According to Kim Kardashian, "it's probably more painful than childbirth." But it doesn't have to be that way.
Kim Kardashian West's pregnancies haven't been without health hurdles. During her first, she was diagnosed with both placenta accreta (a rare complication in which the placenta embeds too deeply in the womb) and preeclampsia (dangerously high blood pressure). Now in the 37th week of her second pregnancy, the reality star revealed that this time around, her soon-to-arrive baby boy was breech. Key word: was.
“This weekend, I checked into the hospital and underwent a procedure called an external cephalic version (ECV), which is done to manually turn the baby from a breech position to a head-down position,” Kardashian West, 35, wrote in an update on her web site (as reported by People).
For the unfamiliar, a breech baby is one that's positioned with it's butt or feet to come out first through the vaginal canal, rather than the ideal position for birth: the head down, positioned toward mom's back. Most babies settle into this position on their own within the 32nd and 36th weeks of pregnancy.
But if the baby is still breech between weeks 36 and 38, doctors may recommend trying an ECV or a "version" to turn the fetus, explains Joanne Stone, MD, director of maternal fetal medicine for the Mount Sinai Health System in New York. "For many women, doing a version is a very reasonable alternative," but that doesn't mean it's for everyone.
Here is everything you should know about the procedure.
It doesn't always work
Experts estimate that ECV is successful at turning the baby more than half of the time, but that doesn't mean your problem is solved.
"Some babies will turn again even after a successful version," Dr. Stone says. "There's really no guarantee it's going to be effective for any certain woman."
Recent research suggests that women who attempt ECV may cut their chances of needing of a C-section in half. But even if the re-positioning is successful, there's still a chance that a C-section will be necessary , says Dr. Stone. "We don't know why entirely, but it could be that the baby still isn't in a true head-down position."
Version may be more successful if it is done as early as possible after the 36-week mark; the fetus is smaller then with more room to move in the uterus and is surrounded by more fluid, Dr. Stone explains. It may also be more likely to work for second or third children because it's possible that women who've been pregnant before have more flexible abdominal muscles, allowing the baby the necessary room to roll.
For those women, the procedure can be quick. "Perhaps the woman's abdominal muscles are really more relaxed, and it takes a few seconds," says Dr. Stone. "In [Kardashian West's] case, she's had a baby before, but she also probably has pretty good abdominal muscles, which can make it a little more difficult to turn."
In the majority of breech cases, planned C-sections are the necessary option. Breech babies have a higher risk of the umbilical cord getting pinched or the baby's head and shoulders becoming wedged in the cervix, and a C-section can side steps these complications. While a vaginal birth isn't impossible, a study last year out of the Netherlands found that the risk of death for breech babies delivered vaginally is 10 times higher.
ECV is not a safe option for all women
The mother must meet certain medical requirements before getting an ECV, Dr. Stone explains. And these rules may vary from hospital to hospital. "There have to be enough fluids to turn the baby, and the woman shouldn't be in labor—details like these are really important," she says. (ECVs are typically done near a delivery room where a C-section can be performed quickly in case a problem occurs.)
If the patient is pregnant with twins, has diabetes, or is overweight, ECV is usually not recommended.
It can be pretty painful
Kardashian West said the process "probably hurt more than childbirth."
Not a surprising description, says Dr. Stone. "It involves actually physically turning the baby by placing hands on the woman's uterus to almost help the baby do somersaults inside the uterus."
Sometimes guided by an ultrasound, the doctors (it could be one, two, or even three, like in Kardashian West's case) will put firm pressure on the abdomen so that the baby rolls into a head-down position.
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Although Kardashian West reportedly received no medication to ease the pain beforehand, it is in fact an option, Dr. Stone says. "It can be performed under epidural anesthesia, and having that anesthesia helps that just like it would during labor. It can make it relatively comfortable."
Some women try to turn the baby on their own
Some try propping themselves up in an upside-down position with the hips elevated for short periods during the day, playing music near the abdomen, or acupuncture therapy, called moxibustion. However, the research is scant on whether any of these really work, says Dr. Stone.
"Everyone has there own anecdotal stories of trial and error when it comes to trying to turn a breech baby," she says. "I had a patient whose second child was breech and she tried moxibustion, and the baby did turn. But who knows what the real reason for the turn was. People can certainly try things as long as they are not harmful."