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This is for information only.
Do not attempt to perform this procedure without proper training
by a qualified health care provider.
If a situation arises which warrant an attempt at external version of the breech baby, then certain criteria must be met in order to assure the safety of such an attempt.
If it is possible, a sonogram should be performed to ascertain the position, lie and attitude of the baby. It is also important to be certain of the placenta site.
If a sonogram is not available, an attendant with adept skills in palpation and auscultation of the placental sounds may be comfortable proceeding without an ultrasound examination.
The ideal time for performing an external version is between 36-37 weeks, after maternal positional and other types of attempts to turn the baby have not been successful. This is close enough to term that if the version stimulates labor, it is safe and the baby usually will not be deeply engaged in the pelvis.
An explanation of this procedure must be given to the mother and her full cooperation elicited. The mother should not be sedated in any way since her assistance is required for her to relax her abdominal muscles and to breathe deeply during the attempted version.
THE PROCEDURE
1. Have the mother empty her bladder.
2. Make sure that the mother is very comfortable. It will help greatly if she is positioned at a slant with her hips and abdomen elevated slightly. She may have a pillow under her head.
3. Listen to fetal heart tones from one to three minutes before beginning the procedure, so that you will be able to quickly identify any variation of heart rate during the version.
4. Being very certain of the baby's position, begin to gently massage the mother's belly, talking softly to the baby as you do so. You can use lots of lotion or scented oil on your hands.
5. Listen to fetal heart tones every five minutes during the attempted version so that you will be certain of the baby's well being. If there is cord involvement, or any sign of distress, You must stop immediately!.
6. Begin the procedure by attempting to lift the presenting part out of the pelvic cavity. Having the mother at a slant (laying mother's head down on a slant board) will help. If the baby is deeply engaged, you may need to lift it out of the pelvis vaginally.
7. Secondly, grasp the baby's head with one hand and begin to exert pressure upon the back of the head, bringing it forward towards you. (Picture the baby doing a forward somersault). If the baby is not laying completely lengthwise in the uterus, do not be tempted to turn the baby the shortest distance if s/he is facing the other way. To turn her/him by pushing her/his head in a backward direction will result in a brow, face or military position, which are all more difficult to manage than is the breech!
8. With your hand, lift the breech firmly and follow the direction of the head, until you can feel the head slip into the pelvis. The mother will be of great assistance at this point as she most assuredly will comment on the change in pressure on her rib cage.
9. Once you think that the breech has turned, check carefully, externally and internally, as it is possible that you will continue turning her/him all the way around and making him/her breech once more!
10. Continue listening to heart tones for the next five minutes to assure well being. There will be a slight variation in fetal heart rate as a result of the change in position, but it should normalize quickly.
11. Once the procedure is complete, it is very wise to advise the mother to assume an upright posture, or walk for an hour, squatting deeply every few minutes, to assist the baby in engaging in the pelvis, and remaining in the vertex position.
12. At no time should undue force be exerted in rotating the breech. You will find that once the breech is disengaged from the pelvis, turning it is not difficult. If it is difficult, there may be a predisposing factor, i.e., an anomaly or a very large or post dates baby inhibiting the version.
13. It is not unusual that this procedure may cause labor to begin, or at least some contractions to occur. Advise the mother accordingly.
If it is determined that an external version is in the best interest of the mother and her baby, by all means attempt to do so. The obstetric model of version relies on the use of tocolytic drugs and continuous ultrasound. The drugs (to reduce contractibility of the uterus) have very negative side-effects and may prove to be very painful (most practitioners attempting this obstetric model of version and may be very rough and forceful, as well as unsuccessful).
MoonDragon's Obgyn Information: Ideas for Turning A Breech Presentation
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