External Turn in Breech Position: Chances of Success?

If your baby doesn’t roll over on its own by week 36, your doctor may do what’s known as an “external turn.” We have with Dr. medical Carsten Hagenbeck, Senior Physician at the University Women’s Clinic in Düsseldorf and coordinator of the Perinatal Center, spoke and shared his expertise with you here. Learn all about the requirements for an outside turn and the individual steps here.

When is an outer turn necessary?

If your baby is still in the breech position at 36 weeks , external rotation can in many cases allow for a spontaneous cranial birth. The external turning is usually performed between the 36th and 38th week of a normal pregnancy . However, it should only be carried out if there is a realistic prospect of success.

If the following conditions are met, the chances of a successful outside turn are good

  • Your child’s rump is still flexible in the pelvic entrance.
  • There is enough amniotic fluid .
  • The stomach is not too tense.
  • You have already delivered a pregnancy.
  • Your child changes positions frequently.

An outside turn cannot be performed in the following cases

  • In the presence of placenta previa (the placenta lies in front of the internal cervix)
  • If there are indications of a child’s undersupply, for example by a conspicuous CTG pattern
  • In the event of a premature rupture of membranes
  • With multiple umbilical cord loops

The procedure for the outer turn

Before an external turn, a detailed discussion should take place with the doctor who will carry out the treatment. He will explain to you exactly how an outside turn works, what technique he uses and what complications can arise. He should also discuss the chances of success of the treatment with you. The various influencing factors for the success of the turn are individual. The attending doctor can give you a personal assessment. At this appointment, ask any questions that are important to you. Feel free to ask if you don’t understand something. A declaration of consent for the external turning is then signed together. In most clinics there is also information about a caesarean section and about possible anesthesia for emergency situations.

In a normal pregnancy, external turning is performed between 36 and 38 weeks of pregnancy. The outpatient procedure takes place in the clinic, because if problems should arise, a caesarean section can be performed there quickly. On the day of the turn, you come to the clinic after a small breakfast. For the external turn, you sit on a couch and the doctor uses an ultrasound to determine how the child is lying in the pelvis. For the actual treatment, lie flat on your back and slightly raise your pelvis. Your pelvis and the hollows of your knees are supported by pillows so that the abdominal wall can relax completely.

A calm atmosphere increases the chances of a successful outward turn. You can “help” yourself by relaxing as much as possible. Breathe in and out calmly and consciously let go of all tension in your body. During the turn, the child’s heartbeat is repeatedly recorded with the ultrasound device. Often, an anti-labor drug is given as an infusion through the vein. This allows the uterus to relax completely and give the child plenty of space.

On average, a successful outer turn only takes a few minutes. The gentle pressure can be a bit uncomfortable in some places. But it is not a painful procedure. If something is wrong or you feel uncomfortable, the turn will be stopped immediately. If the external turn was successful, the doctor will check the child’s position and heart activity again. A CTG is then written for 30 minutes. If everything is ok and you feel good, you can go home. The following day, heart sounds and position are then checked again.

Chances of success are usually over 50 percent

The chances of success for the outer turn are around 50 percent. The chances are greater if you have already given birth to a child and the baby’s rump can be moved easily from the outside. If the external turn is performed carefully and cautiously, the risks for mother and child are very low. In a few cases, however, the baby’s heartbeat worsens as a result of the procedure. For safety reasons, a caesarean section may have to be performed. Short-term abnormalities in the heart sound pattern occur relatively frequently, but do not affect the child. Rarely do children turn back to their starting position, but can then be easily turned again.

Alternatives to the external turn: haptonomy, light turn, Indian bridge, moxibustion, acupuncture

In addition to the outward turn, alternative methods also exist. Learn more about Moxibustion, Haptonomy, Light Turning and the Indian Bridge in our Alternative Methods of Turning article .

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