Turning a Breech Baby: External Cephalic Version

Hi, Mama. If you’re reading this, your pregnancy is not going the way you planned. It’s kind of ironic. Only 4% of babies reach full-term in the breech position. Yet somehow, someway, your baby fell into that statistic. 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 planned c-section, or have an external cephalic version (ECV).

If you’re in the same boat, I feel you.

Turning a Breech Baby: External Cephalic Version

Most likely, your doctor has already recommended an ECV to turn your baby. If you’re anything like me, there are questions floating around in your head: Should I have an ECV or a c-section? Is an ECV safe for my baby? My goal is to answer these questions and give you the info you need to decide if you should have an external cephalic version.

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.

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:

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.

What is an External Cephalic Version?

An external cephalic version is a non-invasive procedure that attempts to turn a breech 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 c-section. 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 potentially painful waste of time for another.

I carefully weighed the pros and cons of an ECV and decided that it wasn’t right for our situation. However, it could be a great choice for you. The purpose of this post isn’t sway you one way or another. I want to give you the information you need, so you can decide if an ECV is the best option for you and your baby.


5 Fast Facts About An External Cephalic Version

1: How is an ECV Performed?

An external cephalic version is a medical procedure that attempts to turn breech babies 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.

An ECV is actually very simple. Most ECVs only take 4-16 minutes 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 push down onto your stomach and try to guide the baby into the correct position. I know this sounds gruesome, but honestly, it isn’t.

If you’re looking for an ECV success story, this Youtube video shows exactly how easy and painless an ECV can be.


2: Is an ECV Painful?

Which brings me to the next point. Is an ECV painful? Like labor, it really depends. Some women experience no pain at all. Their biggest complaint is some discomfort (or like the woman in the video, “it feels funny”). Other women experience a significant amount of pain and require an epidural. It depends on a lot of personal factors, such as the baby’s position and your anatomy.

I didn’t get an ECV, so I can’t say one way or another. However, I do remember what it felt like for Cali to move into the breech position. It was unbearably painful and my entire abdomen felt sore the next day. The memory of that pain haunted me when I considered the ECV. I’m an extremely short woman and Cali was a very big baby. Our labor was difficult and despite my dreams of medicine-free, natural birth, I got an epidural. Do I regret it? Nope. But, my point is, the pain depends on you and your baby. If it does hurt, get an epidural. There’s no shame in an epidural.


How to Turn a Breech Baby - External Cephalic Version


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. Why so low? Sometimes the baby just will not cooperate. Maybe the doctor can’t get a good grasp on the baby. Sometimes the operation screeches to a halt due to fetal stress. In many instances, it’s not an all or nothing kind of deal. 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. This scenario was one of my biggest fears when I considered an ECV. The good news is, that result is actually rare. If you have an ECV after 37 weeks, the reversion rate is only 6-7%. Those are pretty good odds.

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

4: Factors that Affect the Success of an ECV

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

High BMI- I hated this one. Seriously, I already felt bad for gorging on ice cream and Mexican food. Then I found out that my gluttony also hindered an ECV. Studies can’t seem to agree on how much obesity affects the success rate of an ECV. Some studies indicate that a high BMI is insignificant. Older studies suggest that the effect is much greater. 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.

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.

Anterior Placenta- I researched the heck out of the factors surrounding a successful ECV with anterior placentas. An anterior placenta faces toward toward the abdomen. In my mind, this meant that it was a nice, cushy barrier between your baby and the doctor’s hands.The truth is, research indicates that a healthy anterior placenta only slightly affects the success rate. One study showed that moms with a normally positioned anterior placenta had a success rate of 46%, versus a posterior placenta’s 53%.

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, research seems to indicate otherwise. There was a slight increase in complications for VBAC moms, but nothing substantial.

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 babies.

Related: Breech Births: What You Need to Know to Have a Breech Delivery

5: Risks of an ECV

My biggest fear going into an ECV was a placental abruption and the possibility of having an emergency c-section. If that’s your fear, let me tell you that it’s basically like being afraid of getting eaten by a shark while swimming at the beach. Yes, it does happen, but it’s extremely unlikely. Despite the sketchy success rates, 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 stress, but even that is super rare. Having said that, there 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. In rare cases, the cord may twist around the baby’s neck even further.
• Membrane rupture
• Fetal stress
• Fetal Risks Associated with Terbutaline (tachycardia, hyperglycemia, etc.)

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. I mean, you’re already there, right?

However, in most cases, they’ll probably just send you home. Most moms are totally comfortable going home that day. 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 Baby After 36 Weeks. Take note of the techniques that are advised only for mommies with currently breech babies. Spinning Babies is also an excellent resource.


The Question Remains: Should I Get an ECV?


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. In my case, I just had too many factors stacked against me to justify putting Cali at risk (even if that risk was 1%). I was overweight, a new mom, I had anterior placenta, Cali was Frank Breech, and my blood pressure was dangerously rising. Not to mention, my baby was already displaying a serious stubborn streak.

However, that doesn’t mean that an ECV isn’t right for you. An external cephalic version is very safe and it could turn your baby around. 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.

If you found my advice helpful, please share via the buttons below to help other moms-to-be. To read about the methods I used to turn my breech baby, check out my post, How to Turn a Breech Baby After 36 Weeks.


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

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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.