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What does ecv mean


What Is External Cephalic Version (ECV)?

Written by Danny Bonvissuto

Reviewed by Nivin Todd, MD on August 25, 2022

In this Article

  • What Is External Cephalic Version?
  • External Cephalic Version Procedure
  • Does ECV Hurt?
  • External Cephalic Version Risks
  • External Cephalic Version Success
  • Are There Possible Complications From an ECV?
  • External Cephalic Version Alternatives

What Is External Cephalic Version?

External cephalic version, or ECV, is a maneuver your doctor may use when your unborn baby is set up to come out bottom first or feet first. Those positions are called a breech birth, and they can make a vaginal birth more difficult. With an ECV, your doctor turns the baby into a headfirst, or cephalic, position toward the opening of the birth canal.

External Cephalic Version Procedure

It’s usually done by your obstetrician. Your baby's heartbeat will be monitored for about a half-hour before the ECV. In some cases, you may get medicine through an IV to relax your uterus. This won't affect your baby.

Then, by pressing their hands on the outside of your belly, your doctor will try to turn your baby. The goal is to get your baby to do a little flip in your womb and finish up head-down. This can take several hours.

Your doctor may use an ultrasound to check your baby's position and guide the process.

Does ECV Hurt?

To turn your baby, your doctor will use firm pressure. Everyone reacts differently, so you might feel discomfort or pain. Many women go through an ECV without any painkillers. But your doctor may give you an epidural or other pain medication or even put you to sleep during the procedure.

External Cephalic Version Risks

An ECV isn't right for you if you're expecting more than one baby or you need a C-section.

It also works best on women with a pear-shaped womb and not those with a heart-shaped womb, called a bicornuate uterus.

Other reasons your doctor might tell you not to get an ECV are:

  • You have vaginal bleeding within 7 days of the procedure.
  • Your baby has an abnormal heartbeat or health problems.
  • Your water has broken.
  • Your baby is larger than average.
  • Your amniotic fluid levels are too low or too high.
  • Your baby’s head is hyperextended, meaning it’s straight instead of bending forward.
  • You have a heart problem or a placenta previa, which can cause severe bleeding during pregnancy and delivery.

ECVs are usually safe, but there are some risks. In rare cases, it can cause changes in your baby's heart rate, tearing of the placenta, and preterm labor.

The procedure is usually done near a delivery room in case you need an emergency C-section.

External Cephalic Version Success

ECVs work about half the time. If your doctor can't get your baby to flip after the first attempt, they may try again after a week or so.

The odds of success are higher if:

  • The ECV is attempted soon after 36 weeks of pregnancy, before the baby grows too large.
  • You’ve given birth before.
  • There is enough amniotic fluid surrounding the baby.

Things that can lower the chances that an ECV will work include:

  • The baby has dropped to your pelvis.
  • Your uterus is tense or hard.
  • Your doctor has trouble touching and feeling your baby’s head.

After a successful ECV, babies flip to the headfirst position, then flip back to breech. And sometimes breech babies flip on their own before birth, though the bigger they get, the less room there is to move.

Doctors deliver most breech babies by C-section. A vaginal birth may still be possible, depending on your health, your baby's health, and their position. Ask your doctor about your options.

Are There Possible Complications From an ECV?

After a successful ECV, most women go on to have normal vaginal births. But call your doctor right away if you have contractions, bleeding, or you don't feel your baby moving the way you did before the procedure.

External Cephalic Version Alternatives

If an ECV can’t get your baby into a headfirst position, you have other options for giving birth. They may include:

  • Deliver the baby vaginally in breech position
  • Have your baby by C-section (this is less risky than a vaginal birth)

External cephalic version (ECV) | Pregnancy Birth and Baby

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Giving birth is more challenging for babies who are bottom-down, or breech, when labour starts. This page explains external cephalic version (ECV), which tries to turn breech babies to the head-down position ready for a normal vaginal birth.

The breech position

Throughout your pregnancy, your baby repeatedly turns around and changes position. Most babies will settle into a head-down, or 'cephalic', position by 36 weeks of pregnancy. But about 3 in 100 babies are in a breech position at 36 weeks. For these babies, birth would be more difficult than if they were in the cephalic position.

Some breech babies turn naturally in the last month of pregnancy. If this is your first baby, the chance of the baby turning itself after 36 weeks is about 1 in 8. If this is your second or subsequent baby, the chance is about 1 in 3.

If your baby is still in a breech position at 36 weeks, your doctor or midwife might suggest you consider an external cephalic version, or ECV. The aim is to turn your baby so that it is head-down when labour starts.

An ECV is performed after 37 weeks of pregnancy.

Can anyone have an ECV?

Most women can have an ECV if they have a healthy pregnancy with a normal amount of amniotic fluid. However, an ECV is not recommended if:

  • you need a caesarean for other reasons
  • you have had vaginal bleeding in the previous 7 days
  • the baby's heart rate is not normal
  • a complicated pregnancy
  • you are having twins or triplets
  • you have an unusually shaped uterus
  • you recently had vaginal bleeding
  • you have placenta praevia (your placenta is growing close to, or on, your cervix)
  • other health conditions, like high blood pressure or diabetes

ECV might also not be recommended if your unborn baby is unwell or not growing well.

If you have had a caesarean section before, an ECV can still be performed but there are special considerations that need to be discussed with your doctor.

How is an ECV performed?

A health professional with appropriate expertise, usually an obstetrician, puts their hands on your abdomen to try to turn your baby into a head-down position.

A cardiotocograph, or CTG, will monitor your baby’s wellbeing for 20 to 30 minutes before the procedure.

A small needle will be inserted into your hand so that medication to relax your uterus can be administered directly into your vein.

An obstetrician will then perform an ultrasound to confirm the position of the baby, and then attempt to turn the baby by pressing their hands firmly on your abdomen. Some women find this uncomfortable, while others don’t. The pressure on your abdomen lasts a few minutes. If the first attempt is unsuccessful, the obstetrician might try again.

The CTG might be applied again after the procedure to assess your baby’s wellbeing before you leave.

It usually takes about 3 hours from start to finish.

Where would I have an ECV?

Although complications from an ECV are rare, it is recommended that the procedure is done by an experienced health professional, in a hospital where there are facilities for emergency caesarean section. About 1 in 1,000 women go into labour after an ECV. About 1 in 200 women need an immediate caesarean section.

Will ECV work?

ECV can work, although there is no guarantee of success. If it does work, there is a small chance the baby will turn again to the breech position. But overall, ECV improves a woman’s chances of having a vaginal birth.

What happens if ECV doesn’t work?

A vaginal birth may still be possible, depending on your individual clinical circumstances and the type of breech position your baby is in. Talk to your doctor or midwife about your options.

What other methods are there to potentially turn my baby from a breech position?

Some people think that you might be able to encourage your baby to turn by holding yourself in certain positions, such as kneeling with your bottom in the air and your head and shoulders flat to the ground. Other options you might hear include acupuncture, a Chinese herb called moxibustion and chiropractic treatment. There is no good evidence that these work. Discuss with your doctor or midwife before having any treatment during pregnancy.

Sources:
Mater Hospital Brisbane (Pregnancy: External Cephalic Version), Royal Australian and New Zealand College of Obstetricians and Gynaecologists (Breech Presentation at the End of your Pregnancy), BioMed Central (Does moxibustion work? An overview of systematic reviews (BMC Research Notes 20103:284)), Department of Health (Clinical practice guidelines: Pregnancy care), SA Department for Health and Ageing (Perinatal practice guideline: Breech presentation), NSW Health (External Cephalic Version (ECV) for Breech Presentation)

Learn more here about the development and quality assurance of healthdirect content.

Last reviewed: April 2020


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Related pages

  • Breech birth
  • Breech pregnancy

Need more information?

External Cephalic Version for Breech Presentation - Maternal, child and family health

This information brochure provides information about an External Cephalic Version (ECV) for breech presentation