The best chance for a safe and healthy delivery comes when baby is born head first. Complications increase when baby is in any other position, including the breech presentation. Often, the breech presentation leads to a cesarean birth. With that in mind, many couples research the option of external cephalic version, or ECV. This procedure encourages baby into the head-down position and makes a vaginal birth more likely.
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External cephalic version is the attempt to manually turn the baby from a breech to a head-down position. (1) It should only ever be attempted by a professional who has trained and practiced the maneuver.
An external version is performed by a qualified midwife or doctor. It is is usually done in a hospital setting where emergency care is available if necessary. Your provider will place two hands on your abdomen. He or she will then apply firm, consistent pressure to the baby’s bottom and head in the attempt to turn the baby.
The version may or may not be guided by ultrasound – check with your provider to determine their policy. Your provider will monitor baby’s heart rate both before and after the version to ensure that baby tolerated the procedure well.
Sometimes, a woman will receive an injection of tocolytic drugs – drugs that stop contractions – before an external version. The goal is to help relax the uterus and make it easier for the baby to turn. The most common tocolytic medication is terbutaline. Evidence suggests that the routine use of tocolytic drugs is associated with greater success at turning the baby to a head-down position (2).
Some providers might even suggest an epidural before the procedure. This is more likely if the ECV wasn’t successful the first time and you’re undergoing a second attempt. Again, the idea is that a relaxed uterus will give the best chance of baby turning. While some studies suggest that the likelihood of a successful ECV may increase if mom has an epidural, the success rates also significantly increase if mom uses hypnosis during the procedure (5). An external version may be the perfect opportunity to pull out your Meditations and Imagery for Labor audio tracks and practice some deep relaxation!
Your provider will typically attempt an external version between 36 weeks and 38 weeks of pregnancy, when baby is close to full term.
Research shows that attempting ECV at 34-35 weeks may make it more likely that baby is born head-down. However, it may also increase the risk of late preterm birth (4). More research is needed to determine the optimal timing for an external version.
Across the board, research affirms that external version makes it more likely that baby will be head-down at birth and reduces the need for a cesarean section (2). ECV has an average success rate of 58% (6).
Unfortunately there’s no guarantee that baby will stay in that position – sometimes they flip back to breech. This is more likely if you attempt the ECV before 36 weeks.
The main risks of an external version are changes in the baby’s heart rate, rupture of the amniotic sac, placental abruption, and preterm labor (1).
In a review of 84 studies and almost 13,000 versions, the total complication rate following a version was 6.1%. However, only .24% were serious complications and only .35% resulted in emergency cesareans. For these reasons, the review concluded that ECV is a “safe procedure” (3).
Remember that cesarean birth, the most common outcome if baby remains in a breech position, also comes with risks. Consult with your doctor or midwife about your concerns. But, know that most professionals believe that an external version is a safer procedure than a cesarean section.
Most people would agree that external version is somewhat uncomfortable, especially if the uterus begins to contract.
If baby is breech, you might consider a few other options in addition to the external cephalic version.
External cephalic version, or ECV, might be a useful option to help turn your baby from breech to a head-down position. Talk to your doctor or midwife about the pros and cons of the procedure, and ask questions about the details of how they perform an ECV. As you do your homework, you can feel confident that you’re making best choices for you and your baby.
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The best chance for a safe and healthy delivery comes when baby is born head first. Complications increase when baby is in any other position, including the breech presentation. Often,
