External cephalic version (ECV)

External cephalic version (ECV) is a procedure in which your doctor 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 their bottom or feet facing your cervix (neck of the womb) instead of head-down towards the birth canal.

You may be recommended to have an ECV because a vaginal birth is more challenging and risky for your baby if they are in breech position.

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

As your pregnancy progresses, most babies turn and settle into a head-down (cephalic) position. It is very common and normal for babies to be in a breech position earlier in pregnancy.

As you get closer to your due date, the chances of your baby turning head-down by themselves gets smaller. They are more likely to turn head-down by themselves if you have given birth before.

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

ECV is usually recommended 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.

If you have a healthy pregnancy, it's likely that you can have an ECV.

ECV may not be suitable for you if:

• you need a caesarean for other reasons, such as placenta praevia
• you have had vaginal bleeding in the past 7 days
• you are having twins or a multiple pregnancy
• your waters have broken
• you have high blood pressure or pre-eclampsia
• you have an unusually shaped uterus

ECV may also not be suitable if your baby:

• is unwell or not growing well
• has a lower amount of amniotic fluid than expected
• has the umbilical cord around their neck

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

An ECV can take up to 3 hours from start to finish.

You and your baby will need to be monitored before and after. ECV is performed by an obstetrician who has had special training.

Before an ECV

Before your procedure:

• You will have an ultrasound to confirm that your baby is still in breech position.
• You will be connected to a fetal monitor, also known as a cardiotocograph (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.
• Your baby's heart rate, as well as your pulse, blood pressure and breathing rate will be monitored.

During an ECV

Your obstetrician will try to turn your baby by pressing their hands gently on your abdomen. One hand will be over your baby's bottom and the other hand will be behind your baby's head.

They will press in a clockwise or anti-clockwise direction to encourage your baby to roll.

You may find this uncomfortable. The pressure on your abdomen lasts a few minutes.

If your baby doesn't roll on the first try, the obstetrician can try again, up to 4 times. Your doctor will try to make your baby turn for a maximum of 10 minutes overall.

After an ECV

After your procedure, even if it was unsuccessful:

• Your baby's heart rate will be monitored with a fetal monitor.
• Your blood pressure and heart rate will be monitored.
• You will have another ultrasound to check your baby's position.
• You will get an anti-D injection, if you have a rhesus negative blood type.

ECV is a safe procedure, but as with any procedure, there is a small risk of complications.

Occasionally, ECV can cause bleeding from your placenta or changes in your baby's heart rate. It can also cause your waters to break.

About 1 in every 200 people having an ECV need an emergency caesarean because of complications.

As part of shared decision making, together with your healthcare providers you are encouraged to discuss the risks and benefits of an ECV. This way you can make an informed decision and know what is best for you.

Although complications are rare, you should have your ECV at a hospital that has facilities to deliver your baby by emergency caesarean section.

ECV is successful about half the time. If you've had a baby before, ECV is more likely to work.

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

If your baby doesn't turn, you can:

• plan a caesarean section
• attempt to have a vaginal breech birth

You can discuss your options and the risks and benefits of each choice with your doctor or midwife.

Read more about making a birth plan.

Read more about understanding informed consent and your rights when having a baby.

There is no good evidence to support claims that other treatments can help make your baby turn. These treatments include acupuncture, chiropractic treatment, moxibustion (a Chinese medicine treatment) or moving into certain positions.

It's a good idea to talk to your doctor or midwife before trying any of these treatments, as they may pose risks to you or your baby.

• Read The Royal Australian and New Zealand College of Obstetricians and Gynaecologist's factsheet about breech presentation at the end of your pregnancy.
• Visit The Royal Hospital for Women's informative webpage about external cephalic version (ECV).

Other languages

The Royal Women's Hospital has helpful information in many foreign languages about when to call your hospital during advanced pregnancy if you are concerned about your baby.