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What is external cephalic version? — External cephalic version, or "ECV," is a procedure to try to turn a baby around while they are still in the uterus.
Before birth, babies lie in the uterus in different positions. They can lie with their head, shoulders, legs, or buttocks closest to the vagina. Doctors call it "breech" when a baby's feet or buttocks are closest to the vagina (figure 1).
Toward the end of pregnancy, most babies are head-down. This is the safest position for a baby to be in for a vaginal birth. But in some cases, the baby is still in the breech position toward the end of pregnancy.
If your baby is breech, your doctor or midwife might give you the option of having an ECV to turn the baby to a head-down position. This is to increase your chances of having a vaginal birth.
When is ECV an option? — Your doctor or midwife can talk to you about whether ECV is an option for you. If so, it is usually done when you are at least 36 weeks pregnant.
In general, ECV is not done if:
●You have any conditions that would make labor and vaginal birth unsafe.
●There are concerns about the baby's health.
●You are already late in labor or your water has broken.
If you are offered ECV, your doctor or midwife will explain the risks and benefits to help you make a decision. It can help to ask yourself certain questions, too (table 1). For example, how important is it to you to have a vaginal birth? How would you feel if ECV did not work and you needed to have a c-section anyway?
What are the risks of ECV? — Most of the time, ECV done by an experienced doctor or midwife does not cause problems. But in rare cases, problems can happen. These might include:
●Temporary changes to the baby's heart rate
●Problems with the placenta
●Your water breaks
●Vaginal bleeding
If serious problems happen during the procedure, you might need an emergency c-section right away. But this is very uncommon.
The risk of losing the baby (stillbirth) due to ECV is extremely rare. This risk is smaller than the risks that come with having a c-section.
What happens before the procedure? — Before the procedure, your doctor or midwife will:
●Do an ultrasound – This is a test that uses sound waves to create pictures of your baby in your uterus. It can help confirm the baby's position.
●Check your baby's heart rate – They might monitor the heart rate during the procedure. They will check it again after the procedure.
ECV is done in the hospital. This is so the medical staff can be prepared to do a c-section right away if any problems happen. But this is very uncommon.
How is ECV done? — When it is time for the procedure, you will lie on your back on an exam table. You might have a cushion or wedge tilting you to 1 side. Try to stay relaxed and not tense the muscles in your belly.
Then, your doctor or midwife will:
●Give you a shot of medicine – This is to help relax your uterus. In some cases, it might not be needed.
●Put powder or gel on your skin – This is to help their hands slide over your skin more easily.
●Press on your belly to move the baby – This is done in a specific way. The doctor or midwife will use their hands to carefully try to turn your baby so the head is down (figure 2). This might be uncomfortable, but should not be very painful. This part usually takes less than 5 minutes.
The doctor or midwife will monitor your baby's heart rate during or after the procedure. If they are not able to turn the baby right away, they might take a break to let you rest, then try again.
What happens after the procedure? — After an ECV, the doctor or midwife will:
●Make sure that your baby's heart rate is normal
●Talk to you about what to do next – If the ECV worked, you will probably be able to keep your regular prenatal appointment schedule, and wait to go into labor. In certain cases, your doctor or midwife might suggest giving you medicines to start labor right away after the ECV. This might happen if you are more than 39 weeks pregnant or if your baby has changed its position several times late in pregnancy.
If the ECV did not work, you might have the option to try again on a different day. If it still does not work then, your doctor or midwife might recommend scheduling a c-section. A vaginal breech birth might be an option in certain situations.
What are my options if I choose not to have an ECV? — If your baby is breech and you do not have an ECV, your options will depend on your situation and your baby's health.
Options might include:
●Waiting to see if your baby turns on their own – If your baby does turn head-down, you can try to have a vaginal birth.
●Scheduling a c-section – Some people schedule a c-section close to their due date. Because a baby will sometimes turn on their own, an ultrasound will be done before the c-section. This is to confirm the baby's position in the uterus.
●Vaginal breech birth – This means giving birth vaginally when your baby is in a breech position. This comes with risks and is not usually recommended. But it might be an option in certain situations if the doctor or midwife has experience in this area.
Some people wonder about trying to help their baby turn by moving into different positions, such as lifting the pelvis or leaning upside down. You might also have heard about acupuncture or something called "moxibustion," which involves burning herbs near a specific acupuncture point. There is not a lot of evidence that these techniques work, but they are also probably not harmful. Talk to your doctor or midwife if you are interested in these alternatives.
When should I call the doctor? — After an ECV, call your doctor or midwife right away if:
●You have any bleeding from your vagina.
●Your water breaks.
●You start having contractions or think that you might be in labor.
●You have any concerns about your baby's movement.
Patient education: Breech pregnancy (The Basics)
Patient education: Labor and delivery (childbirth) (The Basics)
Patient education: Vaginal birth after a cesarean (The Basics)
Patient education: C-section (cesarean delivery) (Beyond the Basics)
