Most babies who are in a bottom down (breech) position will turn to the normal head down position (cephalic) by 37 weeks. After 37 weeks they are much less likely to turn by themselves. However, it is often possible to manually turn a baby head down by applying gentle pressure on the mother’s abdomen, thus improving the chances of having a straightforward birth. This technique is known as an External Cephalic Version or ECV and this page explains what is involved and answers some commonly asked questions.
Who can have an ECV?
ECV is normally offered to women who are more than 37 weeks pregnant with a baby in the breech position. There may be reasons why your obstetrician (doctor) would advise you not to have ECV, e.g. if you have had a previous caesarean birth, if your baby is not growing well or if you have had vaginal bleeding or your waters have broken.
After your antenatal check up at 37 weeks, if your baby is breech your midwife or doctor will discuss the possibility of an ECV with you, including the risks and benefits. If an ECV is agreed then you will be given an appointment and information about coming in to hospital for the procedure.
What are the benefits?
Research has shown that ECV is safe and works in most cases.
- ECV makes it more likely that you will give birth normally, reducing the risks for you and your baby that are associated with the major surgery of a Caesarean birth. These include thrombosis (blood clots), infection and haemorrhage.
- A straightforward birth this time reduces your chances of having a caesarean birth in any future pregnancy.
Are there any risks?
Risks associated with having an ECV are very rare. However, an ECV may cause:
- Your baby’s heartbeat to slow down briefly. There is only a small risk of this. It happens to eight out of every 100 babies that have ECV, and they usually recover after just a few minutes. The procedure is always performed in the Delivery Suite so that on the extremely rare occasions that a baby is not coping well in their new position they can be born by caesarean.
- Labour to start straight away. There is no need to worry as at 37 weeks your baby will be ready to be born.
- Discomfort for some women, but it should not be painful.
If your blood group is rhesus negative you will be offered an injection of Anti D in case there has been any mixing of yours and the baby’s blood during the procedure.
When, where and how?
The ECV is performed in the Delivery Suite (Tunbridge Wells Hospital at Pembury) at around 37 weeks.
On arrival your midwife will check you over and monitor your baby’s heart rate continuously for 20 minutes to make sure everything is normal. You will be asked to sign a form to say that you agree to have the procedure.
Your baby’s position will be checked using a portable scanner. You will be given a small injection of a drug called Terbutaline which will help your uterus (womb) to relax and therefore increase the chance of success. You will be asked to lie flat on the bed and the doctor will gently try to turn the baby in a forward or backward manner. If the doctor cannot turn your baby easily within a few minutes, they will stop trying.
Whatever the result, the midwife will monitor your baby’s heart rate again for a further 20 minutes before you go home.
What is the success rate?
Around 75% (3/4) of babies will be successfully turned to a head down position. This will mean that the pregnancy can then continue as normal with a good chance of a straightforward labour and birth.
If the ECV doesn’t work the doctor will discuss with you your options for the birth. In this hospital we normally advise that babies that remain breech at the end of pregnancy are born by Caesarean.
Is there anything I can do that might help turn the baby?
Positioning in late pregnancy
Some people believe that getting into certain positions (such as on all fours) late in pregnancy can encourage a baby to turn by itself; however, there is no significant research that shows that this will definitely work. Please ask your midwife to explain what you should do if you would like to try this.
Complementary therapies: Moxibustion
This is a traditional Chinese technique using ‘moxa sticks’ (made from an herb) as a gentle heat source applied to acupuncture points on your feet. Some scientific studies suggest it can be effective, but it hasn’t been researched well enough for us to be sure.
Some women like to try other Complementary therapies such as homeopathy, but again there is not enough evidence to be sure that these are useful. There is no evidence to suggest that Moxibustion or other complementary therapies carried out by an appropriately trained practitioner is harmful to you or your baby, but we advise you check with your midwife or doctor first.