Upside down - the external turn

Mrs. E. beams at us. We are currently in the delivery room of a large hospital in Upper Austria. "What? Was that all? Has it been turned already?" Mrs. E. is visibly surprised and at the same time very relieved. Dr. P. performed a so-called external version on Mrs. E. in the presence of her partner and me as an assistant.

Help, my baby is upside down!

Before that, when the couple came to our delivery room in the early hours of the morning, Mrs. E. had confessed her fears and worries about the turn to me as we were preparing for it. She almost didn't dare to do it because someone in her family had said it was painful and dangerous. In light of my patient's concerns - which has happened several times in the past - I am very grateful to have been given the opportunity to write an educational article about it.

Somersault in the stomach: this is how an external version works

We perform external turns in the morning whenever possible. The couples come early in the morning and report to the delivery room reception.

First, an ultrasound is performed to check the baby's position again. It often happens that the babies have already turned spontaneously and no further intervention is required.

However, if a breech position is determined, the woman comes to the delivery room with her partner. There is usually some excitement, of course, but in most cases we midwives are able to calm the mother down a little by checking the heartbeat and allay the family's fears.

In the background, the ultrasound, an acute labor inhibition and the oil for the abdomen during the turn are being prepared. The operating room is also always on standby during the turns - because the aim is to ensure the greatest possible safety for mother and child.
Finally, one of our doctors who performs the external version comes and introduces himself to the couple. Often the couples and doctors already know each other because they have previously discussed the procedure and the options in the case of a breech presentation in the obstetric outpatient clinic.

Heart sounds, umbilical cord & placenta constantly in view

The manipulation of the abdomen is carried out very carefully. The doctor first oils the abdomen well and, after having the rump in his/her hand, tries to lift it out of the pelvis. The other hand is in the head/neck area, where the counter pressure is then applied. The rotation is performed in the form of a somersault. They often tickle the baby's feet to encourage it to curl up even more. In between, the position of the child and, above all, the heartbeat are checked again and again using ultrasound. Great attention is paid to how the placenta is supplied during this time and where exactly the umbilical cord is located.

The women themselves describe the external turning as a pressure on the stomach. Perhaps with some unpleasant moments. However, everyone - like Ms. E. and her partner - is actually surprised that the procedure is not painful or even unbearable. Many couples are amazed afterwards that you can even pick up a child from the outside over the abdominal wall and simply turn it over.

rotation not at any price

Dr. P. asks the patient to give him feedback about her feelings over and over again. During the entire procedure, he repeatedly checks whether the pregnant woman is still doing well, and he also uses ultrasound to check the baby's well-being.

He also informed Mrs. E. and her partner beforehand that the external version would not be carried out at any cost, but would be accepted by doctors even if the baby did not want to turn over or was unable to do so.
If a turn is not possible, a discussion about other possible modes of birth usually takes place immediately afterwards.

In any case, after an hour of heart rate monitoring, Mrs. E. and her partner have breakfast and later another short CTG.
Both of them intend to inform their friends and relatives in the future that this external version is not something to be feared and is a good option and perhaps even a solution when the baby is in the womb.