External Cephalic Version (or ECV) is a manual procedure that is used to turn a baby from its breech position (bottom or foot facing down) to a head-first position.
This article discusses how the ECV procedure is performed, along with when it should be done (or not) and the outcome and risk factors of this procedure.
The Breech baby position is a foetal position where the baby’s bottom or feet is facing downwards, instead of the normal head position. It occurs in around 3-5% of pregnant women after 37 to 40 weeks of pregnancy.
The probability of childhood handicap for a breech baby is as high as 16%, irrespective of the mode of the baby’s delivery.
Most babies in breech position are delivered through Caesarean (or C-section) instead of vaginal births.
External Cephalic Version (or ECV) is a manual procedure where the breech baby (or foetus) is externally rotated from its breech position first to a sideways position and then finally to a head-first position. This ECV pregnancy procedure enables pregnant women to deliver their babies through the normal vaginal birth, rather than undergoing a C-section.
ECV procedure comprises of the following components:
During this step, the foetus is closely monitored to avoid any harm during the version procedure. Monitoring can be done through foetal ultrasound to confirm the position of the placenta. An electronic foetal heart monitoring is used to measure the heart rate. A foetus, whose heart rate increases at a normal rate with its movement, is a healthy one, which is suitable for the version procedure.
During this procedure, your doctor will place both hands on your foetus’s head and buttocks in order to attempt turning it to a head-down position. Before the procedure, you will be administered tocolytic medicines such as terbutaline to relax your uterus.
Your doctor may recommend additional version procedures if the first attempt is not successful.
The ECV procedure is performed after 37 weeks of pregnancy. Though most babies repeatedly keep changing positions throughout the pregnancy, they usually settle into a cephalic (or head-down) position by the 36th week. According to statistics, 1 in every 25 babies is in a breech position after 36 weeks. Even though breech babies can take the natural position in the last month, the chances of this happening are about 1 in 8 (for first pregnancies) and 1 in 3 (for second and subsequent pregnancies).
At this stage, your doctor may recommend the ECV procedure before the start of your labour.
According to 2016 statistics, 93.2% of the breech babies in the U.S. are delivered through Caesarean operation. This has led to a rapid growth of baby deliveries happening through Caesarean.
ECV procedure is done to improve the probability of a natural vaginal birth.
An ECV procedure is not recommended for expecting mothers, if they:
Additionally, the ECV procedure is not done when:
The use of the ECV procedure can reduce the 3-4% of breech births to around 1%. ECV also contributes towards reduction in premature labour, breech-related complications, and premature babies.
Although there is a chance that following the ECV procedure, the baby can turn back into the breech position, ECV can improve the overall chances of having a normal vaginal birth.
An ECV procedure usually lasts for around 3 hours. As ECV is a non-invasive procedure, the pain or discomfort factor is restricted to a limited time. However, based on patient response, the pain perception of the expecting mother is largely influenced by the success (or failure) of the procedure, along with the length of the procedure. Most women, who underwent longer procedures or a failed version, have reported more pain. On the other hand, women who underwent a successful ECV have reported less pain.
While foetus monitoring can reduce the risks of ECV, there are potential risks associated with ECV, including:
ECV has an average success rate of 58%. According to 2016 statistics in the U.S., 68% of the women who had a successful ECV went on to have a normal vaginal birth, while only 25.2% underwent a C-section.
According to the latest medical research studies, women who have already undergone a C-section can benefit from an ECV procedure for their subsequent pregnancies. Researchers have concluded that women with previous C-section have a success rate (50%) at ECV, quite close to the success rate (51.6%) for women who have not undergone any previous C-section.
The success of the ECV procedure is dependent on multiple individual factors, including:
Other factors that contribute strongly to the ECV success rate are:
Depending on the breech position of your baby and other individual factors, a normal vaginal birth is still a possibility, even if the ECV procedure does not succeed.
An ECV procedure carries a minor risk of causing bleeding, which could lead to the mixing of the mother’s and the baby’s blood. To prevent this, pregnant women with Rh-negative blood type is injected with Rh immunoglobin to prevent a condition called Rh sensitization, which can lead to complications in future pregnancies.
If you do not want to opt for the ECV procedure, there are alternative methods to consider, including:
The right position in the womb goes a long way in ensuring a safe delivery both for the child and the mother. Speaking to your doctor about opting for an ECV, if the baby is breech, is the best way to determine if it is a procedure which is suited to you, or if there are any alternatives you may try instead.