Thursday, October 12, 2017

Turning Breech Babies and cesarean outcomes

Spinning Babies has said head down is half the story.
And now it turns out that just how babies get head down is important.

In recent years, the manual turning of the breech baby to head down has been poorly reviewed for adverse outcomes (Culver's review of the Cochrane data base, 2013, 2015). 

This September new research compared the cesarean rate after successful External Cephalic Version (ECV) with the cesarean rate after spontaneous cephalic version (Boujenah, 2017). ECV is the procedure when a doctor or midwife manually turns the baby head down by manipulating the baby through the mother's abdomen, while spontaneous cephalic version is when a breech baby turns head down on their own.


And now it turns out that just how babies get head down is important.
A research team wanted to assess if the cesarean rate went up or down after successful External Cephalic Version (ECV) compared to when babies turned themselves head down. ECV is the procedure of a doctor manually turning the baby.

This study had 643 women who attempted ECV, and 198 succeeded in getting baby head down. These women’s labors were compared with the next two women who presented for labor after their breech babies turned head down spontaneously. Both groups, then, had breech babies in pregnancy and one group had head down babies after babies turned on their own and the other group’s babies were turned head down by the doctor.

After ECV the cesarean rate was about 1 in 5 compared to fewer than 1 in 10 for babies who had been breech but turned themselves head down (respectively 20.7% versus 7.07%) Funky head positions were more than 1 in 4, 28.6% versus 0% between the matched baby positions.

Boujenah concludes, a successful ECV increases risk of caesarean section compared with a spontaneous cephalic version in which the baby flips under their own power. See more on this at https://www.ncbi.nlm.nih.gov/pubmed/28951278

....

Yesterday Jennifer Walker, Spinning Babies Approved Trainer, spoke in The Netherlands at a conference dedicated to improving External Cephalic Version (ECV) skills. Among the questions raised by the Dutch midwives and obstetrician-gynecologists was, "Why is there a higher cesarean rate after successful ECVs than spontaneous versions?" and "How might we raise our 48% national rate for successful ECVs?"

From the Spinning Babies perspective, Jennifer Walker opened with a new question, "Perhaps, we're asking the wrong question. Instead of asking "How can we improve our ECV rate?" should we not be asking, "Why are babies in the breech position?"

In Spinning Babies we often say babies find the best position in the space available. Baby's position is not random. The pelvis is not only a bony passage. It's filled with muscles and ligaments that support and anchor the uterus in the pelvis. These soft tissues allow or restrict anatomical space.

ECV success is not just babies being able to be head down, true success is babies being able to be born vaginally and without injury. Force doesn't resolve a lack of space or uterine torsion which is necessary for both the successful ECV and ease in the labor following ECV. A research study on a protocol using Spinning Babies before the ECV may show improved outcomes.

Jennifer invites us to consider that "when a woman has done this in contact with her body and her baby then she is at peace, because this is their journey, together."



References
Successful external cephalic version is an independent factor for caesarean section during trial of labor - a matched controlled study.

(Cochrane Database Syst Rev. 2015 Feb 9;(2):CD000184. doi: 10.1002/14651858.CD000184.pub4.
Interventions for helping to turn term breech babies to head first presentation when using external cephalic version.


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