In around 4% of pregnancies the foetus will present in the breech (head-up) position. While vaginal birth is still possible with the assistance of midwives or doctors skilled in vaginal breech birth, the majority of babies reaching term in the breech position will be delivered by caesarean. One alternative is to attempt external cephalic version (ECV).
ECV is a procedure used to turn a baby from a breech position to a vertex (head-down) position. The procedure is generally performed at or after 36 weeks of pregnancy. Before ECV is attempted the mother is given an injection of a tocolytic medication to relax the uterus and prevent uterine contractions. While the uterus is relaxed, the doctor places their hands on the surface of the abdomen, one near the foetus's head and the other near the buttocks, and attempts to push and roll the foetus to a vertex position. Keeping in mind that some babies prove impossible to turn and others revert to a breech position after a successful ECV, the overall success rate for ECV is averaged at around 38%.
A research study was recently conducted to determine the benefit of utilising neuraxial anaesthesia when performing ECV. Used in the administration of an epidural, neuraxial anaesthesia is a type of regional anaesthesia. When injected into the fatty tissue that surrounds the nerve roots as they exit the spine, neuraxial anaesthesia effectually numbs the patient from the abdomen to the toes. While using neuraxial anaesthesia can make the ECV procedure far more comfortable for the mother, it also offers the important benefit of creating total relaxation of the abdominal muscles.
The research study, conducted in the USA by Carvalho et al, determined that using neuraxial anaesthesia during ECV increases the rate of success to approximately 60%. While there is a cost implication of using anaesthesia during the procedure, in most cases this will be far outweighed by the cost-saving created by avoiding an elective caesarean.
The skills of midwives and doctors in breech vaginal birth are known to be dwindling. Increasing the success rate of ECV has the potential to increase the chances of a vaginal birth. This presents significant benefits to mothers and their babies in avoiding intervention and the risks of major surgery, as well as the disappointment that can come when the chance to birth naturally is lost.
Both the financial and emotional benefits of a successful ECV seem to far outweigh the costs associated with administering neuraxial anaesthesia. As such the use of anaesthesia may be a viable option for increasing the chance of ECV success and reducing the rate of caesarean birth for breech presenting babies.
Carvalho, B., Tan, J., Macario, A., El-Sayed, Y., & Sultan, P. (2013). A cost analysis of neuraxial anesthesia to facilitate external cephalic version for breech fetal presentation. International Anesthesia Research Society. Published ahead of print April 16, 2013. Retrieved from http://www.anesthesia-analgesia.org/