Two sides to every story: The ECV

As I’m sure your social media feed has already informed you, Kimye have welcomed their second bub, a baby boy named Saint.

A couple of weeks ago a mum-friendly website posted an article, “Kim Kardashian’s baby is no longer breech after a “painful and scary” medical procedure”, (read it here). It was admittedly 95% Kim’s words extracted from her website about having a breech baby and attempting to turn the baby externally, through what is called an ECV (External Cephalic Version).

Kim goes on to explain how ‘she was prepared for an emergency caesarean…her waters could break… and that it was more painful than childbirth as she wasn’t given drugs.’
I believe this article missed an opportunity in this article to explain; What an ECV is? What are the risks? What is the success rate? Can you use pain relief?  Are their alternative remedies or avenues available to explore for turning a baby from a breech position to a cephalic position (head down)?

Of course by Kim Kardashian-West publishing her experience (as is her right), and the media reinforcing it without a counter argument, or without any evidence-based research to back up what she is saying, I believe this is doing women (who may find the whole childbirth thing scary enough as it is) a disservice.

So below we’re breaking down what is an ECV with some evidence based research (we can’t promise it’ll be as entertaining and dramatic!):

What is Breech?
Breech is the name given to a baby that is head up, bottom (or feet) down towards the vagina. This accounts for approximately 3-4% of pregnancies. This fetal position is regarded as higher risk for the baby regardless of the mode of birth (Cochrane Review 2015). 

 

What is an ECV?
External Cephalic Version aims to turn the baby from a breech position to a cephalic position, by pressing gently on the mothers stomach.

Andrew Bisits is the Director of Obstetrics at the Royal Hospital for Women, Sydney, Australia – a tertiary academic hospital which oversees 4000 births per year. He’s been in obstetrics for 30 years and has a strong interest in breech pregnancies and vaginal breech birth.

Below is Andrew Bisits performing an ECV:

Who performs an ECV?

Obstetrician’s perform ECVs. This is not under a midwives scope of practice in Australia.

What are the risks?

An excerpt from the Cochrane Review 2015, External cephalic version for breech presentation before term (review), concluded that ‘compared with no ECV attempt, an ECV commenced before term improves cephalic presentation (head down) at birth. Beginning an ECV between 34 to 35 weeks may have some benefit in terms of decreasing the rate of non-cephalic presentation (babies not head down), and risk of vaginal breech birth. An early ECV may increase the risk of late preterm birth.’

The review also highlights the importance of careful discussion with women about the timing of an ECV so that informed decisions can be made.

The overall complication rate of ECV’s according to evidencebasedbirth.com was 6%, and the rate of serious complications (placenta abruption or stillbirth) was 0.24%

What is the success rate of turning bubs?

According to BabyCenter the success rate of an ECV is 58%. If the baby is in a transverse lie (sideways), the success rate increases to 90%. This website also reported that the ECV was more likely to work if it wasn’t a woman’s first baby.

Can you use pain relief for the procedure?

Pain relief, such as nitrous oxide (happy gas) inhalation during the procedure decreases the level of ‘severe pain experienced by some women’ and appears to be safe for both mother and child, with no effect on the success rate of ECV or the perinatal outcomes (Burgos et al. 2013) –
Source: nitrous oxide for analgesia in external cephalic version at term: prospective comparative study.

Having seen ECV’s performed, how uncomfortable a woman finds the procedure varies. Not everyone will find this more painful than childbirth, yes uncomfortable, but not traumatising pain. Talking about viability of using pain relief would be a question to ask your obstetrician before commencing the procedure.

Alternative methods for trying to turn babies?

Speak to your healthcare providers about the potential benefits of massage, acupuncture, swimming, positions etc.

Can I have a vaginal breech birth?

Vaginal breech birth has become a lost skill over the years, and many doctors will choose (and believe it safer) to perform as caesarean section. It is important to discuss the risks and your personal pregnancy situation with your healthcare provider, however there are some obstetricians that will support vaginal breech birth.

Can I opt for a caesarean section and not have an ECV?

Of course, it’s your pregnancy and your baby. This is also a good conversation to have with your obstetrician and midwives.

 

 

Evidence-based info for parents-to-be.
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