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External Cephalic Version (ECV) Procedure

About the Procedure

If at 36 weeks your baby continues to be (or just became) breech, we will have a conversation with you about why you may or may not want to consider an External (outside the body) Cephalic Version (rotation of the fetal head), commonly called an ECV or “version.” This is a great option to explore if you are interested in trying everything available to you to turn your baby and attempt a vaginal birth.

The ECV is a scheduled medical procedure performed at the hospital by an OBGYN who is specially trained in this procedure. This clinician will place their hands on your abdomen and use pressure to turn the baby while watching the baby with an ultrasound.

This procedure has an overall 58% success rate and the research shows that the earlier in full term you attempt an ECV, the more successful it will be (closer to 37 weeks than 40 weeks, for example). There are some factors that increase the chance of success, most of which we don’t have much control over, such as the amount of fluid, position of the baby, and position of the placenta.

A successful ECV increases the chance that the baby will turn to head down and the likelihood of vaginal delivery.

The most common risk during the procedure is the fetal heart rate (FHR) decelerating (occurs about 60% of the time). Majority of FHR decelerations resolve with discontinuation of procedure. During the procedure, the FHR is checked every 2 minutes to evaluate and monitored for 1 hour post-procedure to ensure fetal well being.

We will review the benefits and risks of ECV in more detail with you during your ECV counseling visit.

Procedure Protocols 

Here’s what’s going to happen before, during, and after the procedure.

Prior to ECV:

  • Fasting (no eating – clears only) before the procedure
  • We will:
    • Review risks/benefits and obtain informed consent prior to initiating any procedure
    • Discuss the pros and cons of using or not using an epidural during the procedure
    • Complete an ultrasound to assess fetus position and fetal wellbeing, with baseline fetal heart rate monitoring prior to initiating the procedure

During ECV:

You will receive a medication called terbutaline 25mcg, which is  a shot given in the muscle (usually thigh) to relax your uterine muscles. Your provider will attempt the procedure with support of a nurse and resident and with your support person present. Your provider will place their hands on your abdomen and attempt maneuvers to manually rotate your baby to a head down position while closely monitoring the fetal heart rate to ensure well being of your baby throughout, as well as assessment of your comfort level.

After ECV:

  • If you have Rh negative blood type, Rhogam will be administered
  • We will perform monitoring of the fetal heart rate for 1-2 hours post-procedure


How do I prepare for my ECV?

The day before the procedure you should have a normal day but please do not eat anything after midnight on the day of the procedure. The day of the procedure, you can drink clears up to 4 hours prior to the procedure. Arrive at the hospital and review the risks, benefits, and alternatives and give consent for the procedure. Next, you will receive medication to relax the uterus (+/- epidural). During the procedure, the clinician touches your stomach to turn the body, which may cause some pressure or discomfort. The baby will be monitored throughout the procedure. Following the procedure, you will remain in the recovery area for 1-2 hours in order to ensure that the baby tolerated the procedure well.

I was breech at term as a baby! Does that increase my risk as the birthing person that my baby will be breech?

Yes. Parents who were delivered at term from breech presentation are twice as likely to have firstborn newborns in breech presentation compared to parents who were delivered in head down (cephalic) presentation. This suggests a possible genetic component to fetal presentation.

I had a successful ECV! What does this mean for my delivery?

Patients who had a successful ECV are candidates for a vaginal delivery. As long as the fetus remains vertex at the time of labor, vaginal delivery can be attempted unless other factors arise. Reviews confirm that overall an ECV is associated with lower rates of cesarean delivery with minimal risk to patient and fetus.

Please reach out to our care team if you have any questions!