Date: December 2019
For review December 2021
Ref: B-190/WS/OB & G/Maternity SF/External Cephalic Version 6
Before birth, most babies are in a head-down position in the mother’s womb. When the babies are bottom-first this is called breech. This occurs in about 5 % of pregnancies after 37 weeks. More complications can occur if the baby is delivered as a breech compared to a baby in head-down position. You have been advised to have a procedure (ECV)
to try to turn your baby into this ‘head downwards’ position. This will make a vaginal delivery safer and help avoid you needing to have a Caesarean section for this particular reason.
Q. Do I have to have an ECV if my baby is breech?
No. The decision for ECV should be made between you and the doctor, after a discussion of all the risks and benefits. Other options, such as a vaginal delivery or a Caesarean section, are available to you.
Q. Why should ECV be attempted?
Many studies from around the world over the last 15 years have shown that the number of babies remaining in the breech position at the end of pregnancy can be reduced by ECV. Almost all women with a breech baby at the end of their pregnancy choose to give birth by Caesarean section, so a successful ECV will considerably reduce the risk of a Caesarean delivery. However, a small number of women who have the baby successfully turned may still require a Caesarean section for other reasons during labour.
Q. When can ECV be done?
As many breech babies will turn by themselves before 36 weeks we recommend that ECV is not attempted until the 36th week of pregnancy.
Q. How is ECV done?
For this procedure, you will be seen on the Delivery Suite, after 36 weeks into your pregnancy. The procedure itself will last about 15 minutes. However, you can expect to be in hospital for two hours, which includes us recording the baby’s heart rate. An ultrasound scan will have been done before you come to the clinic to check your baby’s position and that there is enough water around the baby to allow it to turn. When you arrive for your appointment your baby’s heart rate will be checked for 5-10 minutes to make sure your baby is healthy. We will usually briefly scan your baby to check its exact position. While you are lying on the bed, the doctor will place his/her hands on your abdomen moving the baby up and out of your pelvis. The baby is turned either forward or backward until the baby is in the head-down position. You will then have another ultrasound to confirm the new position. Afterwards, whether we have been successful or not in turning your baby, we do another recording of your baby’s heartbeat. If your baby does turn we like to see you the following week to check he/she has not turned back to breech again.
Q. Can ECV be attempted on all breech babies?
We do not like to try and turn babies who have not been growing normally, or if the water around them is very reduced. If you have had significant bleeding after the 28th week of pregnancy, or if you have high blood pressure during your pregnancy we would prefer not to try.
Q. What is the risk of attempting to turn my baby?
An ECV is a very safe procedure, however, in common with all procedures, there are potential risks involved.
The main risks of the procedure are:
- The baby can turn back to the breech position after the ECV has been performed.
- There is bleeding behind the placenta, which might require delivery of the baby by Caesarean section
- There is a rupture of membranes;
- Your baby becomes distressed and needs to be delivered.
Your doctor and midwife will ensure that the appropriate measures are taken to reduce your risk of the development of complications. In the unlikely event of a problem occurring during or after the ECV, your baby is mature enough at 36 weeks, to be delivered by Caesarean section, and this would be done.
Q. What if I my blood group is Rhesus negative?
If you have a rhesus negative blood group you should have already received an anti-D injection in your pregnancy. During the ECV it is possible for the baby’s cells to mix with yours and it is recommended that you have an extra anti-D injection following the ECV, whether it was successful or not.
Q. Is ECV painful for my baby or me?
There may be some discomfort as we try to change your baby’s position, but if it becomes painful we will stop immediately if you ask us, so you are in control. We obviously do not wish to hurt you or your baby.
Q. How successful is ECV?
The success rate depends on a number of individual factors including the position of your baby’s legs (i.e. bent or straight at the knee), the size of your baby, the amount of water around him/her, and whether you have had other pregnancies. Overall at least half (50%) of babies should turn.
Q. How likely is the baby to turn back if ECV was successful?
When ECV is performed after 36 weeks, less than 1:20 (5%) of babies will ‘turn back’. If this does happen most babies can be turned again to headfirst if you want us to try.
Q. What if my baby does not turn?
You will need to decide with your Obstetrician whether to have your baby ‘normally’ - i.e. breech vaginal delivery - or by Caesarean section. All options should be discussed with you so that you can make the best choice for yourself.
Q. What can I expect after the ECV?
Your tummy may feel a bit tender for a couple of days. If you have constant tummy pain or bleeding, your baby’s movements become suddenly less, or you are worried, contact Central Delivery Suite immediately.
Q. Are there any alternatives to ECV?
There is a type of heat therapy called moxibustion (a type of Chinese medicine which involves burning a herb close to the acupuncture point located at the tip of the fifth toe) together with acupuncture that may help turn babies from breech to headfirst position. However, there is no research evidence for your doctor to recommend this above an ECV.