You said it. They can't force you into a c-section. It might help to bring some of the research with you though.
If your uterus can't handle a version, chances are it can't handle labor. I'd rather find out during the version than during labor. They are prepared for an emergency during version.
Sela HY, Fiegenberg T, Ben-Meir A, Elchalal U, Ezra Y. Safety and efficacy
of external cephalic version for women with a previous cesarean delivery.
Eur J Obstet Gynecol Reprod Biol. 2009 Feb;142(2):111-4. Epub 2008 Nov 18.
Department of Obstetrics & Gynecology, Hadassah Hebrew University Medical
Center, Ein-Kerem, P.O. Box 12000, Jerusalem 91120, Israel.
OBJECTIVE: To evaluate the success and morbidity rates for attempted
external cephalic version (ECV) in patients with one previous cesarean
delivery (CD) and a breech-presenting fetus at term. STUDY DESIGN: This is a
retrospective study of outcomes of ECV at our institution for all women with
one previous CD and a breech-presenting fetus at term between January 1997
and June 2005. A literature review was also performed as a Medline search
(1966-2006). RESULTS: ECV was attempted for 42 women with a
breech-presenting fetus and previous CD. The success rate of ECV was 74.0%,
and 84% of women with successful ECV delivered vaginally. All fetal and
maternal outcomes were favorable. Only four Medline reports met our
inclusion criteria, representing a total of 124 patients and a mean ECV
success rate of 76.6%. Thus we assessed 166 cases of attempted ECV and find
an average ECV success rate of 76.5% and favorable fetal and maternal
outcomes. CONCLUSIONS: Women with a breech-presenting fetus at term and
previous CD, who desire a trial of labor, should be counseled regarding the
accumulating evidence about the efficacy and apparently safety of this
procedure and may be offered an ECV attempt.
Abenhaim HA, Varin J, Boucher M. External cephalic version among women with
a previous cesarean delivery: report on 36 cases and review of the
J Perinat Med. 2009;37(2):156-60.
C.H.U. Sainte-Justine Hospital, University of Montreal, Montreal, Canada.
AIMS: Whether or not women with a previous cesarean section should be
considered for an external cephalic version remains unclear. In our study,
we sought to examine the relationship between a history of previous cesarean
section and outcomes of external cephalic version for pregnancies at 36
completed weeks of gestation or more. METHODS: Data on obstetrical history
and on external cephalic version outcomes was obtained from the C.H.U.
Sainte-Justine External Cephalic Version Database. Baseline clinical
characteristics were compared among women with and without a history of
previous cesarean section. We used logistic regression analysis to evaluate
the effect of previous cesarean section on success of external cephalic
version while adjusting for parity, maternal body mass index, gestational
age, estimated fetal weight, and amniotic fluid index. RESULTS: Over a
15-year period, 1425 external cephalic versions were attempted of which 36
(2.5%) were performed on women with a previous cesarean section. Although
women with a history of previous cesarean section were more likely to be
older and para >2 (38.93% vs. 15.0%), there were no difference in
gestational age, estimated fetal weight, and amniotic fluid index. Women
with a prior cesarean section had a success rate similar to women without
[50.0% vs. 51.6%, adjusted OR: 1.31 (0.48-3.59)]. CONCLUSION: Women with a
previous cesarean section who undergo an external cephalic version have
similar success rates than do women without. Concern about procedural
success in women with a previous cesarean section is unwarranted and should
not deter attempting an external cephalic version.
de Meeus JB, Ellia F, Magnin G. External cephalic version after previous
cesarean section: a series of 38 cases.
Eur J Obstet Gynecol Reprod Biol. 1998 Oct;81(1):65-8.
Department of Obstetrics, Gynaecology and Reproductive Biology, University
Hospital of Poitiers, France.
OBJECTIVE: To determine if external cephalic version (ECV) is a reasonable
alternative to repeat cesarean section in case of breech presentation. STUDY
DESIGN: Retrospective study of 38 women with one previous cesarean section
and a breech presentation after 36 weeks of gestational age who have had at
least one experience of ECV. Statistics used the Fisher's test with
significance when P<0.05. RESULTS: Version attempts were successful in 25 of
the 38 women (65.8%). Seventy-six percent of the successful version women
went on to have vaginal birth after cesarean section. A total of 19
successful vaginal deliveries occurred (50%). Success rate of ECV was
lowered when breech was the indication of the previous cesarean section. The
vaginal delivery rate was increased after successful ECV in patients
previously vaginally delivered, but this difference did not reached
significance (P=0.057). No maternal or neonatal complications occurred.
CONCLUSION: ECV is acceptable and effective in women with a prior low
transverse uterine scar, when safety criteria are observed.
Schachter M, Kogan S, Blickstein I. External cephalic version after previous
cesarean section--a clinical dilemma. Int J Gynaecol Obstet. 1994
Department of Obstetrics and Gynecology, Kaplan Hospital, Rehovot, Israel.
OBJECTIVES: To describe our limited experience with external cephalic
version from breech to vertex presentation at term, with the use of
ritodrine tocolysis, in women who had undergone a previous cesarean
delivery. METHODS: Eleven parturients after previous cesarean delivery
underwent external version after 36 gestational weeks, utilizing tocolysis
with ritodrine, after excluding cases of low-lying placenta, severe
oligohydramnion or ruptured membranes. Patients were then followed until
delivery and scar examination was carried out after vaginal delivery, or at
re-cesarean section, according to mode of delivery. RESULTS: All 11
attempted versions were successful. Six patients subsequently delivered
vaginally and five by re-cesarean section. None of the uterine scars showed
any signs of dehiscence. Three of the five infants delivered by re-cesarean
section weighed over 4000 g, whereas all of the vaginally-delivered infants
weighed under 3500 g. CONCLUSIONS: External cephalic version to vertex
presentation after previous cesarean section was successful in all 11
carefully selected patients. No untoward effects were noted, and no signs of
scar dehiscence were found. The safety and efficacy of this procedure after
previous cesarean delivery should be examined further.
Flamm BL, Fried MW, Lonky NM, Giles WS. External cephalic version after
previous cesarean section. Am J Obstet Gynecol. 1991 Aug;165(2):370-2.
Department of Obstetrics and Gynecology, Kaiser Permanente Medical Centers,
Los Angeles, Riverside, CA 92505.
Approximately 100,000 cesarean sections are performed each year in the
United States because of breech presentation. Numerous studies have shown
that external cephalic version can eliminate the need for many of these
operations. However, because of the fear of uterine rupture, these studies
have generally excluded patients who have undergone previous cesarean
section. To evaluate the validity of this exclusion policy, we studied
patients with one or more previous cesarean sections and breach
presentations near term. Version attempts were successful in 82% of 56
patients who had undergone a previous cesarean section. Sixty-five percent
of the successful version patients went on to have vaginal birth after
cesarean section. There were no serious maternal or fetal complications
associated with the version attempts. We conclude that external cephalic
version is a reasonable option in patients with prior low transverse