What is an External Cephalic Version (ECV)?

By Carrie Bruno

December 19, 2019

Carrie is the founder of The Mama Coach. She is a RN, IBCLC lactation consultant, sleep consultant and mama of two little guys. She leads the North American team of Mama Coaches and is committed to making motherhood easier.

All your ultrasounds during this pregnancy have shown a breech baby. Breech position is when the baby’s head is up by the ribs and the bum is in the pelvis. This occurs in 3% of all pregnancies. Around the 34th week of pregnancy, your health care provider is going to check one last time as some babies can turn around on their own. If this has not happened yet you may be offered an external cephalic version (ECV).

What is an ECV?

External = from the outside  Cephalic = head down Version = turning.

An ECV is performed by a health care professional, most likely, an obstetrician.  When you arrive at the hospital the baby’s heart rate is monitored in a non-stress test (NST).  Mom will get an IV and potentially some medication to help relax the muscles in the uterus which can make the procedure occur easier. Just before the ECV start, the bed is tilted so that mama’s head is lower than her feet to encourage baby to move out of the pelvis.  

With both hands on the outside of the mother’s belly, one by the head and one by the bum, the doctor uses external force to push and roll baby, turn him or her, so the baby’s head is in the pelvis.  

The average ECV procedure takes approximately 4 mins. If, on the first attempt baby is still breech the doctor may suggest a second attempt in the same visit. The overall success rate is 58% so the odds are in your favour.

After the ECV is completed, successful or unsuccessful, baby’s heart rate is monitored again. This NST may be a little longer than before as some babies are excited from the pressure. The monitoring is continued until baby returns to normal.  

What are the potential benefits and risks?

If you are one of the lucky ones to have a successful ECV you are then allowed to try for a vaginal delivery.  The position of baby’s head is confirmed head down again in early labour with a bedside ultrasound. The procedure is more likely to succeed if mama has already had one pregnancy and childbirth, baby has not dropped down in the pelvis (engaged), there is a normal amount of water surrounding the baby and if it’s performed near term of 36 weeks or more completed weeks pregnant.

In making the decision to attempt an EVC you must weigh the success rate with the potential complications.  The complications that may occur include:

  • Prelabour rupture of membranes (your water breaks)
  • Change in fetal heart rate (the umbilical cord gets twisted or squeezed)
  • Placental abruption (the placenta comes away from the uterus)
  • Preterm labour (if your body goes into labour before 37 weeks) 

What are some reasons you may not be able to have an ECV?

When working or doing anything in health care you have to ensure we are making the best and safest choices.  There are a few conditions that unfortunately rule out the possibility of having an ECV performed as it becomes too risky.  These conditions include:

  • Pregnancy with multiples; twins, triplets or more. 
  • Any previous health concerns with baby or concern with baby heart rate during monitoring
  • Placenta previa (placenta is covering the cervix)
  • Previous placental abruption (placenta has pulled away from the uterus)
  • The amniotic sac is broken and your leaking water

When is the best time to have an ECV?

This is tricky. You want to make sure that baby has enough room to turn but also big enough to make sure he or she doesn’t turn back.  Depending on the ultrasound and measurements of your fundal height but typically it is done around 36-37 weeks. 

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