Should a woman whose baby is breech have a Caesarean, or can she safely opt for a normal delivery? The question, triggered by court cases in which pregnant women have been ordered to undergo Caesareans on their doctors' advice, appears to be dividing the medical profession. While some insist that a planned Caesarean is the treatment of choice for breech, others argue that in most cases, vaginal delivery is not a problem. Yet there is another option which gives a breech baby a healthy chance of being delivered head, rather than bottom (or feet) first. It is not always offered, although it should be, according to the Royal College of Obstetricians and Gynaecologists. It is called external cephalic version - persuading the baby to turn the right way round.

Although most unborn babies settle into the head-down position after months of floating about, it is still a mystery why some 3 per cent fail to follow that programmed reflex and persist in staying with the head at the top of the womb until very late in pregnancy. Although not necessarily a problem, breech presentation can cause complications, especially if the baby is very large: even doctors in favour of a vaginal delivery often use stirrups, episiotomy and sometimes an epidural.

Thirty years ago, doctors frequently tried to turn breech babies, using anaesthetics, and other drugs to soften the womb. But the technique fell out of favour because anaesthetising the woman resulted in it being performed too vigorously and led to complications. It also used to be carried out at 32-34 weeks - pointless since many babies who are breech at this point will turn by themselves.

Turning has recently come back into fashion although nowadays it is offered to women late in pregnancy, from 37-40 weeks. The woman lies flat while her doctor, using external manipulation, gently encourages the baby to do a somersault. No anaesthetics or other drugs are normally used, although sometimes a drip is set up to prevent contractions starting.

Although much depends on the skills of the "turner", randomised controlled trials in the UK have shown that cephalic version can reduce the number of breech presentations by 48 per cent, with studies from other countries showing a success rate of 93 per cent.

In an otherwise uncomplicated pregnancy, turning is normally safe. But it carries a slight risk of the membranes rupturing and of cord entanglement, so the foetal heart rate is carefully monitored. It is usually done with an operating theatre available in case an emergency delivery is necessary.

Crawling in pregnancy, interspersed with resting knees to chest, is also thought to help turn a breech baby; some women swear by acupuncture, osteopathy or homeopathy. But some babies are stubborn and refuse to turn whatever you do. A large international trial being coordinated in Canada should show whether vaginal or Caesarean delivery is better for them and their mothersn

Cherrill Hicks

For information on exercises contact the National Childbirth Trust, 0181-992 8637.

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