External Cephalic Version (ECV)

If your baby is still in a breech position by week 37 of your pregnancy, your doctor or midwife may try to turn it to the vertex (head-down) position using external cephalic version (ECV). In the hands of an experienced doctor or midwife, ECV is a very safe procedure with a success rate of 60 to 70 percent.

Approximately 4 percent of babies are breech, or in the feet or buttocks first position, at term (37 to 42 weeks). This may be caused by several conditions, including placenta previa, multiple fetuses, uterine abnormalities, fetal anomalies, poor uterine tone and prematurity. However, most cases have no apparent cause. Virtually all breech presentations are delivered via c-section, accounting for 12 percent of all c-section births. According to some experts, the routine use of ECV could reduce the rate of c-sections by approximately two-thirds.

Before attempting an ECV, your doctor will use ultrasound to confirm your baby’s size and position, the amount of amniotic fluid present, and the location of the placenta. He or she will continue to monitor your baby closely during the ECV for signs of stress and to verify its position. You will be given medication to relax your uterus and then your doctor or midwife will place both hands on your abdomen where the baby’s head and buttocks are located and apply pressure to turn the baby in a slow, gentle somersault. The baby is never forced to turn; ECV is done only if it can be done easily. However, you may feel a significant amount of pressure.

ECV is not attempted earlier than 37 weeks because the baby may revert back to the breech position before birth (about 4 percent of fetuses return to a breech position after a successful ECV), most babies rotate to the vertex position on their own by the 37th week, and if complications arise from the ECV the baby may have to be delivered by emergency c-section. ECV should be done either in or very near the labor and delivery area since immediate delivery in the event of a problem may be necessary. This is a rare occurrence but a possibility with the ECV procedure. However, ECV should be performed as soon as possible after the 37th week because the fetus small (while still considered full term), giving it more room to move, and it is still surrounded by a healthy amount of amniotic fluid (fluid levels begin to decrease towards the end of the pregnancy). If the ECV fails, it may be attempted again later.

The risks associated with ECV are minimal occurring only 1 to 2 percent of the time and include umbilical cord entanglement, abruption placenta, preterm labor, premature rupture of the membranes (PROM) and severe maternal discomfort.

Be sure to discuss ECV thoroughly with your doctor or midwife and resolve any questions or concerns you have. ECV should not be attempted if you have oligohydramnios (low amniotic fluid) or placenta previa, are in active labor, your water has broken, or if you are carrying more than one baby.

If you would like to try to turn your baby yourself, here are two simple techniques:

• Handstands are reported as being the most successful technique to get a baby to turn. Perform them in a swimming pool where you will be safe if you tip over. Spend about 15 minutes warming up and then stand in water deep enough so that just your head is above water. Do 5 handstands in a row, remaining in the handstand as long as you can.
• The same pelvic tilt that is used to strengthen your body for delivery and relieve back pain can also work to help your breech baby turn, and research shows this method has an 88 to 96 percent success rate. Try this exercise twice a day, for 10 minutes at a time, for 2 to 3 weeks starting around week 32. It is best if you perform this on an empty stomach. Lie flat on your back and raise your pelvis so that it is 9 to 12 inches above your head. Stay in this position for at least 5 minutes, but for no more than 15 minutes. This works by allowing gravity to push and tuck the baby's head into the fundus of the uterus where the baby often somersaults to a vertex position.