ECV: Should I Try External Version if Baby’s Breech?

Katie GriffinOnline Childbirth Classes for Natural Birth, Pregnancy

ECV: Should I Try External Version If Baby's Breech?

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 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.

What is external cephalic version (ECV)?

External cephalic version is the attempt to manually turn the baby from a breech to a head-down position. (1)

How is ECV performed?

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.

Will I be given medication before the ECV?

Sometimes tocolytic drugs – drugs that stop contractions – will be given through an injection 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 baby will be more likely to turn if the uterus is completely relaxed.  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!

When in my pregnancy will an ECV be done?

Your provider will typically attempt an external version between 36 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.

What are the chances that the ECV will be successful?

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 a version is performed before 36 weeks.

What are the risks of ECV?

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%. Only .24% were serious complications and only .35% resulted in emergency cesareans.  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 a version is typically considered to be a safer procedure than a cesarean section.

Will the ECV hurt?

Most people would agree that external version is somewhat uncomfortable, especially if the uterus begins to contract.

Is there anything else I can try to turn baby from a breech position?

If baby is breech, you might consider a few other options in addition to the external cephalic version.

  • Chiropractic Care – The Webster Technique is a chiropractic technique.  The procedure encourages rotation of the baby by relieving abdominal muscle tension.
  • Maternal Positioning – Some women attempt positions like a breech tilt position, where mom lays on her back and places her hips above her head.  Check out www.spinningbabies.com to learn more about positioning.
  • Use of Sound – Keeping the volume at a comfortable level, play music through headphones placed just above mom’s public bone.  The idea is that baby will move towards the sound.

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.

Kopa Birth’s online birthing classes allow you to prepare for a natural hospital birth from the comfort of your own home, 24/7. Enroll today in our free online childbirth class and start preparing for your natural birth!

References:

(1)  American Congress of Obstetricians and Gynecologists.  (2015).  If Your Baby Is Breech.  Frequently Asked Questions Pregnancy.

(2)  Hofmeyer, G.J.  (2000).  External cephalic version facilitation for breech presentation at term.  Cochrane Database Syst Rev. (2): CD000184.

(3)  Grootscholten, K., Kok, M., Oei, S.G., Mol, B.W., van der Post, J.A.  (2008).  External cephalic version-related risks:  a meta-analysis.  Obstetr Gynecol.  112(5):  1143-51.

(4)  Hutton, E.K., Hofmeyr, G., Dowswell, T.  (2015).  External cephalic version for breech presentation before term. Cochrane Database of Systematic Reviews Issue 7. Art. No.: CD000084. DOI: 10.1002/14651858.CD000084.pub3

(5)  Weiniger, C.F.  (2013).  Analgesia/anesthesia for external cephalic version.  Curr Opin Anaesthesiol.  26(3):  278-87.

(6)  American College of Obstetricians and Gynecologists (2000, reaffirmed 2012). External cephalic version. ACOG Practice Bulletin No. 13. Obstetrics and Gynecology, 95(2): 1-7