External Cephalic Version (ECV)

What is external cephalic version?

External cephalic version (sometimes called ECV or EV) is a procedure healthcare providers will use to rotate a baby from a breech position to a head-down position. A head-down position is ideal for a vaginal delivery.

At around 36 weeks of pregnancy, most babies will turn so they’re in this position. But sometimes, this doesn’t happen.

If an external cephalic version doesn’t turn your baby and it stays breech, you’ll most likely have a C-section.

About 3 out of 100 babies are in a breech position after 36 weeks. Depending on the comfort level of your provider, they may recommend trying ECV at around 37 weeks.

What happens during the procedure?

Your healthcare provider (usually your obstetrician) will place their hands on your belly to turn your baby to a head-down position. The procedure is done externally by applying firm pressure to your abdomen. This pressure lasts several minutes and can cause your uterus to cramp. They don’t place their hands inside your vagina for ECV.

The whole procedure may take about two hours. This includes the time to check your baby before and after. Providers typically perform ECV near an operating room in case you need an emergency C-section.

How painful is an ECV?

You may feel some discomfort when pressure is applied to your belly. Many healthcare providers will give you medicine to relax your uterus. This can make it easier to turn your baby. Some healthcare providers will also offer you pain medication, but this is optional.

When is ECV not recommended?

Your healthcare provider will check your medical history to see if ECV is safe. Certain factors may make it unsafe, like:

• You have a low amniotic fluid
• You’ve had vaginal bleeding
• You’re having multiples
• Your baby’s heart rate is abnormally high or low
• You have placenta previa
• You have an irregularly shaped uterus
• You have high blood pressure or diabetes
• You need a C-section for another reason

If you have a condition that prevents you from taking medications to stop contractions, you might not be able to have an ECV.

What are the benefits and risks of ECV?

The benefit is that you can increase your chances of a safe and successful vaginal delivery. Breech pregnancies aren’t dangerous until it’s time for delivery. If you want to deliver vaginally, turning a breech baby might be your best chance at having the childbirth you planned.

Possible risks of ECV are:

• Premature rupture of the membranes
• Placental abruption
• Preterm labor
• Fetal distress
• Vaginal bleeding

Your provider will discuss the risks with you. Together, you can decide if it’s a safe option.

Can an external cephalic version make you go into labor?

Yes, it can make you go into labor. ECV procedures typically happen near an operating room for this reason.

What is the success rate of ECV?

The average success rate is about 58%. This means a little more than half of all ECVs will result in a baby being turned.

What happens if ECV doesn’t work?

Some healthcare providers may be comfortable delivering a breech baby through the vagina. It depends on their expertise and your health history and pregnancy. Speak with your healthcare provider about your delivery options if ECV doesn’t work. They might recommend other methods to encourage your baby to turn.

Is ECV riskier than C-section?

A C-section carries slightly more risk than ECV because it involves surgery. But it’s hard to compare them because providers use them for different reasons.