UBC Reports | Vol.
51 | No. 4 |
Apr. 7, 2005
Prof Turns Breech Baby Problem on its Head
By Hilary Thomson
It’s a new approach to a traditional procedure and
it may save thousands of mothers the risks and recuperation
associated with Caesarean section surgery.
Called external cephalic version (ECV), the current procedure
is used to re-position a fetus in breech (bottom down) presentation.
Also known as “turning the baby,” the manual,
external procedure manoeuvres the baby by applying pressure
on the mother’s abdomen, causing the baby to somersault
into a head-down position. ECV is traditionally employed in
the last two weeks of a normal 40-week pregnancy, and enables
a vaginal delivery in 30-50 per cent of cases.
Eileen Hutton, of UBC’s division of midwifery, wants
to boost the success rate by performing ECV as early as 34
In the first study of its kind in the world, Hutton’s
research team will recruit 1,460 mothers-to-be whose babies
are in breech position. In the five-year international randomized
trial funded by $2.8 million from the Canadian Institutes
for Health Research, some women will have an ECV at 34-35
weeks and others at 37 weeks and researchers will compare
differences in outcomes at birth and in the one-month period
Women will be recruited from more than 80 centres in countries
that include Canada, the U.S., Argentina, Chile, Netherlands,
Israel and Jordan.
Researchers will look at the impact of early ECVs on the
rate of C-sections performed as well as rates of premature
births associated with the procedure. Investigators will do
a cost-analysis as part of the study and will compare costs
associated with earlier and late ECVs. They’ll look
at costs of complications at the time of C-section, such as
infection, which can require extended hospitalization, specialist
attention and home care.
At full term, about three to four per cent of all babies
will present in breech position, says Hutton, adding that
the rate is constant internationally. The cause for breech
presentation is not known.
“We know that most physicians now recommend C-sections
for breech pregnancies, however, women who have this surgery
have more problems compared to mothers who have vaginal births,”
says Hutton, pointing out that C-sections are the largest
contributing factor to maternal deaths and serious illness
associated with birth. In addition, the scar resulting from
the surgery complicates all subsequent pregnancies.
When Velda McAlduff-Low discovered the baby she was expecting
was in breech presentation, she didn’t hesitate in choosing
ECV in the hopes of avoiding a C-section.
“I knew that the six-week recovery time needed for
the surgery would make it next to impossible to care for my
baby and my toddler at home,” says the 44-year-old Delta
resident, who last month successfully delivered a baby girl
The procedure takes about five minutes and is usually performed
without anaesthetic, although considerable pressure is applied
to the abdomen. One obstetrician pushes her fingers against
the mother’s belly to lift the fetus’ buttocks
up. In a co-ordinated movement, another specialist pushes
the head downward. The entire procedure is guided by ultrasound
“After several attempts, the team was successful in
turning the baby,” says McAlduff-Low. “The procedure
was painful but well worth it I am absolutely glad I had it
“We want to reduce adverse outcomes for women with
breech babies. If early ECVs are effective, they represent
a low-tech, safe alternative to surgery,” says Hutton,
who is also a midwife and mother of three, none of whom required
The study has started recruitment at BC Women’s Hospital
as the first site, under the leadership of Dr. Marie-France
Delisle. Women wishing to be involved in the study must be
pregnant with a single fetus with gestational age 33-35 weeks,
in breech presentation.
For more information, contact BC Women’s Hospital &
Health Centre at 604.875.2253.
The study is co-ordinated through the Centre for Healthcare
Innovation and Improvement at the B.C. Research Institute
for Children’s and Women’s Health (BCRICWH) and
the Maternal, Infant and Reproductive Health Research Unit
at Sunnybrook and Women’s Health Sciences centre in
As part of Children’s & Women’s Health Centre
of British Columbia, BC Women’s Hospital & Health
Centre is the only facility in B.C. devoted exclusively to
the health of women, newborns and families.
BCRICWH operates in partnership with UBC and the Children’s
& Women’s Health Centre of British Columbia, an
agency of the Provincial Health Services Authority.
For more information on the study, visit http://www.utoronto.ca/miru/eecv2.