“Turn, Turn, Turn: Breech Presentation and External Cephalic Version” – with Dr. Stephanie Melka

Dr. Stephanie Melka returns to Healthful Woman to discuss ECV, a procedure to turn babies who are breech. She and Dr. Fox discuss how this procedure works, complications in breech delivery, C-sections, and more.

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Dr. Fox: Welcome to today’s episode of “Healthful Woman.” A podcast designed to explore topics in women’s health at all stages of life. I’m your host, Dr. Nathan Fox, an OBGYN and maternal fetal medicine specialist practicing in New York City. At “Healthful Woman” I speak with leaders in the field to help you learn more about women’s health, pregnancy and wellness. All right, Melka, welcome back to “Healthful Woman” glad to have you. 

 

Dr. Melka: Thanks for having me back. Happy to be here. 

 

Dr. Fox: We’re gonna be talking today about a procedure called external cephalic version, we call it ECV for short, it’s sometimes just the last word version for short, and explain, what exactly are we talking about here today? 

 

Dr. Melka: The ECV is the procedure to turn a baby that’s breech, meaning head up, to be head down. 

 

Dr. Fox: Right. And so, why would anyone even think of doing that? Like, why would you try to change the position of a baby during pregnancy? 

 

Dr. Melka: For a variety of reasons we’ll get into. We try to avoid delivering these babies vaginally, the alternative would be doing a C-section for a breech baby. 

 

Dr. Fox: Right. And I think that’s sort of a broader topic that we should focus on before talking about the procedure is this idea of breech presentation where the baby, again, like you said is head up butt down, the end of pregnancy, and how we manage them, specifically how we deliver them. And the interesting thing I always found is that it’s actually uncommon, like, 95% plus of babies, by the time mom goes into labor, the baby find its way into head down. And we don’t really understand how that happens. There’s a process but we don’t really get it. Is it just geometry that’s sort of the shape of the uterus that facilitates that? Or is there something in the baby’s brain that somehow the baby knows how to get down there. 

 

And there is some evidence actually supporting that, because babies with certain abnormalities of the brain are more likely to end up breech. And there’s some thought that maybe there’s something inherent to the baby to find, so to speak, that position, which is amazing, and fascinating, but we don’t really understand it. But ultimately it’s uncommon, most babies are head down. And when the babies are head up, they used to be all delivered vaginally, right? Like 100% of them. And it’s one of the reasons why C-section rates have gone up over the years because we started delivering those babies more and more by C-section. What was the reason that people switched from delivering them vaginally to C-section? Was it fear of injury to the baby? Or was it that just the labors didn’t progress normally? 

 

Dr. Melka: I think it was more fear of injury to the baby. You have one bad outcome, and it sort of changes your outlook on all of these procedures. And I think over the years, there was concern over worse outcomes with the babies. And then fewer people did it. And then fewer people taught people how to do it. And then you now are at a point where you don’t have many people. 

 

Dr. Fox: Right, really, it’s an interesting story, because most babies who are breech and were delivered vaginally do fine, right? They’re fine, right after the birth, long term, everything’s okay. But the way babies are shaped, the head is the biggest part of the baby to come out. And so when a baby comes out head first and the mom’s pushing and pushing. And once the head comes out, generally the body comes out very easily afterwards. There are some exceptions to that. But generally, that’s what happens. But with a breach, it’s sort of not always the case, because it’s sort of trying to deliver the baby from the smallest diameter to the largest diameter. And so, as the baby’s coming out, there’s a higher chance potentially of something getting injured on the way out whether it’s an arm, or the shoulder, or maybe the head getting stuck potentially. And then it takes a longer time to deliver. And during that time, maybe there’s less oxygen to the baby. So those are sort of the concerns. And people who are delivering babies who are extremely skilled at breech deliveries. And, again, these things rarely happened. But if they did, as you said, it leaves an impression on people. 

 

And what also happened over the same time period. You know, we’re talking over the past hundred years is C-section’s got so much safer. So the alternative to breech delivery used to be like, “We can’t do that, like, it’s a C-section, that’s horrible.” You know, so it’s such a big deal to do. But as they got safer over time, sort of the alternative wasn’t as unappealing and so more and more people converted from delivering babies breech vaginally to C-section, as you said, then it starts to snowball. Because then they do fewer, then the people who are learning learn fewer, then they don’t have the same skill set and they feel less comfortable doing it. So they’re more likely to lean toward C-section. 

 

And this was happening steadily from 1980 till about 2000. And then in 2000, there was a really big study that came out where they looked at breech babies, and they, what we call randomized the moms into either planning for a C-section or trying to deliver them vaginally. And then the group that delivered vaginally, there was a higher incidence of the babies having injuries, problems, NICU admissions, and so forth. And that’s basically when, in the U.S. and most places, breech deliveries just plummeted. Interestingly, when they looked at long term follow up with these babies there really wasn’t a big difference. It was more short term issues. But, by that time, like, when I was training, which I trained right after that time period, we didn’t do any breech deliveries really, unless it was almost an accident. You know, mom showed up, and she was already delivering breech and it just wasn’t done. And so, really, people didn’t train in it. And it wasn’t a standard of care. So it’s very unusual. I rarely see someone deliver a baby breech if it’s one baby. 

 

Dr. Melka: I haven’t in the 12 years now I’ve been at Sinai, unless, like you said, the ones that just come in delivering. 

 

Dr. Fox: Right. It’s part of the reason we had our podcast about twins, where we do deliver the second twin as a breach because it’s a different circumstance than it was just one baby, why it does require training to do because you don’t get a lot of training, you don’t get any training really with Singleton breeches, it’s the same maneuvers, but we don’t have, people, again, were practicing in 1950 to 1980. We’re doing them all the time. And so this was something we just did every day, and not so much for us. And so, it’s become very unusual to try to deliver these babies vaginally. Some do, it still happens, but it’s very unusual. And so an alternative is to try to move the baby’s position from head up to head down to increase the chances she’ll go into labor with the baby in that position, and you can deliver vaginally. 

 

And that’s where the ECV comes in. And that’s where the word, so external, means we’re putting our hands outside of mommy on her belly as opposed to internal. Cephalic is the fancy term for the head, right? For the baby’s head. And version, meaning we’re changing it from one position to another, from up to down. That’s where external cephalic version comes from. How is it actually done? Like, what would you do with your hands is the doctor doing this procedure? We’ll get to sort of the logistics of the whole day for someone undergoing this, but what do you physically have to do? 

 

Dr. Melka: So you’re just putting your hands on mom’s belly and kind of pushing down with the head and pushing up on the breech and pushing your hands almost like in a circular motion, getting the baby to spin. 

 

Dr. Fox: Right. Like almost if the baby’s sort of like the hands on a clock, you know, you’re trying to move it so the head, instead of being at 11 o’clock is now at 6 o’clock. It’s a tight space. So they don’t frequently just like flip with minimal effort, you have to put some effort, but also that’s the skill, you know, how much effort? Too much, too little? And to try to figure that out. And we can turn clockwise, so to speak, towards… 

 

Dr. Melka: Or counterclockwise. 

 

Dr. Fox: Or counterclockwise based on the [inaudible 00:07:36]. So that’s sort of what happens. And when do we do this procedure? 

 

Dr. Melka: Generally, around 37 weeks, you wanna do it before mom goes into labor or her water breaks just because of an increase in complications in that setting. And don’t wanna do it too early either, just because of potential risks. 

 

Dr. Fox: It’s one of these things where there’s so many variables pushing you to do it later, and so many variables pushing you to do it earlier. We do end up at 37 weeks, give or take. The reasons you would not wanna wait, like you said, she may go into labor beforehand, then you really can’t do it. And now she’s having a C-section. Also, the baby does get bigger, makes it harder to do. And also, if you wait, frequently, the baby will, what we call descend or engage and get lower down into mom’s pelvis, like where the pelvic bones are, if the butt gets lower, it’s just harder to move out of there. So it’s like sort of better if the baby’s floating high, which makes sense. So that’s why you would wanna do earlier. 

 

But on the flip side, pardon the pun, if you wanna do it earlier, the issues are, number one, the baby may turn on its own. And so you don’t need to do it. Like if you wait longer, the babies will turn on their own to head first many of them. Number two, if she goes into labor, or there’s a complication, the baby’s delivered, now you have a premature baby. And so generally we do around 37 weeks, because it seems to balance it. Some people do it slightly earlier, some people slightly later. But basically, that’s when we try to do it. 

 

And when we talk about this with women, a lot of them are surprised that it’s even an option. It seems almost like medieval to them that we can do this. And they’re afraid that we’re gonna hurt the baby. So how do you address those concerns that women have that this is gonna somehow harm the baby? 

 

Dr. Melka: So, when you look at big studies, when this is done, you don’t see worse outcomes in babies that are turned versus not turned, and then the specifics for a particular case, we always do this in the hospital. So we’re able to intervene if there is an emergency and safely deliver a baby fast. We have fetal monitoring that we do in between attempts, and afterwards for several hours, making sure that the baby’s still staying healthy. 

 

Dr. Fox: Right. And essentially, when women ask us this question, I find that they’re usually asking us one question. And it doesn’t even dawn on us, I mean, they’re worried that we’re gonna like, the baby is gonna have like a broken bone, or like bruising. So it’s interesting, the babies, they’re underwater, right? They live in a water bag, and so when we’re maneuvering them, they don’t feel like trauma in that sense, like babies aren’t born with bruises from this procedure, and I think that’s sort of like their biggest fear. And I’m saying, no, no, like, that’s not even like an option, that doesn’t happen with this. The concerns we’re thinking about is, this might put her into labor, which happens, it’s like 5% to 10% of the time, which isn’t really, I wouldn’t call it a risk, but maybe like a consequence that this could happen. And if we were successful, and she went into labor, like, okay, heads down, you’re in labor, maybe that’s a good thing. If we were not successful, and she went into labor, like, okay, so you’ll have your C-section today instead of we would have done it a couple of weeks from now. 

 

The risk of something else happening, like, the heart rate dropping, and not coming up, or starting to bleed, or something like that is, it’s possible, which is why we do it in the hospital. But it’s really in the range of 1% or less, it’s pretty unusual. I mean, over the years I’ve seen a couple of those situations. But again, since we’re in the hospital, we’re actually in the operating room we’re like ready to go, the baby’s out within a couple of minutes, and everyone’s fine. But that sort of event is still very rare, fortunately. And that’s really the main risk of this happening. During the procedure sometimes the baby’s heart rate goes down, but then we release and the baby’s heart comes back up, that’s usually just a response to being squeezed or something like that. And so it’s considered a very safe procedure. Are there any women you would not offer it to? 

 

Dr. Melka: You wouldn’t offer it to somebody who’s not gonna have a vaginal delivery anyway. There’s certain factors you look into to determine success. Is it an exceptionally big baby that you don’t think is gonna turn? Is the fluid low where there’s gonna be less room for the baby to turn? Does she have fibroids or a septum like a wall in the uterus which could block the baby from turning? Because, in those cases, you’re looking at the risk benefit profile a little bit differently. You know, we’re taking the same risk with a much lower likelihood of success. 

 

Dr. Fox: I sort of feel the same way that there are a few people we don’t offer this to because, like you said, they really shouldn’t be delivering vaginally anyways. It’s like a placenta previa, like, whatever, it doesn’t really matter which direction the baby is, or something of that nature. And then there’s these situations where we’re not really sure, like if the baby’s measuring very big, or sometimes very small, we’re concerned with the safety of doing it, or with fluid and all the things you mentioned. What do you tell people, typically, like, what’s the baseline success rate of having the baby ends up head down after the procedure? 

 

Dr. Melka: Seventy five percent. I think on the lower end, 50%, on the higher end, for the ideal candidate, 95%. 

 

Dr. Fox: I find that the biggest factor that’ll take someone from a 50% to a 95% is, has she had children before? I mean, someone on their first baby, it’s generally less likely to be successful. There’s a lot of reasons for that, some of it is her uterus tends to be a little bit like thicker and tighter, and sometimes her abdominal wall tends to be a little bit stronger, and it’s just, you know, that’s the nature of once you start having a lot of babies, your body gets more accustomed to that. And it could also be just general, for lack of a better word, stretchiness of the uterus as you have more babies. So someone who’s on their first baby, I tell them, it’s usually about 50/50. And someone who’s had more I tell them, yes, 75% to 90%, somewhere in that range, it’s much better. And then, other things like the fluid and how far pregnant she is. And there’s some things you could look at, which help the prediction. Her size sometimes matters, just a lot of factors. But the biggest one is, has she had children before. But, either way, 50/50, you know, glass half full, glass half empty. Those are pretty good numbers. 

 

And then, what about things like an epidural? Right? So when someone has this, do you normally recommend she has some sort of pain relief before this? 

 

Dr. Melka: I do offer it to everybody. I think the data shows in nullips, meaning someone having their first baby, there is an improvement in success rate. But I really leave it up to the patient in terms of what their comfort level is. I’m always willing to try without and the downside is you try it’s uncomfortable, and then you have to stop. And then you can get them an epidural or spinal and then try again. 

 

Dr. Fox: The procedure does hurt without an epidural. I mean, it’s not pleasant to have someone doing this on your belly, there’s no question. I mean, it doesn’t hurt the baby, it hurts the mother. It’s painful to have someone do this. And so, for women who want to not have pain during the procedure, for sure, they should get an epidural or spinal, which is safe and it’s the same thing we use for women in labor or having a C-section. Or, sometimes women are, it’s harder for them to undergo this, and sometimes people flinch a lot or they move, which is understandable. And so an epidural helps with that. 

 

And that’s probably why it improves the success rate in some people, you’re just able to maneuver a little bit easier, because she’s not in pain, not sort of fighting you, so to speak, which is, again, not a problem if someone’s fighting you. Like, that’s a normal response to someone grabbing your belly and trying to move it, so, it just sometimes makes it easier. And the other reason some people feel more comfortable with an epidural because if there were an emergency, there’s like already anesthesia that you can operate. That’s not the reason we do it. But, okay, in that 1% of the time it’s a little bit easier, or she goes into labor, there’s an epidural there already, but that’s not really the main reason we would place it. And what about, a lot of people get medicine beforehand to relax the uterus. Is that something that you do regularly? 

 

Dr. Melka: Probably not routinely, but I think more often than not, I do. Nitro over terb, I prefer. I think the Nitro works a bit faster. 

 

Dr. Fox: Nitro and terb sounds like American gladiators. I like terb. I think I like Nitro better. 

 

Dr. Melka: Those could be our gladiator names. 

 

Dr. Fox: Yeah. One is Terbutaline and one is Nitroglycerin. Yeah, those are actual medications with real names, they just are abbreviated into Gladiator names, which is pretty cool when you’re in the operating room, “Give me Nitro. We need them.” 

 

Dr. Melka: And I’ve had times with the terbutaline, that people just got this dramatic response of tachycardia, like their heart rate goes up. And all of a sudden, she’s lying there, she’s like, “My heat’s beating out of my chest. I like, I have to jump out of my skin right now.” And I think it just sort of adds to the kind of anxiety that people often have going into this. 

 

Dr. Fox: Yeah. It’s amazing because when we’re training we give it, you would sort of keep giving it until that happens, because you’d say, “Ah, now we know it’s working,” which is, all right. I mean, it did relax the uterus. So that’s something that we frequently do in that sense. And then the other thing is, when we’re doing this at 37 weeks, one of the interesting aspects of this is if we, let’s say, don’t do it at 37 weeks, there is a percentage of women who the babies are gonna turn on their own between 37 weeks to 39 weeks. Meaning, of the people who you either don’t do it on, or you try and you “fail” and the head’s still up. By the time we would do their C-section at 39 weeks, there’s like 5% to 10% of those babies end up head down anyways, sort of like laughing at you, “Haha, I’ll show you.” On the flip side, for people in whom we are successful. Some of them the baby does flip back to breech, which is, again, sort of them giving you the… 

 

Dr. Melka: The finger on the inside. 

 

Dr. Fox: Yeah, exactly. It’s like, “Did you think you’re getting me to go head down?” And again, that’s something we tell people about, that it’s not a guarantee that just because we get the head down at 37 weeks, because it’s not, even though we turn it head down, there’s still way to go for it to get sort of what we call engaged to the pelvis. And that’s also why sometimes if people go into labor very soon after this procedure, they have a higher risk of a C-section in labor, because the head doesn’t really get into the right place it needs to in the right directions. 

 

Dr. Melka: Also, one of the reasons we would, when we can, avoid inducing someone right afterwards, you know, some of it is early term births, slightly increased risk with the baby. So I try to get them to 39. Sometimes the head turns but doesn’t drop. There are times where we have to deliver someone at 37 weeks, let’s say she has preeclampsia. We would but there is a higher risk. 

 

Dr. Fox: The head really needs to navigate that pelvis. And it happens sort of slowly over time when it sort of nestles its way into the right position. And to try to do that very quickly. And it works frequently, but just less often than if it happens on its own. So, we generally try to wait afterwards before delivering, but sometimes we don’t have that choice. So, if someone is seeing you, she’s healthy, there’s no like problems and let’s say it’s her first baby, and she’s 36 weeks pregnant, and the baby’s breech. How do you talk to her about the option of ECV? Whether she’d wanna do it, or she wouldn’t wanna do it. How does that conversation go? 

 

Dr. Melka: You know, I generally bring up both options. One option is try to turn the baby at 37 weeks. The other option is schedule the C-section around 39 weeks, go over the risks with the version like we talked about, you know, maybe it doesn’t work. Not that it’s a risk. But you go through all this and it doesn’t work. You know, some women have a little bit of a fear of it. I think you said people see it as like almost barbaric. Like you’re just like pushing and a lot of women are like, “This seems so uncivilized.” Versus just waiting and then doing the C-section at 39 weeks. And I think it’s just sort of like an individual person’s motivation. You know, some people are more tied to a vaginal delivery than others. Safety-wise, I think they’re both equal. So I think it’s mainly that preference. 

 

Dr. Fox: Yeah, I don’t find it’s generally a decision that women make because of specific safety or, again, I think it’s usually just in their gut. Some people are sort of like squeamish. They’re like, “What?” They’re like, “No,” they’re like, “I’m not on board with that.” 

 

Dr. Melka: And I’ll say that to people too. I’ll be like, “What does your gut say?” Or sometimes when I’m talking to them about this, and I say, we’re at the hospital and we’re turning and I’m like using my hands and they’re giving me this look and her eyebrows raising and I’m like, “You don’t look like you’re on board with this.” But, yeah, I think it’s very much like just a gut [inaudible 00:19:30]. 

 

Dr. Fox: Yeah. And then, for the women who they find it like, “Oh, yeah, whatever. That sounds cool.” And they wanted a vaginal delivery. Like, “Yeah, let’s try it.” And, again, we’re reassuring them it’s safe. We’re watching you. We’re not, you know, proposing something that we think is a problem. We’re proposing something that’s usually done and recommended, and it’s at least recommended to be offered. No one has to do it, obviously. But then, for the women who are just like not on board, they’re like, “No, I’m not taking a part of it.” Okay, so someone decides they’re gonna do it. So, what happens logistically? Like, what would her day be like? The day like, we schedule it for Tuesday morning, she’s 37 weeks. 

 

Dr. Melka: It’s all done in the hospital. And I look at it, you’re sort of preparing for the “not worst case scenario,” but you go in prepared that you’re gonna have to do an emergency C-section. So you want the patient to have an empty stomach, to have had her bloodwork done. Nowadays we’re doing COVID tests for this. Get to the hospital, check in, you get brought into a room, put in a bed, IV. Put on a monitor. You’ll talk to us, you’ll talk to the residents helping us, the anesthesiologists. 

 

Dr. Fox: We do an ultrasound. 

 

Dr. Melka: Yes, I’m getting there. We will do an ultrasound. We don’t want to turn the baby from head down back to head up. 

 

Dr. Fox: Many people show up for this procedure. They get an ultrasound so it’s heads down, success, and they go home. 

 

Dr. Melka: Yes. 

 

Dr. Fox: Yeah, that happens a lot. 

 

Dr. Melka: Even better, when that happens when they’re breech at 39 weeks and ready for their section, the baby’s head down. And they’re like, “Can I have a section anyway?” 

 

Dr. Fox: I was already happy to have it… 

 

Dr. Melka: I was ready for today. 

 

Dr. Fox: Right, I got the baby nurse booked. 

 

Dr. Melka: Yeah. Anyway, my preference is to do this in the operating room. I think there’s more room. If there is an emergency, you have everything and everyone you need right away. But, I don’t always require it. 

 

Dr. Fox: Some places don’t, some places do it in like somewhere like a labor room or an intrapartum suite or something, which is fine. Yeah, but I agree. Either way. We do it in the operating, it’s just the biggest room, also, New York City hospitals, it’s hard to find rooms that are big enough for people. 

 

Dr. Melka: Real estate. So you go in the operating room, if you’re doing a spinal, the anesthesia team will give you the medication, you lay down, look again with the sonogram, monitor the heartbeat for a couple of minutes. And then, again, use our hands pressing on the belly trying to push to get the head to go down and breech the butt to go up. And then you try for like a minute or two, you kind of feel pretty quickly if it’s working. Again, we have a resident with us that’ll look with the sonogram as well. And then we’ll put the fetal heart monitor back on, you’ll almost always see a drop in the heart rate. I tell people that, it’s pretty common when you do this, that the heart rate will be low for a minute, three, four minutes. And it almost always gets better afterwards. And if it doesn’t, I mean, you do that monitoring periodically, in between attempts, and then, at some point, you just throw in the towel and say it’s not working. 

 

Dr. Fox: Right. And that’s pretty quick. I mean, the whole procedure, I tell people, it’s either gonna work or it’s not, and we don’t go to work on you for like an hour and a half, it’s like five minutes. And again, we have a really good sense, we try one way, if it doesn’t work, we’ll try the other way, and then we’ll go back, but after like two, or three, or four attempts, if it’s not working, it’s not working. We try not to be too crazy with this. 

 

Dr. Melka: Sometimes you try one person. Sometimes you try two people where I might say, “Okay, I’m gonna push the head this way.” I’ll say to someone else, “You push the breech that way.” I almost find within a minute or two, you know if it’s gonna work or not. 

 

Dr. Fox: Yeah, and it’s one of these things where it’s all tactile, it’s with your hands. And that’s part of the training is to just feel like where’s the baby? How do I get the baby up out of the pelvis? And what to do with your hands and your fingers? And it’s one of these things, you have to do them to sort of have a sense of is the baby moving? Is it not? And then also, if they have a sense, where’s the back versus the front, versus the back of the head and front, you have to sort of get all those things. And then, so, what happens when it’s over. So the five minutes are gone, you’re successful, you’re unsuccessful, what happens? 

 

Dr. Melka: So you watch the heart rate, you make sure it’s back to normal, that you’re seeing all the reassuring signs. And then you move out of the operating room, typically to the recovery area, and wait for a couple hours. Monitoring the heartbeat, making sure you’re not seeing any changes within the next few hours, letting the spinal anesthetic wear off and then go home. 

 

Dr. Fox: Yeah, I mean, she’s not in labor, and everything’s fine. She’s gonna go home. Again, whether we were successful or unsuccessful. If we were successful, she goes home, baby’s head down. We’ll see her in the office next week, whatever. Same, unsuccessful, the only difference is, really, she goes into labor, and if we were successful, baby’s head down, we’ll be planning for a vaginal delivery. And if we’re unsuccessful we’ll do a C-section then. And the same thing after she goes home, if she’s in labor five days later, it really depends just at that time, where’s the head? It’s like a half day total for someone when they come in, and it’s sometimes longer if they have to wait or this, but, basically, the procedure itself is only about five minutes. 

 

One interesting thing we should definitely talk about is, and we get asked this a lot when women have a baby that’s in breech, presentation are other ways to potentially turn the baby. So this is the way that’s the ECV the version is the way that’s been studied, been tested. What we do, this is what’s recommended, you know, all these things. But, if you go online, you’ll find a whole bunch of other potential ways to turn the baby various, like exercises, like positions mom can get into to maybe move the baby, or acupuncture, or there’s a certain something called moxibustion, certain like incense you basically that you light like by your feet. There’s a lot of these things out there. But what do you tell women when they ask you about them? 

 

Dr. Melka: Honestly, I tell women, they’re welcome to try anything they want, but don’t get hurt. You know, I don’t think the data on those things are good. I think, if anything, the data shows they don’t work. But I think women appreciate the chance to try the stuff. With the positions, that’s the stuff you like hang on an ironing board off the back of your couch with your legs up and all this stuff, and like, I’ve had one or two people try that and fall off. Or if you don’t do yoga, this is not the time to do the 90 minute yoga class your friend said worked to turn her baby. 

 

Dr. Fox: Right. It’s hard because what ends up happening is, a lot of people who have babies in breech presentation in pregnancy. And as you get closer to your due date, baby start to turn to head first, right? So we said like less than 5% of babies will be head up at the time of delivery. But when you’re at 24 weeks, 50% of them will be head up, and it sort of they slowly make their way. So, if a woman has a baby that’s in the breech presentation, and no matter where she is in pregnancy, and no matter what she does to try to alleviate that, there’s a percent, whether a high percent or a low percent, they’re gonna end up head down. And so what ends up happening is you read either a case series of 20 women who had breech babies, and they did A, B and C, and 16 of those 20 babies turned to head down. Wow, 80%, that’s awesome. But the details are, how far pregnant were they when they did it? Or were there 20 other women who they didn’t include in the study who it didn’t work? 

 

And so, when you look at sort of better-designed studies that compared doing one of those things, to doing nothing but just waiting, the number of babies who end up head down seemed to be about the same. The only thing that’s ever really been shown to change that number is actually this procedure to physically move the baby. Now, does it mean that none of those things could work? Well, no, of course, it could work. I mean, who knows in any individual or this, and so, I’m also pretty lax, if someone wants to try them, yeah great, acupuncture is safe, it’s wonderful. If you wanna do it, go do it. Like I hope it works. And if it does, wonderful, and I agree, I say like, just don’t, if someone’s gonna try to contort your body, like just be careful with these things. 

 

But I think that people should also be very wary about just reading stuff online where someone gives a testimonial, said, “I had this and I went to this person and my baby turned to head down.” A lot of that stuff is misleading in that sense, not that they’re telling something false, but it’s misleading because it implies that the reason the baby turned to head down is because they saw this person and did certain things. Whereas, it could have just as easily said, “My baby was head up and I binge watched season 2 of “Lost” and now my baby was head down.” And so, it doesn’t mean that it did it. But maybe “Lost” would do it. I’m not sure. We have to talk more about TV shows on this podcast, I think. So, okay. 

 

Dr. Melka: I would think it would be “Game of Thrones” season 8, that it just wants to make an escape and not. 

 

Dr. Fox: That’s the season… 

 

Dr. Melka: No more “Game of Thrones” get… 

 

Dr. Fox: Season 8 would be the one… 

 

Dr. Melka: …me out of here. 

 

Dr. Fox: Yeah, that would be the one that definitely would, it turned the tides. I agree. All right. Great. So that was the external cephalic version podcast. We are in favor of it. Just to be clear. It’s not just us, but like, by we, like, obstetricians, this is nationally something that is recommended that doctors should train to do this. And if they can’t, they should refer to someone who does it. And it should be offered to women where the baby is in a breech presentation closer to 37 weeks, unless there’s a reason not to. And so we offer, we talk, and I think most women, at least that I have run into, want us to try and, like we said, some don’t and that’s fine too. We’re always happy to wait and see what happens. Thanks for coming on. All right, we’ll have you again. Thanks for talking about ECV. 

 

Dr. Melka: Thanks for having me. 

 

Dr. Fox: Thank you for listening to the “Healthful Woman” podcast. To learn more about our podcast, please visit our website at www.healthfulwoman.com, that’s healthfulwoman.com. If you have any questions about this podcast or any other topic you would like us to address, please feel free to email us at hw@healthfulwoman.com. Have a great day. The information discussed in “Healthful Woman” is intended for educational uses only, and does not replace medical care from your physician. Healthful Woman is meant to expand your knowledge of women’s health and does not replace ongoing care from your regular physician or gynecologist. We encourage you to speak with your doctor about specific diagnoses and treatment options for an effective treatment plan.