External cephalic version (ECV)

This leaflet is for women and birthing people who have been recommended an ECV because your baby is in a bottom first (breech) position. At the end of pregnancy, approximately 3-4% of babies are in a breech position (3-4 in 100).

What is ECV?

Your baby is in the breech position, which can make vaginal birth more complicated. You have therefore been advised to have an external cephalic version to turn the baby to a head down (cephalic) position. This can help make a vaginal birth safer and help avoid a caesarean birth. For this procedure you will be seen in clinic 22, after 36 weeks of pregnancy. The procedure itself will last about 5-20 minutes. However, you can expect to be in hospital for at least two hours, which includes taking recordings of your baby’s heart rate.

Before the procedure

You are advised not to eat for four hours prior to the procedure, but can drink water. You will be seen by the doctor performing the procedure, who will ask details of your medical and pregnancy history. This is a good opportunity for you to ask us any questions about the procedure.

We will ask if you take any tablets or use any other types of medication either prescribed by a doctor or bought over the counter in a pharmacy. Please bring all your medications and any packaging (if available) with you. Please tell the clinic staff about all of the medicines you use.

Your baby’s heart rate will be monitored to confirm their wellbeing. You may be recommended to have an injection to relax the uterine (womb) muscles, this makes turning the baby easier. This medication may make you feel flushed and you may become aware of your heart beating faster than usual, but this should only last for a short time.

During the procedure

You will have an ultrasound scan to confirm your baby’s position. While you are lying flat on the bed, the obstetrician will place his/her hands on your abdomen moving your baby up and out of the pelvis. Your baby is turned either forward or backward until your baby is in the head-down position. The procedure may be uncomfortable and if at any stage you feel unable to tolerate the discomfort you should tell the doctor who will stop. The doctor will try a forwards roll and a backwards roll but if your baby will not move either way then they will stop.

At the end of the procedure your baby’s position will be confirmed by an ultrasound scan.

After the procedure

Your baby’s heart rate monitoring will be repeated for up to an hour. If all is well, you will be able to go home with a plan in place for follow up care.

If the ECV was successful, you will be offered a community midwife appointment or a scan one week after the ECV to confirm your baby has stayed head down– there is a 3-5% chance that the baby could turn back to the breech position.

If the ECV was unsuccessful, you may be able to have another go depending on your gestation, or have the option of either a vaginal breech birth or a planned caesarean birth.

Rhesus negative blood group

When a baby is turned, there is a possibility that some of the baby’s blood will be transferred to the mother, which can sensitise her to the baby’s blood cells. This can affect future pregnancies. For this reason, if your blood group is rhesus negative, an injection of anti-D will be recommended at the end of the procedure. You will also have a blood test to check if the dose of anti-D given to you is sufficient. Your doctor or midwife will explain this in more detail.

Benefits

External cephalic version facilitates the birth of your baby by altering the position of the baby into the head-down position.

Risks

An external cephalic version is a very safe procedure. However, as is common with all procedures there are potential risks involved.

The main risks of the procedure are:

• we are unable to successfully turn your baby (about 50%, 1 in 2 people)
• your baby can return to the breech position after this procedure (about 5%, 5 in 100 people)

More rarely:

• there is bleeding behind the placenta, which might require birth of the baby by caesarean birth (0.5%, 1 in 200 people)
• there is a rupture of membranes (referred to as your waters breaking)
• there is immediate or delayed fetal distress, which can require your baby to be born by urgent caesarean birth

Your obstetrician and midwife will ensure that the appropriate measures are taken to reduce your risk of the development of complications.

Alternatives

You may decide to continue the pregnancy with the baby in a breech position and aim for a vaginal breech birth.

A planned caesarean birth, which is when you birth your baby via an incision made in your abdomen (tummy).

MyChart

We would encourage you to sign up for MyChart. This is the electronic patient portal at Cambridge University Hospitals that enables patients to securely access parts of their health record held within the hospital’s electronic patient record system (Epic). It is available via your home computer or mobile device.

More information is available on the MyChart section on our website.

Contacts/further Information

• Rosie Hospital, clinic 22 | CUH
• RCOG - Breech baby at the end of pregnancy patient information leaflet (opens in a new tab)
• NHS - What happens if your baby is breech? (opens in a new tab)
• Tommy’s - What happens if my baby is breech? (opens in a new tab)
• Rhesus negative blood type: care in pregnancy and after birth | CUH

Sources of evidence

Impey LWM, Murphy DJ, Griffiths M, Penna LK on behalf of the Royal College of Obstetricians and Gynaecologists. External Cephalic Version and Reducing the Incidence of Term Breech Presentation. BJOG 2017