Ask a Doctor

Jennifer L. Papp, DO
Doctors Obstetrics and Gynecology
5131 Beacon Hill Rd., Ste 220B  
Columbus, Ohio 43228
(614) 544-2430

Q: What is External Cephalic Version (Breech) and What Do I Need to Know?

A: External cephalic version (ECV) is a procedure used to turn a baby from breech position or side-lying position into a head-down position before labor begins.  Once a head-down position is achieved, the chances for a vaginal delivery increase.  Patients who have completed 36 weeks of pregnancy can be offered ECV.  The average success rate is 58%.  However, about 4% of babies return to breech position after a successful version.

Prior to attempting ECV, patients should have an ultrasound examination.  The baby should also be evaluated using a non-stress test prior to initiation of the procedure.  ECV should be performed in a facility capable of performing an emergency cesarean delivery.

Before the version attempt, the patient might be given an injection of medication to relax the uterus and prevent uterine contractions.  Some patients might also receive epidural anesthesia to help them relax and decrease the potential pain associated with the procedure.  ECV may be performed by one person or two.  The doctor will place both hands on the surface of the abdomen one by the baby's head and the other by the buttocks and then push and roll the baby to a head-down position.  Patients may feel some discomfort during the version, especially if it causes the uterus to contract.  A version will be stopped if the baby has significant heart rate changes, if there is discomfort to the patient, if the attempt cannot be completed easily or is unsuccessful after a brief period.  Following the attempt, a nonstress test is repeated and the patient is monitored until stable.

A successful version increases the probability that a baby will be in the head-down position for an uncomplicated vaginal delivery.  With frequent monitoring, the risks of external cephalic version to the mother and baby are low.  It is important to remember that not all patients are candidates for ECV based on certain maternal and fetal factors.  As with all medical procedures the potential risks and benefits must be carefully balanced and these should be thoroughly reviewed with your obstetrician.