External version

EXTERNAL VERSION

With an external version, a breech baby can be turned into a headfirst position. An external version is a safe and effective way to reduce the number of breech positions. The chance of a successful version is on average 65%. For a first baby, the success rate is 40%. If it is not your first baby, the chance that the version is successful is even more than 80%.

A VERSION IS SAFE!

Extensive research has been done into the safety of the external version. There appears to be no increased risk of complications such as premature rupture of the membranes, premature birth, or problems with the umbilical cord. We also investigated whether there was an increased risk of the placenta detaching after a version, but because this complication is so rare, no difference could be found. However, it was found that during 5% of the versions, the baby's heartbeat temporarily lowers. This is a normal phenomenon. Tension of a nerve on the baby's head can slow down the heart rhythm. Within 10 minutes, the nerve irritation is gone, and the heartbeat returns to normal. In only 1% of cases there is no improvement in the heartbeat. In this case, you will be referred to a gynaecologist for a CTG to check the heart rhythm.

A prerequisite for a safe version is that it is performed by people who are experienced in it and that the baby's heartbeat and position is monitored during the version (by ultrasound).

At Puur, four obstetricians have been trained as version specialists: Marette Stolp, Barbara Ebskamp, Michelle van der Salm and Margo Linssen. They perform approximately 30-40 external versions each year and therefore have extensive experience. The success rate at Puur is high: higher than the national average and higher than the surrounding hospitals.

WHEN TO TURN?

The most ideal moment to turn over a baby depends on the space in the belly of the pregnant woman, the amount of amniotic fluid, the size of the child, and the degree of descent of the tailbone into the maternal pelvis. This is different for each individual. At Puur we prefer to perform first births from 34 weeks, and preferably before 36 weeks. For a second (or subsequent) child we only rotate from 35/36 weeks.

If during the pregnancy there has been bleeding, growth retardation, high blood pressure or too little amniotic fluid, then there are contraindications for a version and the baby cannot be turned by the midwife, but possibly by the gynaecologist. For women with a history of Caesarean sections, the version is always performed in the hospital by the gynaecologist.

HOW DOES A VERSION WORK?

The version is performed by two obstetricians. Prior to the version, an ultrasound is made to check the position, the amniotic fluid, the heartbeat and the umbilical cord. During the version, the midwife will try to turn the baby by hand. By pushing the bottom and the head in a certain direction, the child is brought into a transverse position. Then it will turn into the head position.

Sometimes the rotation does not succeed immediately, and several attempts are necessary during one external version. About 45 minutes are scheduled to perform a version, but the rotation itself is usually done within 15-20 minutes. The rest of the time is used for instructions, checking and reporting.

Before, during and after the version, the baby's heartbeat is monitored by ultrasound and/or doptone, because a baby can react to the version by lowering its heartbeat. This is normal; the baby’s heartbeat will recover within 5 to 10 minutes. If this does not happen, the baby will be referred to the hospital for a heart scan (CTG).

PAIN

An external version can be somewhat painful, but most women find the pain to be quite bearable. It is recommended to rest beforehand and to take paracetamol. By doing some deep abdominal breathing and relaxing your belly during the version, the turning is easier and less painful. It is very pleasant if the woman's partner is present during the version for support.

AFTER THE VERSION

After an external version the abdomen may be a bit sore or sensitive. This is normal and you can take paracetamol if necessary. Do not plan too much after the version and try to get some rest.

Always contact your midwife after a version in case of:

  • Contractions
  • Abdominal pain
  • Blood loss
  • Amniotic fluid loss
  • No or little child movement
  • Other particularities or concerns

If the version was successful, an appointment will be made at the midwife's office shortly afterwards to check the position. If the version was unsuccessful, you may consider repeating the attempted version at a later date. If the baby remains in a breech presentation, a referral to a gynaecologist will be necessary.

Every external version is registered in the version register of the KNOV (Royal Dutch Organization of Obstetricians). After the birth, a number of details concerning the delivery are also recorded in this register. The version register is used to collect national data on breech presentation and external version, but also for anonymous scientific research. Your permission will of course be asked for this.

AFTER BIRTH

A breech presentation can have a slight influence on the baby's hip development. There is therefore a slightly higher risk of hip dysplasia. It is advisable to have an ultrasound made of the baby's hips three months after birth. This can be requested through the family doctor.