External Cephalic Version

External cephalic version or ECV is a procedure used to turn a breech baby into a head down position before the start of labor. It is usually done around 36-37 weeks of pregnancy and in some cases just before the water breaks. A successful ECV increases the chances of vaginal delivery. If the version is not successful a Cesarean delivery or C-section may be recommended.

How is an ECV done?

Before the procedure, an injection is given to relax the muscles of the uterus and to prevent uterine contractions. Fetal position is confirmed using an ultrasound, and electronic fetal monitoring is performed before, during and after the version.  During the procedure, the doctor (obstetrician) may place his hand on the abdomen and give a gentle but firm push on the head of the baby to help him roll into a head down position. The external cephalic version is successful in 50% of expectant moms who gets it done. The obstetrician may try the procedure again if the first attempt was not successful.

ECV is not recommended if:

  • The amniotic sac (water) has ruptured
  • The mother has complications like placenta previa or placenta abruptio
  • The fetus is in distress
  • The fetus has any birth defect
  • It is multiple pregnancy (twins, triplets or more)
  • The uterus has an abnormal shape

The chances of ECV to be successful increases if:

  • This is your second pregnancy
  • There is plenty of amniotic fluid
  • The baby is not engaged on the pelvis yet
  • The baby is high up


Is ECV painful?

The entire procedure may be little uncomfortable, rather than painful. Try to relax physically and mentally so that the procedure is easy and the discomfort is less. The amount of discomfort will also depend on how sensitive your abdomen is and also on the pressure applied to turn the fetus. ECV is generally considered to be a safe procedure without many complications.

In some rare cases, the baby may turn back to breech position even after a successful ECV. A Cesarean section may then be recommended to take the baby.

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