June 20, 2007 An international study led by a McMaster researcher aims to determine if a manual procedure to turn breech babies in the uterus can result in fewer births by caesarean section.
The clinical trial, led by Eileen Hutton, assistant dean of midwifery at McMaster, is examining whether attempting to turn breech babies earlier in a pregnancy than the current practice will mean a higher success rate for the procedure, and ultimately fewer C-sections.
The number of births by caesarean section has been climbing in Ontario for the past five years. One of the reasons for the need for a C-section is fetuses that are in a breech presentation -- with their feet, instead of their heads, towards the pelvis. A fetus is in breech position in about one in every 25 to 30 full-term births. Although breech babies can be delivered by vaginal birth, most care providers recommend caesarean births.
A procedure called external cephalic version (ECV), in which a doctor or midwife uses their hands to manipulate the mother's abdomen and help the baby turn in a somersault-like motion, is recommended for women whose babies are in breech position at 37 weeks gestation. The procedure is successful in turning the baby in about 30 per cent of first-time moms, and 58 per cent of subsequent pregnancies.
"This is the first trial of its type, in which the timing of ECV is being studied," said Hutton, principal investigator of the trial, which involves about 20 countries and is funded by a $2.8 million grant from the Canadian Institutes for Health Research. "Although ECV is recommended for breech presentations at full-term, the success rate is not particularly good. We're hoping to determine if performing the procedure earlier, results in better outcomes."
The study began early in 2005, and is expected to be completed in another year. So far, nearly 1,000 women have been recruited to take part, and another 500 are still needed. The trial involves women in countries as diverse as Australia, Chile, Oman, Hungary, Egypt, Israel and Estonia, as well as Canada and the United States.
There are seven hospital centres in Ontario taking part, and Hutton's team is actively recruiting more centres, including Hamilton Health Sciences and St. Joseph's Healthcare in Hamilton.
When women are identified as having babies in the breech position, and agree to take part in the trial, they are randomly assigned to receive ECV at 37 to 38 weeks gestation, or at some point between 34 and 36 weeks gestation.
A pilot study conducted by Hutton in 2002 showed that earlier ECV was about 10 per cent more successful in turning breech babies than later ECV.
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