What is cephalic version?

So, you’re here because someone told you that your baby might need a cephalic version. And naturally, your first thought was, “What in the world is that?!”

Don’t worry – we’ve got you covered. In this article, we’ll break down what a cephalic version is all about and why it’s important for both mother and baby.

Starting at Square One: What Is Cephalic Version?

Before diving too deep into what a cephalic version entails, let’s get one thing straight: cephalic just means “head-first.” You know how babies are typically born head-first? Yah – that’s called the cephalic presentation.

Got that sorted? Good.

Now onto the juicy stuff. A cephalic version, also known as an external cephalic version (ECV) is essentially when doctors try to manually turn the baby around so they become head-first in preparation for birth.

“Why would anyone ever need that?” you may ask yourself. Well…

Sometimes Babes Don’t Behave

Unfortunately, some sassy little fetuses can be stubborn and refuse to flip on their own before labor begins. In fact:

  • 3-4% of term pregnancies will end with an undelivered breech (i.e., butt or feet first) presentation
  • 25% of vaginal deliveries of breech presentations require operative delivery (forceps or vacuum extraction)
    (Source: American Family Physician)

Additionally, there are certain conditions which make delivering a breech birth unsafe or unwise:

  • Nuchal arms = when baby has one arm up near their neck/head
  • Head entrapment = head gets stuck after body emerges
    (Source: Medscape)

It Takes Two (Docs) to Tango

If you have pregnancy complications that require a Cephalic Version, you’ll be happy to know it isn’t just one doctor coming at you with their hands ready to spin your baby around like they’re playing pin the tail on the donkey.

Nope – a successful ECV requires at least two doctors: one who will manually turn the baby and another who is there to monitor both mom and babe’s health.

But Wait, There’s More…

ECVs aren’t always as simple as turning a toy top over. Sometimes mother or fetus factors make it more difficult for success:

  • Misshapen uterus
  • Scarred uterus (e.g., from previous c-section)
  • Excess amniotic fluid
    (Source: American Family Physician)

Additionally, while an incomplete version of breech-to-cephalic presentation occurs in up to 50% of women undergoing an ECV attempt, only about 40% actually deliver vaginally.
(Reference: Current Opinion in Obstetrics & Gynecology)

So clearly this process has its challenges!

The Procedure Itself

Enough talking about what goes into preparing for a cephalic version– let’s get into what happens during the procedure itself! To start off…

Let’s Get Prep’d

Before beginning the actual versioning process, Mom will likely need medication administered intravenously. Why? In short – because having someone spinning your baby around inside your body can be painful.

These medications may include an analgesic such as Demerol or butorphanol (can we talk about how mind-bending these names are?) along with some sort of muscle relaxant like terbutaline.

Then it’s go time….

Boogie Woogie

Once medicated-up properly and assured that everything looks good enough via ultrasound imagery,the real ‘fun’ begins:

  1. Assuming proper patient positioning; typically sitting upright
  2. Doc 1 places their hands on your abdomen to locate baby’s head, then they will place the other hand at lower uterine segment
  3. Applied pressure in a downward/cephalic direction with one hand while using the other to apply upward pressure on rear end/bottom
  4. Once doc feels appropriate amount of fetal mobility and can no longer feel breech presentation parts ‘the twisties’ (technical term) begin
  5. While still applying both types of pressure , doc will attempt gently pulling or pushing fetus into presenting see using ultrasound as monitor
  6. Position is confirmed via monitoring that fetus heart rate gives okay sign

Afterwards, Mom will likely be monitored for some time just to make sure everything’s stable.

To Cephalic Version or Not to Cephalic Version?

We’ve covered why an ECV might need to happen – but what if we told you it didn’t have to occur? That’s right — for many pregnancies in which the baby is breech, simply delivering by cesarean section (C-section) may be safer.

Some factors which influence whether an attempt at external cephalic version makes sense include:

  • How far along mom is
  • Baby size/position
  • Uterus shape/scarring
    (Source: MedlinePlus)

Ultimately, deciding whether or not a potential bad-ass babe needs a version requires consultation between mother and health care providers – don’t forget that there are pros and cons for each route!

Take Home Messages

Let’s sum up:

A “cephalic version” either describes when doctors mechanically turn around a stubbornly positioned fetus before labor begins.

The procedure involves careful management from multiple physicians due its difficult nature.

Sometimes delivering vaginally isn’t safe/appropriate for certain labor presentations or maternal issues; so options should always be discussed.

Did you learn something new? Whether your head was spinning like a top or well-oriented from the get-go, hopefully you now have greater understanding of this unique process.

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