Turning a Breech Baby: External Cephalic Version vs. a C-Section

If your baby is breech after 36 weeks, you have a difficult choice to make. This late in the pregnancy game, you have three options: coax that stubborn baby to turn naturally, have a doctor perform an external cephalic version (ECV), or schedule a c-section. When I found out that my baby was breech, I wrestled with the idea of an external cephalic version vs. a c-section endlessly. Now on the other side, I’ve compiled this quick external cephalic version vs. c-section pros and cons list to help you decide which procedure is best for your family.

About the Breech Baby Series

I’m Erin and my passion is helping moms-to-be and new moms overcome their baby blunders. This topic, breech babies, is very close to my heart.

External Cephalic Version vs a C-section Pros and Cons

I found out that my baby was when I was 36 weeks pregnant.

This discovery started a frantic race to turn my breech baby before 39 weeks or face a planned c-section. During this time, I was confused, disappointed, and a little scared. The research and articles on breech pregnancies is vast, but overwhelming. But at the end of the day, I found the techniques that worked and turned my breech baby at 39 weeks.

That’s why I created this Breech Baby Series. I hope here you’ll find all of the answers you need to cope with your breech pregnancy.

Here are the other posts in the Breech Baby Series:

External Cephalic Version vs C Section - Pros and Cons

This post may contain affiliate linksIf you make a purchase from one of the links I will make a small commission at no charge to you. I only recommend what I trust. Blunders in Babyland does not diagnose, treat, or give out any professional advice for any medical conditions. 

Pros and Cons of an External Cephalic Version

An external cephalic version attempts to turn a breech baby manually. At the beginning of the procedure, the doctor will generally administer terbutaline to prevent early labor, confirm the baby’s position with an ultrasound, and palpitate for your baby’s little booty and head. An ECV is considered a noninvasive, very safe procedure. The caveat is, an ECV only has a 60% success rate, even in the best of situations. In addition, some mothers worry about the safety of the baby and the chance of a reversion at a later date.

Related Post: Turning a Breech Baby: External Cephalic Version


  • Average 60% success rate
  • Noninvasive procedure
  • Minimal recovery time (most patients can go home that day)
  • Dramatically increases the chance of giving birth vaginally
  • Quick. On average, lasts between 4-16 minutes.
  • Many women don’t require pain medications for the procedure
  • If ECV is successful, you’ll receive the benefits of a vaginal birth, such as shorter recovery, less post-partum complications, increased success with breastfeeding, etc.


  • Average 40% failure rate. This percentage ranges based on certain factors.
  • Cumulative 1% increased risk of serious complications, such as a placental abruption, bleeding, emergency c-section, or infant mortality
  • 5% chance of temporary fetal heart distress
  • Many ECVs require terbutaline- Short term risks to the infant include tachycardia, hyperglycemia, hypertension. Some studies have correlated exposure to terbutaline in the third trimester with impaired developmental abilities, such as cognitive, motor, and psychiatric.
  • Soreness is a reported side-effect
  • Roughly 6% chance the baby will revert to breech if performed after 37 weeks (16% if performed before)
  • Increased chance of a c-section at a later date
  • If baby does revert to a breech position, an emergency c-section may be required

Pros and Cons of a Planned C-Section

When I first considered an external cephalic version vs. a c-section, it seemed like a no-brainer. A c-section was an anathema to me.

The women in my family are basically genetically engineered for childbearing. Wide hips, big boobs, extremely efficient fertility rates (we breathe and we get pregnant). So, giving birth was the one thing I knew I would be good at. I never considered a c-section; I would have literally been the only woman in my family to have one. A c-section was the ultimate failure.

If you find yourself feeling the same way, STOP!

Like most things attached to motherhood, these preconceptions are ridiculous. Planned c-sections are SO low-key, extremely convenient, offer many of the same advantages as a natural birth, and in no way reflect your birthing success.


• Convenient and Low-stress— birth is planned, you’re able to plan your maternity leave more efficiently, very little unknowns.
• Can opt for a “Gentle C-Section” or “Patient-Centered C-Section”; This focuses on the natural aspects of birth, such as immediate skin-to-skin, delayed cord-clamping, immediate breastfeeding etc. Many doctors are willing to make these accommodations as long as the infant is safe.
• Almost zero risk to the baby
• VBAC is a very viable option for the next child
• Can choose a surgeon, whereas with emergency c-section, a surgeon may be assigned that will not comply with your birth plan


For Baby

• Low AGRAR score
• Small chance that your baby may receive a minor cut from surgery

For Mother

Maternal mortality rate higher than vaginal births
•  Small increased risk of severe postpartum complications, such as infections or blood clots.
• Longer recovery rate— 3-5 days in the hospital, extended home recovery with physical limitations.
• Other c-section related risks, such as accidental incisions and additional surgeries.
• Future VBAC complications (less than 1% risk for a uterine rupture)
• More likely to have c-section in the future (however, the same applies to breech pregnancies, according to some studies)
• The Scar.

Final Thoughts on an External Cephalic Version vs. a C-section

An external cephalic version vs. a c-section is not a cut and dry comparison. Both procedures have incredibly low complication rates and both are considered extremely safe for the mother and baby. An ECV represents a slightly increased risk to your baby, whereas a c-section represents a slightly increased risk to you. Ultimately, the decision depends on your personal situation. Whichever procedure you opt for, be confident that you are making the right decision for your child. Other women may make a different choice, and some people will criticize you for your decision, but only you know your situation.

Many moms have so many negative feelings about both procedures, so I want to encourage you that there is no “right” or “wrong” decision here. Do what’s best for you and your little one!

If you opt for an ECV, you are not being “selfish” for attempting to have a natural birth. If you schedule a c-section, you are still having a “real” birth and you are absolutely not a failure.

No woman that has carried a baby for 9 months straight should believe either of these lies!

On a final note, if you’re nearing D-Day, don’t lose hope. You can still turn that baby around. I did! If you want to know how I turned my baby at 39 weeks, check out my earlier post, How to Turn a Breech Baby After 36 Weeks. I don’t care what they say; it ain’t over until the bloated pregnant lady sings.

I hope this external cephalic version vs. a c-section pros and cons list was helpful to you. Please let me and other mommies know your story and experiences in the comments below.

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One Comment

  1. This is very helpful, thanks! A good summary of all of the data.

    I do think it is helpful to note that the fatality risk of a c-section, while ~11 times higher than vaginal birth is still only 2.2 in 100,000 (according to Dr. Google). Compare that to the largest, randomized study I was able to find on ECVs and infant mortality, in which 4 of the ~2500 ECVs resulted in infant death. Now, this study did not specifically establish causality, so it’s difficult to ascertain whether those 4 deaths were directly caused by the ECV.

    None of this makes the decision for my wife and me very easy, but we still have 24 hours before our ECV…we have time, right?

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