Giving a pain reliever by injection into the spines of women due to have their first baby, which is in the breech (feet down) position, doubles the rate of a head-down position after external manipulation of the fetus, according to new research at Hadassah University Medical Center in Jerusalem's Ein Kerem. Turning the fetus around after the 37th week of pregnancy (of the normal 40 weeks) usually prevents the need for such women to have their babies born by cesarean section, a surgical procedure that leads to longer hospitalization and higher rates of complications including infections. The study by Dr. Carolyn Weiniger and colleagues at Hadassah's department of anesthesiology and critical care medicine and obstetrics & gynecology was just published in the on-line edition of the US journal Obstetrics and Gynecology. Weiniger told The Jerusalem Post that once a woman has a cesarean section, she has a 90 percent risk of having subsequent deliveries by cesarean rather than a less-risky vaginal birth. Thus giving a spinal analgesic before undergoing external cephalic version (manual manipulation of the fetus to turn it into the head-down position) can have a major influence on the woman's quality of life and reduce hospitalization costs, she said. Around the country and the world, most women with fetuses in the breech position have a cesarean section, as there are not many experts in external cephalic version. In the randomized Hadassah study, 36 women received the spinal analgesia bupivacaine (a lower dose than that used for an epidural injection during the last stages of childbirth) and then underwent manipulation, compared to 34 who underwent manipulation without the spinal analgesia. The fetuses of 66.7% of the first group were manipulated into a head-down position, compared to only 32.4% of those who did not receive the injection. Weiniger suggested that the analgesia made external manipulation more successful because it relaxed the abdominal wall, increased patient comfort and allowed a more concerted effort by the obstetrician to turn the fetus over. External manipulation is usually more more successful in changing the fetus from the breech to head-down position in women who have previously given birth. The authors noted, however, that if external cephalic version with a spinal injection is used as a routine option to convert breech presentations to head-down presentations, more work must examine potential adverse outcomes in a larger group of pregnant women. Although there are only a handful of Israeli experts with considerable experience at manipulating fetuses to turn them over, some have been very successful without using spinal analgesia - as high as 75% of the time in all women, and 50% in women who have not given birth before.