Need to talk? Call 1800 882 436.
It's a free call with a maternal child health nurse. *call charges may apply from your mobile

Is it an emergency? Dial 000
If you need urgent medical help, call triple zero immediately.

beginning of content

External cephalic version (ECV)

4-minute read

Giving birth is more challenging for babies who are bottom-down, or breech, when labour starts. This page explains external cephalic version (ECV), which tries to turn breech babies to the head-down position ready for a normal vaginal birth.

The breech position

Throughout your pregnancy, your baby repeatedly turns around and changes position. Most babies will settle into a head-down, or 'cephalic', position by 36 weeks of pregnancy. But about 3 in 100 babies are in a breech position at 36 weeks. For these babies, birth would be more difficult than if they were in the cephalic position.

Some breech babies turn naturally in the last month of pregnancy. If this is your first baby, the chance of the baby turning itself after 36 weeks is about 1 in 8. If this is your second or subsequent baby, the chance is about 1 in 3.

If your baby is still in a breech position at 36 weeks, your doctor or midwife might suggest you consider an external cephalic version, or ECV. The aim is to turn your baby so that it is head-down when labour starts.

An ECV is performed after 37 weeks of pregnancy.

Can anyone have an ECV?

Most women can have an ECV if they have a healthy pregnancy with a normal amount of amniotic fluid. However, an ECV is not recommended if:

  • you need a caesarean for other reasons
  • you have had vaginal bleeding in the previous 7 days
  • the baby's heart rate is not normal
  • a complicated pregnancy
  • you are having twins or triplets
  • you have an unusually shaped uterus
  • you recently had vaginal bleeding
  • you have placenta praevia (your placenta is growing close to, or on, your cervix)
  • other health conditions, like high blood pressure or diabetes

ECV might also not be recommended if your unborn baby is unwell or not growing well.

If you have had a caesarean section before, an ECV can still be performed but there are special considerations that need to be discussed with your doctor.

How is an ECV performed?

A health professional with appropriate expertise, usually an obstetrician, puts their hands on your abdomen to try to turn your baby into a head-down position.

A cardiotocograph, or CTG, will monitor your baby’s wellbeing for 20 to 30 minutes before the procedure.

A small needle will be inserted into your hand so that medication to relax your uterus can be administered directly into your vein.

An obstetrician will then perform an ultrasound to confirm the position of the baby, and then attempt to turn the baby by pressing their hands firmly on your abdomen. Some women find this uncomfortable, while others don’t. The pressure on your abdomen lasts a few minutes. If the first attempt is unsuccessful, the obstetrician might try again.

The CTG might be applied again after the procedure to assess your baby’s wellbeing before you leave.

It usually takes about 3 hours from start to finish.

Where would I have an ECV?

Although complications from an ECV are rare, it is recommended that the procedure is done by an experienced health professional, in a hospital where there are facilities for emergency caesarean section. About 1 in 1,000 women go into labour after an ECV. About 1 in 200 women need an immediate caesarean section.

Will ECV work?

ECV can work, although there is no guarantee of success. If it does work, there is a small chance the baby will turn again to the breech position. But overall, ECV improves a woman’s chances of having a vaginal birth.

What happens if ECV doesn’t work?

A vaginal birth may still be possible, depending on your individual clinical circumstances and the type of breech position your baby is in. Talk to your doctor or midwife about your options.

What other methods are there to potentially turn my baby from a breech position?

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 include acupuncture, a Chinese herb called moxibustion and chiropractic treatment. There is no good evidence that these work. Discuss with your doctor or midwife before having any treatment during pregnancy.

Learn more here about the development and quality assurance of healthdirect content.

Last reviewed: April 2020


Back To Top

Need more information?

External Cephalic Version for Breech Presentation - Maternal, child and family health

This information brochure provides information about an External Cephalic Version (ECV) for breech presentation

Read more on NSW Health website

Breech presentation and turning the baby

In preparation for a safe birth, your health team will need to turn your baby if it is in a bottom first ‘breech’ position.

Read more on WA Health website

Breech pregnancy

When a baby is positioned bottom-down late in pregnancy, this is called the breech position.

Read more on Pregnancy, Birth & Baby website

Malpresentation

Malpresentation is when your baby is in an unusual position as the birth approaches. Sometimes it’s possible to move the baby, but a caesarean maybe safer.

Read more on Pregnancy, Birth & Baby website

Labour complications

Even if you’re healthy and well prepared for childbirth, there’s always a chance of unexpected problems. Learn more about labour complications.

Read more on Pregnancy, Birth & Baby website

Pregnancy at week 35

You'll probably be having lots of Braxton Hicks contractions by now. It's your body's way of preparing for the birth. They should stop if you move position.

Read more on Pregnancy, Birth & Baby website

Anatomy of pregnancy and birth - pelvis

The pelvis helps carry your growing baby and is especially tailored for vaginal births. Learn more about the structure and function of the female pelvis.

Read more on Pregnancy, Birth & Baby website

Rhesus D negative in pregnancy

Find out what being Rhesus D negative could mean for your baby and how it is treated.

Read more on Pregnancy, Birth & Baby website

Placental abruption - Better Health Channel

Placental abruption means the placenta has detached from the wall of the uterus, starving the baby of oxygen and nutrients.

Read more on Better Health Channel website

Glossary of pregnancy and labour

Glossary of common terms and abbreviations used in pregnancy and labour.

Read more on Pregnancy, Birth & Baby website

Call us and speak to a Maternal Child Health Nurse for personal advice and guidance.

Need further advice or guidance from our maternal child health nurses?

This information is for your general information and use only and is not intended to be used as medical advice and should not be used to diagnose, treat, cure or prevent any medical condition, nor should it be used for therapeutic purposes.

The information is not a substitute for independent professional advice and should not be used as an alternative to professional health care. If you have a particular medical problem, please consult a healthcare professional.

Except as permitted under the Copyright Act 1968, this publication or any part of it may not be reproduced, altered, adapted, stored and/or distributed in any form or by any means without the prior written permission of Healthdirect Australia.