Overview

An external cephalic version (ECV) is when we turn a baby from a breech to a head-down position. A breech position means that your baby is lying with their feet or bottom in your pelvis rather than in a head-first position.

We turn your baby so that they can be born head-first. This reduces the chances of complications in birth.

We do this by putting pressure on your tummy (abdomen). This encourages the baby to do a "somersault" and turn over. 

A breech position is common throughout most of pregnancy. However, we expect that most babies will turn to lie head first by the end of pregnancy. If your baby is breech at 36 weeks of pregnancy, it is unlikely that they will turn into a head-down position on their own. About 3 in every 100 babies are still in a breech position by 36 weeks.

Breech is more common when you are expecting twins or if you have a differently-shaped womb (uterus). However, there is no overall reason for a baby to lie in a breech position.

We offer you an ECV when you are 36 to 37 weeks pregnant, as we think that most babies should have turned on their own by this stage. This also allows time for your baby’s head to move down into your pelvis (engage), ready for birth.

Depending on your situation, you can have an ECV successfully later in pregnancy.

Confirming that your baby is breech

You have a scan if we suspect that your baby is breech. This is called a presentation scan. If your baby is head first, there is no need for us to do anything else. You can continue with your antenatal care as originally planned.

If we find your baby is breech, we arrange for you to have a detailed growth scan. The scan helps us to decide if an ECV is the right option for you. This depends on:

• the exact position of the baby
• the location of the placenta (an organ inside your womb that gives oxygen and food to the growing baby)
• the amount of amniotic fluid (liquid that surrounds and supports the growing baby in your womb)

If an ECV is suitable, we talk to you about the procedure. You can ask us questions or mention any concerns that you may have.

We then book an appointment in the ECV clinic.

Preparing for an ECV

You can eat and drink as usual before your ECV clinic appointment. As the appointment may take several hours, please bring something to keep you occupied.

Having an ECV

At the clinic, we talk to you about the best plan for you and your baby. We then try to turn your baby, if this is appropriate.

We inject a medicine called salbutamol under your skin. This relaxes the muscles in your womb (uterus) and makes it easier to turn your baby.

You may notice that your heart starts to beat faster. This is not dangerous and usually stops after 3 minutes. The medicine does not have any risks for you or your baby.

Salbutamol is not officially approved (unlicensed) for an ECV. The manufacturer of the medicine has not specified that it can be used in this way. But there is evidence that the medicine works to treat this condition.

Read more about unlicensed medicines or contact our pharmacy medicines helpline if you have any questions or concerns.

While you lie on the bed, the specially trained doctor or midwife puts their hands on your tummy, under the baby’s bottom. Gently but firmly, they move your baby in a forwards or sometimes a backwards roll. The procedure takes about 10 minutes. We monitor your baby’s heartbeat closely.

An ECV can be uncomfortable. Please tell the doctor or midwife to stop if you are in pain. If this happens, they may be able to move their hands to a more comfortable position for you. An ECV can be stopped at any time, if needed.

After the ECV

We confirm the position of your baby using an ultrasound scan. We then monitor your baby’s heartbeat for about 30 minutes to make sure that your baby is not distressed.

If you have a rhesus negative blood group (RhD negative), we offer you a blood test and an anti-D injection after the procedure. This is a medicine to prevent your baby from getting a condition rhesus disease if they have a different blood group.

If your baby stays breech, we make a birth plan with you.

After you leave hospital

Follow-up appointments

If your ECV is successful, we will give you another appointment in 1 week to check that the baby is still head down.

If your baby stays breech

If your baby stays breech, the next step is to decide what kind of birth you would like to have. This might be a vaginal breech birth or a caesarean section (when we deliver the baby through a cut made in your tummy and womb).

There are benefits and risks with both caesarean delivery and vaginal breech birth. You need to talk about these with your doctor or midwife at the breech clinic. You can then choose the best birth plan for you and your baby.

Aftercare for your baby

When babies are in a breech position after 36 weeks of pregnancy, there is a slightly increased risk of unstable hips. About 1 to 2 in 1,000 babies has a hip problem that needs treatment.

We offer you a hip assessment for your baby after birth and an ultrasound scan when they are 6 weeks old. This helps us to find if their hip joints are stable. 

Risks of an ECV

The risks with ECV are very small. Rarely, the baby can become distressed. About 1 in 200 babies are then delivered by emergency caesarean section immediately after an ECV. This is because of changes in the baby’s heartbeat or bleeding from the placenta.

Success rates of an ECV

At St Thomas’ Hospital, we successfully turn about 1 in 2 (50% of) babies. This is the same as the national average.

In less than 1 in 100 (1%) of cases, the baby turns back to its original position.

The most common reason why the ECV may not work is because your baby’s bottom has lowered in your pelvis (engaged) and we cannot move it. 

If the ECV is unsuccessful, we might offer you a second ECV depending on your circumstances. Your doctor or midwife will talk to you about this at the time. 

Other treatment options to an ECV

An ECV is the most effective way to turn a baby. We do not currently offer another treatment option.

The use of moxibustion (a type of acupuncture) may be effective between 34 to 36 weeks of pregnancy. Some women like to try lying or sitting in a particular position to help the baby turn. There is no scientific evidence to prove that either of these treatments is effective. 

More information

Cochrane review about the effects of turning unborn babies from bottom first to head first at the end of pregnancy (around 36 weeks or more) for reducing problems during childbirth

Royal College of Obstetricians information about breech baby at the end of pregnancy 

Steps guide to hip development and dysplasia (instability)