatient in the Labor and Delivery unit of a hospital. They do this in case any complications arise that require immediate or urgent delivery of your baby. My nurse midwife was not trained to do the procedure (many aren’t), so I was referred to an obstetrician.

external cephalic version

I was scheduled for my ECV at 8am, but I didn’t have my procedure for several hours. They instructed me not to eat or drink anything after midnight. I had to do paperwork just as if I were having my daughter, and pre-procedure lab work, ultrasound and medication. I had to authorize the physicians to treat myself and my daughter if the need were to arise. They started an IV and drew lab work. I couldn’t be administered any medication until the lab work came back.

When my labs were completed, the nurse was authorized to administer the terbutaline. I was honestly more nervous about the medication than the actual procedure, which was silly in hindsight. I had read that the medicine could make you feel very jittery and your heart might race. My nurse assured me that some women experience neither side effect. I didn’t feel like my heart was racing. I had a steady “shake” throughout my body, which was more weird than uncomfortable. They watched the clock and the ECV was started 20 minutes following the administration of the terbutaline.

external cephalic version

I had three physicians actually working on me, while several residents and a medical student watched the procedure. One physician moved my baby’s head, one physician moved her bottom, and the third operated the ultrasound machine to keep track of head position at all times. They also use the ultrasound to monitor the heart rate and position during the ECV. The success rates on an ECV range from 30-60%, but I had the Chief of Obstetrics at a major research university hospital performing my ECV and she felt my odds were close to 70% going in. I was appreciative of both her honesty and confidence.

I was laid flat on my back and my belly was covered with ultrasound jelly. The jelly is to help reduce friction and allow the providers to slide their hands as the baby moves. They pushed my daughters bottom out of my pelvis before they attempted to rotate her. They determined from the preliminary ultrasound that a “forward roll” would be best to move her. I’ve read that many women describe the procedure as painful; It was very uncomfortable to me, but not painful. I would best describe the feeling as being unable to breathe and extreme pressure. If you’ve ever been laying in the floor and someone accidentally stepped on your stomach, that was how I felt. My husband and the nurse tried to comfort me as they attempted to rotate my daughter. The first attempt was unsuccessful, and my doctors stopped when they felt I needed a break. I tried to breathe through the procedure but it wasn’t easy. Even if they halt the procedure to give you a break, they still have to maintain a decent amount of pressure to keep the baby from reverting to its original position.  My daughter responded well to the procedure, but she didn’t want to be moved. The Chief who was in charge of the procedure said she would like to attempt it one last time. I closed my eyes, squeezed my husband’s hand, and tried to calm my breathing so they could work as long as I could tolerate. I was very uncomfortable and struggling to breathe when they got her into the transverse position (length-wise). She paused the procedure while maintaining pressure to allow me to try to catch my breath. Several seconds later they tried a little more force and she went from transverse to cephalic presentation. My little “audience” cheered and I was beyond relieved that it was over. In a facility where the caseload is comprised primarily of patients with very challenging and urgent needs, there was an obvious sense of achievement in the room.

My doctors were fairly confident that my baby wouldn’t revert due to her size, which had made the procedure a little more difficult. I was placed on my left side while they monitored her heart rate for an hour. She had some slight tachycardia but they felt that was due to my own tachycardia. I closed my eyes and concentrated on slow, deep breathing, and both of our heart rates quickly returned to normal range. I had a few muscle spasms in my back and legs, and I’m not sure if that was caused by the medication or the procedure. I also had some Braxton Hicks contractions, but those quickly subsided as well. I was discharged around 12:30 and I walked to my car.

I’ve been very sore for the last 24 hours, and I have two bruises on my stomach. I originally thought I wanted to be induced following the procedure because of her size and gestational age. Having been through it, now I can’t imagine wanting to be induced or going into labor immediately following the procedure. My abdomen is miserably sore to the touch today, and it really hurts to even laugh. I’m actually hoping that I don’t go into labor for a few more days to allow the soreness to go away.

On the brighter side of things, my daughter is still in the correct position and I can attempt vaginal delivery. I’m glad that I attempted ECV and even more thankful that it worked. Some babies flip quickly with very little pressure, some immediately revert to their previous position, and some won’t flip at all. Don’t perform a “Google MD” search and get yourself too stressed over the procedure, and I certainly don’t recommend reading responses from birthing forums. I read as much peer-reviewed medical information as possible and tried to mentally prepare myself for the ECV.

Thanks for stopping by and reading about my experience having an external cephalic version. Hopefully I’ll be sharing my daughter’s birth story soon. If you’re having an external cephalic version and you have a question regarding my experience just leave a comment or shoot me an email, and I’ll try to respond as quickly as possible.

 

 

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