What is external cephalic version?

External cephalic version (ECV) is a procedure that tries to turn your baby from a breech position to a head-down position, so you can have a normal vaginal birth.

‘Breech’ means that your baby is lying with its bottom or feet down in your uterus (womb) instead of head-down.

Why is it better for my baby to be head-down?

If your baby is in a breech position when you go into labour, a vaginal birth is more challenging. It may be more risky for your baby than if they were head-down.

There is a chance that your baby could be injured during the birth. Their head could get stuck, which is an emergency. There is a higher risk of cord prolapse, which is also an emergency.

Will my baby turn by itself?

Early in pregnancy, it’s very common for your baby to be in a breech position. Most babies will turn and settle into a head-down (cephalic) position as the pregnancy progresses.

By the end of pregnancy, about 3 in 100 babies are in a breech position.

As you get closer to your due date, the chance of your baby turning head-down by themselves gets smaller. Some breech babies turn naturally in the last month of pregnancy. It’s more likely to happen if this is not your first baby.

When should I think about having an ECV?

If your baby is still in a breech position at 36 weeks, your doctor or midwife might suggest you consider an external cephalic version (ECV).

An ECV is performed after 37 weeks of pregnancy, when your baby is unlikely to turn by themselves. If this is your first baby, you might be offered an ECV after 36 weeks.

Is an ECV suitable for all breech babies?

Most people can have an ECV if they have a healthy pregnancy. However, an ECV is not recommended if:

• you need a caesarean for other reasons, such as placenta praevia
• you have had vaginal bleeding in the past 7 days
• there is a problem with your baby's heart rate
• you are having twins or a multiple pregnancy
• your waters have broken

ECV might also not be recommended if:

• your baby is unwell or not growing well
• you have an unusually shaped uterus
• you have high blood pressure
• there is a lower than usual amount of amniotic fluid around your baby
• the umbilical cord is around your baby’s neck

If you have had one caesarean section in the past, you can usually still have an ECV. However, there are special considerations that you should discuss with your doctor.

What can I expect during an ECV?

An ECV is performed by an obstetrician

It can take up to 3 hours from start to finish, as you and your baby will need to be monitored before and after. The turning procedure itself only takes about 10 minutes.

Before the ECV

Before the procedure, you will have an ultrasound to confirm that your baby is still breech. A midwife will connect you to a fetal monitor, also known as a CTG, to monitor your baby’s heart rate for 20 to 40 minutes.

A small needle will be inserted into a vein in your hand, to give you medicine to relax your uterus.

The ECV procedure

The obstetrician will try to turn your baby by pressing their hands gently on your abdomen, with one hand over the baby’s bottom and one hand behind the baby’s head. They will press in a clockwise or anti-clockwise direction to encourage your baby to roll.

Some people find this uncomfortable. The pressure on your abdomen lasts a few minutes. If the first try is unsuccessful, the obstetrician might try again, up to 4 times.

After the ECV

The CTG will be connected again after the procedure to check your baby’s heart rate. Your blood pressure and heart rate will also be monitored.

You might have another ultrasound to check the baby’s position.

If you needed anti-D injections during your pregnancy, you will have another injection after the ECV.

What are the risks of ECV?

ECV is a safe procedure. However, like any procedure, there is a small risk of complications. Occasionally, it can cause bleeding from the placenta or changes in your baby’s heart rate. About 1 in every 200 people having an ECV may need an emergency caesarean because of complications.

Occasionally, ECV can cause your waters to break.

Where should I have an ECV done?

Although complications are rare, ECV should be done in a hospital that has facilities for an emergency caesarean section, just in case it is needed.

Will ECV make my baby turn?

ECV is successful about half the time. If you’ve had a baby before, ECV is more likely to work than if this is your first baby.

If your baby does turn, there is a small chance they will turn back to the breech position. However, most babies will stay head-down.

What happens if ECV doesn’t work?

If your baby doesn’t turn, a vaginal birth may still be possible. This depends on your individual circumstances. You can also plan for a caesarean birth. Talk to your doctor or midwife about your options.

Is there anything else I can do to make my baby turn?

Some people think that you might be able to encourage your baby to turn by holding yourself in certain positions, such as kneeling with your bottom in the air and your head and shoulders flat to the ground. Other options you might hear about include acupuncture, a Chinese medicine treatment called moxibustion and chiropractic treatment. There is no good evidence that these work.

Talk to your doctor or midwife before trying any of these treatments.

Resources and support

For more information on breech presentation at the end of your pregnancy, ECV and other options:

• Breech presentation at the end of your pregnancy
• NSW Health’s: External cephalic version (ECV) for breech presentation