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.
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Last reviewed: April 2020