External Cephalic Version (ECV) is a medical procedure used to try to turn a baby from the breech position (bottom or feet first) to the head-first position before birth.
This is done by a doctor applying gentle, constant pressure to the abdomen to encourage the baby to roll into the optimal position for delivery. ECV is typically offered when a baby is found to be breech at 37 weeks or later in pregnancy, and aims to increase the chances of a normal, head-first birth.
What does an ECV involve?
An ECV involves the doctor putting constant gentle pressure on your tummy to help the baby roll into the correct position.
Procedure for Turning the Baby:
- The baby is in breech position.
- The doctor feels for the baby’s head and bottom.
- The doctor turns the baby around.
- The baby is in position for normal delivery.
Do I have to have this?
The Royal College of Obstetricians & Gynaecologists (RCOG) recommends offering ECV to all suitable women; however, you can discuss other options with your consultant. These include delivering the baby by caesarean section (usually recommended) or delivering vaginally in the bottom-first position. Some women may wish to consider the use of moxibustion for breech presentation at 33–35 weeks of gestation, under the guidance of a trained practitioner.
When will I be offered this?
You will be offered an ECV when your baby is found to be in the breech position (or occasionally in the transverse position) at 37 weeks or beyond.
What are the risks to my baby?
ECV is a very safe procedure with very few risks to you or your baby. However, about 1 in 200 babies may become distressed during the procedure and an emergency caesarean section may be needed. Your baby’s heart rate will be monitored before, during, and after the procedure.
There is a small risk of some of the baby’s blood being transferred from the placenta into your bloodstream. If your blood group is Rhesus negative, this could cause problems in later pregnancies. To prevent this, you will be given an injection of Anti D following the procedure.
Women should be informed that ECV after one caesarean delivery appears to have no greater risk than with an unscarred uterus. If you have had a previous section, an ECV may or may not be appropriate depending on other risk factors; you should be referred for detailed counselling with your consultant.
What are the risks to me?
Most patients describe the procedure as uncomfortable, but some find it painful. If at any time you want the procedure stopped, it will be. You may be given an injection prior to the procedure to relax your womb; some women say this medication makes their heart race and may feel a little sick, but this should pass quickly. The procedure will not cause you to go into labour.
How long will it take to do?
The procedure itself takes only 5–10 minutes, but your baby will be monitored before and after, taking approximately an hour in total.
Will it be successful?
Babies are successfully turned about 40% of the time in first pregnancies and about 60% of the time in subsequent pregnancies. Even if the procedure is unsuccessful, 3% of babies will turn themselves into the head-first position before labour.
Where will it be done?
The ECV will be done on the labour ward or in a scan room by a doctor. It is performed near the labour ward to allow for the rare cases where an emergency caesarean section may be needed.
What if it is not successful?
If the baby is still breech at your due date or when you go into labour, you will be able to discuss with your doctor whether you prefer a caesarean section or to try to deliver the baby vaginally in the breech position.
Are there any reasons why I can’t have an ECV?
You may not be able to have an ECV if:
- You have had more than one previous caesarean section, or any major operation on your uterus.
- Your waters have broken or the fluid surrounding the baby is reduced.
- You have had a recent vaginal bleed or the placenta is low lying.
- The baby is very small and the blood flow from the placenta is reduced.
- The baby’s heart tracing is not normal.
If you think any of these apply to you, discuss with your doctor.
If you have further questions regarding ECV, please ask your midwife or doctor.
