is ecv safe for baby?

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.

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.

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.

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.

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

ECV might also not be recommended if:

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.

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 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 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.

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.

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.

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.

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.

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.

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.

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

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.

It is recommended that External Cephalic Version (ECV) is offered after 37 weeks of pregnancy to women with breech presentation. If an ECV is successful this will increase the likelihood of a normal vaginal birth. For more information please read the Royal College of Obstetricians and Gynaecologists (RCOG) guidelines on Breech baby at the end of pregnancy

ECV is generally safe, however, like any medical procedure, rare complications can occur. A small number of women may experience bleeding behind the placenta and/or damage to the womb. About one in 200 babies need to be delivered by emergency caesarean section immediately after an ECV as a result of these complications. ECV does not usually cause labour to begin.

Therefore, we ask you to have nothing to eat or drink from 6am on the day of your ECV.

ECV is successful in turning babies to a head down position in four out of ten women in their first pregnancies and in six out of ten women who have previously had a baby. The chance of your baby returning back to the breech position is less than one in 20.

The procedure is carried out on the Central Delivery Suite at Southmead Hospital. You will be on the unit for about three hours. Prior to doing the ECV an ultrasound scan is done to confirm that your baby is still breech, and a fetal heart rate trace is performed to check that all is well with your baby.

An injection will be given prior to the procedure to help to relax your womb while your baby is being turned, and the head of the bed may be tipped down to help the baby’s bottom come out of your pelvis.

The Doctor will place their hands on your tummy and encourage the baby to turn in a forward or backward roll, with the aim of finishing in a head down position. This procedure can be uncomfortable and a few women, one in 20, will experience some pain.

If you find it too uncomfortable, tell the doctor and the procedure can be stopped if you wish.

An Ultrasound scan is repeated again after the procedure, and a further recording of the baby’s heart rate for a minimum of 45 minutes. After this, if all is well you can go home.

If you have a Rhesus negative blood group you may already have had an injection of Anti D during your pregnancy and be aware of why it is needed. However, during the ECV (whether it is successful or not) it is possible for your baby’s blood cells to mix with yours and therefore, before you can go home, you need to have a blood test (known as a Kleihauer) to see if this has occurred. You will then also be given another Anti D injection (before going home) and may need more Anti D within the next three days if the Kleihauer blood test indicates this is necessary.

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