External Cephalic Version (ECV)

What Is External Cephalic Version?

External cephalic version, or ECV, is a maneuver your doctor may use when your unborn baby is set up to come out bottom first or feet first. Those positions are called a breech birth, and they can make a vaginal birth more difficult. With an ECV, your doctor turns the baby into a headfirst, or cephalic, position toward the opening of the birth canal.

External Cephalic Version Procedure

It’s usually done by your obstetrician. Your baby's heartbeat will be monitored for about a half-hour before the ECV. In some cases, you may get medicine through an IV to relax your uterus. This won't affect your baby.

Then, by pressing their hands on the outside of your belly, your doctor will try to turn your baby. The goal is to get your baby to do a little flip in your womb and finish up head-down. This can take several hours.

Your doctor may use an ultrasound to check your baby's position and guide the process.

Does ECV Hurt?

To turn your baby, your doctor will use firm pressure. Everyone reacts differently, so you might feel discomfort or pain. Many women go through an ECV without any painkillers. But your doctor may give you an epidural or other pain medication or even put you to sleep during the procedure.

External Cephalic Version Risks

An ECV isn't right for you if you're expecting more than one baby or you need a C-section.

It also works best on women with a pear-shaped womb and not those with a heart-shaped womb, called a bicornuate uterus.

Other reasons your doctor might tell you not to get an ECV are:

  • You have vaginal bleeding within 7 days of the procedure.
  • Your baby has an abnormal heartbeat or health problems.
  • Your water has broken.
  • Your baby is larger than average.
  • Your amniotic fluid levels are too low or too high.
  • Your baby’s head is hyperextended, meaning it’s straight instead of bending forward.
  • You have a heart problem or other conditions that prevent you from receiving certain anti-contraction drugs to prevent placenta previa, which can cause severe bleeding during pregnancy and delivery

ECVs are usually safe, but there are some risks. In rare cases, it can cause changes in your baby's heart rate, tearing of the placenta, and preterm labor.

The procedure is usually done near a delivery room in case you need an emergency C-section.

Continued

External Cephalic Version Success

ECVs work about half the time. If your doctor can't get your baby to flip after the first attempt, they may try again after a week or so.

The odds of success are higher if:

  • The ECV is attempted soon after 36 weeks of pregnancy, before the baby grows too large.
  • You’ve given birth before.
  • There is enough amniotic fluid surrounding the baby.

Things that can lower the chances that an ECV will work include:

  • The baby has dropped to your pelvis.
  • Your uterus is tense or hard.
  • Your doctor has trouble touching and feeling your baby’s head.

After an ECV, sometimes babies flip to the headfirst position, then flip back to breech. And sometimes breech babies flip on their own before birth, though the bigger they get, the less room there is to move.

Doctors deliver most breech babies by C-section. A vaginal birth may still be possible, depending on your health, your baby's health, and his position. Ask your doctor about your options.

Are There Possible Complications From an ECV?

After a successful ECV, most women go on to have normal vaginal births. But call your doctor right away if you have contractions, bleeding, or you don't feel your baby moving the way you did before the procedure.

External Cephalic Version Alternatives

If an ECV can’t get your baby into a headfirst position, you have other options for giving birth. They may include:

  • Deliver the baby vaginally in breech position
  • Have your baby by C-section (this is less risky than a vaginal birth)
WebMD Medical Reference Reviewed by Nivin Todd, MD on August 19, 2020

Sources

SOURCES:

Pregnancy Birth & Baby: "External cephalic version (ECV)."

Mayo Clinic: "Fetal presentation before birth."

The American College of Obstetricians and Gynecologists: "If Your Baby Is Breech."

Royal College of Obstetricians and Gynaecologists: "Turning a breech baby in the womb (external cephalic version)."

Healthdirect (Australia): “External cephalic version (ECV).”

Acta  Obstetricia et Gynecologica  Scandinavica: “Maternal experience of pain during external cephalic version at term.

Williams Manual of Pregnancy Complications, 23 ed: “Chapter 17. Breech Delivery.”

NSW Government Health (Australia): “External Cephalic Version (ECV) for Breech Presentation.”

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