My Baby is Breech – What is an external cephalic version?

If you are in the final weeks of pregnancy and have been told that your baby is breech, your caregiver might suggest what is known as external cephalic version (ECV). You might be nervous, confused, or apprehensive about the breech presentation of your baby, as well as about whether or not the ECV technique works.

What Does a “Breech” Position Mean for Me and My Baby?

During the last month of pregnancy your caregiver will likely palpate your abdomen to try to determine the position of your baby in utero. Ultrasounds are also sometimes used to get a clearer indication of positioning. Somewhere shortly after the 36th week your baby’s head should move to and remain directed downward near the birth canal. If this does not occur it is known as the breech position, and if left unchanged, can pose great risks for you and your baby.

Depending upon the specific positioning of a baby in a breech position, the legs, arms, or buttocks might push through the birth canal first. Delivered this way, a baby might suffer from broken bones or dislocated joints, severe soft tissue and ligament damage, as well as be at an increased risk of a prolapsed umbilical cord where the cord slips through the birth canal before the baby and is pinched in such a way to cut off that vital supply of blood to the baby. Beyond the risks a breech position poses to the baby, it can also have extreme consequences for mothers, too. There can be extensive tearing of the canal, damage to the mother’s urinary tract system, along with excruciating pain because of the awkward birthing presentation.

How Can an External Cephalic Version (ECV) Help My Baby?

There are only a few rare circumstances where caregivers would not attempt to either manually or surgically intervene when a baby is nearing birth and in a breech presentation. These rarities might include imminent birth or complications during labor, making a vaginal birth the only or best option. However, a breech presentation does not have to mean the only option is surgery. Before you consider a caesarian delivery, consider the less invasive option of external cephalic version (ECV).

During an external cephalic version, your doctor, perhaps accompanied by another physician or nurse, will place his hands on your abdomen and attempt to manually shift the position of your baby by lifting, turning, and pushing. While it might seem like an unusual procedure, it actually is successful more than 50% of the time. This results in a large decline in the number of caesarian deliveries that would otherwise be needed.

The external cephalic procedure should not usually be attempted before the 36th week of pregnancy because the earlier the baby is turned, the longer the baby has to return to the breech position. Conversely, if your doctor waits too long to attempt to turn your baby with ECV, there is an increased chance that your baby will be too large to be able to manually move with pressure applied to your abdomen.

What Should I Expect During the External Cephalic Version?

Not every mother experiences the external cephalic version the same, as there are many factors that influence each individual procedure.

  • The size of the baby
  • The position of the baby
  • The level of amniotic fluid
  • The health and anxiety level of the mother

Of these above factors, the only one that you can really have any influence over is your health and anxiety level. The more relaxed you can be during the procedure, the more pliable your muscles will be – an important contributing factor in the ease of the ECV.

Generally, your physician will have you hooked up to a fetal heart rate monitor before, during, and after the procedure to monitor how the procedure affects your baby. During the procedure some women experience little to no discomfort, while others report mild to moderate discomfort because of the pressure applied. Be sure to communicate with your doctor any concerns you have regarding the procedure – it really is a viable option for correcting a breech position and allowing for a healthy, natural vaginal birth.

Dr. Gareth Forde

About Dr. Gareth Forde

An obstetrician-gynecologist, a clinical professor, a researcher, and a father of five—and he delivered them all! He speaks and publishes extensively on maternal and child health issues, where he emphasizes the role of a healthy maternal lifestyle, good nutrition, and breastfeeding on infant development. He chose the field of obstetrics because it is a celebration of life, a happy and exciting profession. “Children are a blessing and they bring joy and laughter to the world,” he says. “I cherish my work, as a doctor and a dad.” The study of genetic imprinting is a major focus of both Dr. Forde’s research and medical practice. This looks at what happens in the womb, how the genes a baby inherits are expressed (turned on and off), and how this influences the child’s health after birth. “This field holds great promise, shedding light on many unsolved mysteries in health and disease from infancy to adulthood,” he adds. Dr. Forde grew up in London, England and Orlando, Florida. He received his medical degree from the University of Minnesota Medical School and is currently pursuing a fellowship in gynecologic oncology at the University of California, Irvine. Prior to this, he practiced with Grand Rapids Medical Education Partners, a consortium of Saint Mary’s Health Care, Spectrum Health, Grand Valley State University, and Michigan State University College of Human Medicine—where he was a clinical professor of obstetrics, gynecology, and reproductive biology. He also has a master’s in molecular and cellular biology from Florida Agricultural & Mechanical University; a Ph.D. in environmental science (computational chemistry) from Jackson State University; and a post-doctoral fellowship in biophysics from Mount Sinai School of Medicine, in New York.”