If Your Baby Is Breech: External Cephalic Version (ECV)

Toward the end of pregnancy, most babies move into a head-first position for childbirth. In some cases a baby may be in a breech position. This means the baby’s buttocks or feet are in place to be delivered first. A breech position makes it difficult to have a vaginal delivery.

If your baby is in a breech position, your healthcare provider may try to turn the baby so that he or she is head-first. This procedure is called an external cephalic version (ECV). An ECV may be done if you are between 36 to 38 weeks in your pregnancy, unless there are reasons not to do it. If the ECV is successful, a vaginal delivery is more likely.

Before the procedure

As with any procedure, this technique may have some risks associated with it. Ask your healthcare provider what these risks may be. This procedure is usually done in a hospital. Follow any directions you are given for not eating or drinking before the procedure.

Before the ECV, the medical team will connect you to a fetal monitor. This is done to check your baby’s well-being during the procedure. You may also need the following tests:

Ultrasound

This may be done to:

• Confirm that the baby is in a breech position
• Find out how much amniotic fluid is in the uterus
• Confirm where the placenta is
• Find or rule out any birth defects (congenital abnormalities)
• See if the umbilical cord is around the baby’s neck. This is called a nuchal cord.

Non-stress test and biophysical profile

These tests check your baby's heart, well-being, and contraction pattern. One or both of these tests may be done before and after the ECV.

Blood tests

Blood is taken to find out your blood type, screen, and a complete blood count in case of an emergency.

During the procedure  

• You will stay connected to the fetal monitor. This is done to check your baby's well-being during the procedure.
• An IV (intravenous) line may be placed in your arm to give fluids or medicines if needed.
• Spinal or epidural anesthesia may be used for pain relief.  Your healthcare team will discuss these options with you.
•  The team may give you medicine to relax your uterus. This medicine can make it easier for the healthcare provider to rotate your baby.
•  You will be placed in a special position on the hospital bed.
• The healthcare provider will then put his or her hands at certain points on your lower belly over your uterus. 
• The provider will try to push the baby into a head-down position. This is done by trying to make the baby do a slow-motion forward roll or back flip. You will feel pressure during this part of the procedure. 
• Once the procedure is complete, the medical team will raise the head of your bed. This will help keep the baby in the head-down position.

Changing your baby’s position

Your healthcare provider presses down on your belly and locates your baby’s head and bottom.

By pressing down on your belly, your healthcare provider may be able to rotate the baby into a head-first position. This often will allow a vaginal birth. 

After the procedure

• You will stay connected to the fetal monitor. This is done to check your baby’s well-being. It also checks for contractions, which can happen after an ECV. You will be monitored up to 2 hours after the ECV, or as directed by your provider.
• If you are Rh-negative, your healthcare provider may order an Rh immunoglobulin injection. This is done to prevent an immune system response (Rh sensitization) that can cause problems in future pregnancies. It is also done to prevent a condition (fetomaternal hemorrhage) that can cause complications if your baby’s blood enters into your bloodstream before or during delivery.
• Once you are home, follow any directions your healthcare provider gives you for eating or drinking after the procedure.
• Follow all specific discharge instructions from your healthcare provider.

Follow-up appointment

Your healthcare provider may ask you to schedule appointments more often to check your baby’s position. Follow the instructions from your healthcare provider.

When to call your healthcare provider

Call your healthcare provider if any of the following happen:

• You have more contractions
• Fluid or blood is leaking from your vagina
• Your baby is moving less
• You have other specific signs or symptoms as directed by your healthcare provider
• You have a significant amount of vaginal bleeding