Is an ECV Worth It? Weighing the Risks and Benefits of ECVs

When I found out that my baby was breech at 36 weeks, the doctor laid three options out for me: figure out a way to turn my baby naturally, schedule a c-section, or undergo an external cephalic version (ECV). I tried to weigh the benefits and disadvantage of this procedure. Is an ECV worth it? Is it safe for my baby. Honestly, the mixed stories about this procedure terrified me.

Turning a Breech Baby: External Cephalic Version

If you’re reading this, your pregnancy is probably not going the way you planned. Only 4% of babies reach full-term in the breech position. Yet somehow, someway, your baby fell into that statistic. I feel for you. In this post, we’re going to weigh the pros and cons of this procedure, so you can decide if its the best for your little one.


This post may contain affiliate links. If 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. Medical Disclaimer: While I can give you advice based on my experience, none of this post should be substituted for actual medical advice.

What is an External Cephalic Version?

An external cephalic version is a non-invasive procedure that attempts to turn the baby head-down manually. It’s typically performed by your doctor or a highly-trained midwife. Many women opt for an ECV to avoid other breech delivery options, such as a breech birth or a planned cesarean.

Like these procedures, an ECV does have some associated risks, which we will get into soon.

I’ve noticed that moms either hate or love an ECV. I believe that is because of the varying rates of success based on the mother and the baby’s physiology, as well as the experience of the practitioner. Where an ECV could be a spectacular idea for one woman, it could also be a waste of time for another.

5 Facts You Need to Know Before Deciding to Have An External Cephalic Version

1: How is an ECV Performed?

An external cephalic version is a medical procedure that attempts to turn infants into the correct position by manual palpitation. It’s usually performed between 37-38 weeks. The likelihood of a successful ECV is much greater before 37 weeks; however, performing it during this time period can have several negative results. Your baby may decide to flip again or, worst case scenario, there could be complications from the procedure and your baby would be delivered too early.

To prepare for the procedure, your doctor will likely require an ultrasound to assess your baby’s health and perform a nonstress test. This will determine if your little one is a candidate for an ecv. 

An ECV is actually very simple. Most ECVs only take less than an hour to perform. Typically, you’re given a tocolytic to discourage your uterine walls from contracting. After hooking you up to a fetal monitor and performing one last ultrasound, your doctor will manually lift the baby out of the pelvis and guide them into the correct position. 

Now, assuming the ecv was successful, you’ll likely stay at the hospital for a couple hours to ensure that you don’t go into labor and to monitor your baby’s vitals. 

This Youtube video shows exactly how easy and painless an ECV can be.

My Breech Baby - 36 Weeks (1)
Me at about 34 weeks. I was blissfully unaware that my baby was breech! All I knew was that my belly hurt!

3: What is the Success Rate of an ECV?

This was the first question that came out of my mouth when the midwife told me about it. The fact is, ideal ECVs have about a 65% success rate. Which, considering that this is a non-invasive procedure, is pretty impressive to me.

What effects the success rate? Sometimes the baby just will not cooperate. Maybe the doctor can’t get a good grasp on the baby. Sometimes there’s not enough fluid to enable adequate movement. Fetal stress could interrupt the procedure.

In many instances, you can reschedule and try again.

Let’s say the external cephalic version goes well and you have a happy baby in the vertex position. Even after all of that drama, some babies decide to flip again. Mine would have certainly done this. My little girls flipped until they were 39 weeks. Having said that, this is event is actually rare. If you have an ECV after 37 weeks, the reversion rate is only 6-7%. Those are pretty good odds.

Best of all, according to one study, most women (75%) go on to have a vaginal delivery.

4: Things that Influence the Success Rate of an External Cephalic Versions

Several physiological factors can lower your chances for a successful external cephalic version. These factors range from the nearly insignificant to major:

  • High BMI- This is the main reason why I decided against an ECV the first time around. New studies can’t seem to agree on how much obesity affects the success rate of an ECV, but older studies suggest it may have a greater influence. However, several researchers agree that a low BMI can positively impact the success of an ECV.
  • Low Amniotic Fluid (AFI)- What really matters is your amniotic fluid. Low amniotic fluid can dramatically decrease the likelihood of a successful ECV. On the opposite end of the spectrum, an excess of amniotic fluid may allow your baby to flip after an ECV.
  • First-Time Moms and ECVs- First-time moms are less likely to have a successful ECV. The success rate of an ECV for a new mom is 33%, compared to the 66% of an experienced mom. This is for two reasons: your baby hasn’t broken in your hips yet, and your abdominal muscles are still nice and taut. Yet another reason why I decided against an ECV for my firstborn and chose one for my second.
  • Anterior Placenta- An anterior placenta faces toward the abdomen. One study showed that moms with a normally positioned anterior placenta had a success rate of 46%, versus a posterior placenta’s 53%. A pretty small difference, but worth mentioning.
  • VBAC and ECV- Once again, there’s a lot of hype about this. Some doctors do not believe that an ECV is safe for VBAC moms. However, some research indicates that there is a slight increase in complications for VBAC moms.
  • Baby’s Position— The percentage is small for this factor, but research seems to indicate that Frank Breech babies are less likely to be moved into the vertex position from an ECV than full breech positions.

5. ECV Risks

If you’re reading this post, you’ve probably already heard about the risks of an ECV. The biggest one being: an ECV may cause  a placental abruption and the possibility result in an emergency c-section.

I spoke to my OBGYN about this for both of my pregnancies. Both times, they said that this is extremely unlikely.

An ECV is considered to be a very safe medical procedure. One doctor conducted several studies surveying 3700 women. Out of all of those women, only two had complications severe enough to lead to an emergency c-section.

The most common risk of an ECV is temporary fetal distress, but even that is super rare. But what are the dangers of an ECV?

Here are some risks that you should consider, no matter how rare:

  • Placental abruption
  • Cord twists- sometimes there’s a reason why the baby wants to be in the breech position cases, the cord may twist around the baby’s neck even further.
  • Membrane rupture
  • Fetal distress
  • Fetal Risks Associated with Terbutaline (tachycardia, hyperglycemia, etc.)

Can an ECV Cause Brain Damage?

From my understanding, this is actually a possible complication of a breech vaginal delivery. In some, rare, cases the umbilical cord may become crushed, resulting in the oxygen and nutrients to become blocked. The end result is nerve or brain damage. 

Typically, your doctor will conduct an ultrasound before performing the procedure to confirm the placement of the baby and the umbilical cord. In all my research, I have not found anything to indicate that ECV increase the occurrence of brain damage. 

But talk to your doctor. If this is a major concern, let them know!

My Breech Baby - Is an ECV Worth It_
Breech Baby #2! While I didn’t feel like an ECV was the right call the first time around, I was confident that this procedure was the right choice this time. Baby had other plans though. She flipped right before our nonstress test. Then, again the next week (after teh the time for an ECV passed!) This baby actually flipped three times before she settled into the head-down position at 39 weeks.

6: You Can’t Have an ECV If…

You have any of these conditions:

  • Placenta previa
  • You are pregnant with multiples—Just a note on this one, 90% of cases where Twin A is breech will result in a c-section. If Twin B is breech and you desperately desire a natural birth, your doctor might suggest a breech extraction.
  • Extreme hypertension
  • Fetal abnormalities
  • Uterus abnormalities
  • Intrauterine growth restrictions

ECV Aftercare

So, you’ve had the ECV and your baby is no longer breech. Congratulations! If you’re far enough in your gestation, your doctor may suggest inducing right then and there. This prevents your little acrobat from flipping again. My doctor said this isn’t the standard though. 

In most cases, if baby’s heart rate is good, they’ll probably just send you home.

Don’t worry if you’re sore for a couple days afterward. That’s pretty common. After you’ve rested up, it’s time to ensure that your baby stays vertex. About 25% cases of successful ECVs result in a c-section. This is primarily due to dystocia (which makes sense, considering awkward positioning and anatomy is usually the initial cause of breech presentations), fetal stress, or reverting to the breech presentation.

You worked hard to get that baby vertex. There are several exercises you can perform that will encourage your baby to stay in the right position. I have listed out a few of those exercises in my article, How to Turn a Breech After 36 Weeks.

Just remember that some of the exercises are advised only for mommies with a baby in the breech position.

 Spinning Babies is also an excellent resource.

Benefits and Risks of ECV - External Cephalic Version (1)

So, is an ECV right for You?

It’s a tough question to answer. The serious complications associated with an ECV are extremely rare, and although the results are a little sporadic, many women have nothing to lose.

For my first pregnancy, I had too many factors stacked against me to justify the risk (even if that risk was 1%). I was overweight, a new mom, I had an anterior placenta, my baby was Frank Breech, and my blood pressure was dangerously rising.

But remember, the second time around, I felt very confident in my doctor’s ability to perform an ecv, and it felt like the right choice for us. 

Weigh the benefits and risks, Mama. Only you can decide if an ECV is right for your situation. If you’re still undecided, I’ve compiled a quick list to display the pros and cons of an external cephalic version vs. a C-section. I hope that helps as well. 

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  1. I had an ECV at 36 weeks for my 1st baby. Baby didn’t budge an inch, but the doctor did break my waters in the process. So a simple ‘low risk’ procedure ended up in an emergency C-section. Bottom line – any intervention comes with risks.

    1. Thanks for sharing your story, Hayley! Wow, scary! I’m so glad everything turned out okay for you guys. I know that MOST ECVs take off without a hitch, but that’s the kind of scenario I was afraid of too.