You’re nearing full term and getting excited for the big day.

You’re about to meet your bundle of joy!

Then, at your prenatal appointment you’re told baby isn’t head down.

Now you’re not sure how birth will unfold.

You’ve already envisioned your birth experience and this new found information could change everything.

As the news begins to settle in you want to know what this can mean for birth. When you think of your baby not being head down you think C-section because that’s what we hear so often. You aren’t sure if baby will turn, if baby can turn or what your maternity care provider can do to help.

Is a C-section birth your only option?

Sometimes a C-section might be necessary, but it isn’t always.

If baby isn’t head down you have a few options:

Use alternative methods to facilitate movement, such as chiropractic care, acupuncture and at-home exercises to encourage optimal fetal positioning. If it results in a successful turn, you will likely wait for labour to begin spontaneously
Waiting for labour to begin spontaneously while hoping baby will turn right before or during labour (which is known to happen). Also being prepared for a vaginal breech birth or unscheduled c-section for a breech or transverse baby
Scheduled c-section around the estimated due date, or an emergency c-section if labour begins prior to the scheduled c-section
Attempt an external cephalic version (ECV) to get baby head down. If successful, some women will then opt for an induction, so baby is born before possibly turning again. Other women wait for labor to begin spontaneously

What Is An External Cephalic Version (ECV)?

An ECV is when your healthcare provider uses their hands externally on your belly to manually turn the baby into a head down position.

When deciding whether or not to attempt an ECV there are somethings to keep in mind.

Here are 5 things to consider when deciding about an ECV:

#1: Are You a Candidate For an ECV?

While ECVs are considered a safe option for some, the risks may not outweigh the benefits for others. Most providers will not perform an ECV before full term for a couple reasons. One, it could cause labor to begin or delivery could become necessary. Two, many babies turn on their own before being full-term. Only around 4% of babies are breech at full-term gestation.

If you have a breech or transverse pregnancy with only one baby you might be a candidate for an ECV. Most providers will not perform an ECV for multiples as there is more potential for complications.

You need to have no signs of placental concerns such as previa, bleeding or intrauterine growth restriction. Adequate fluid levels (you bag of waters must be intact) and baby having a good heart rate are also necessary for ECV.

You also need to be healthy with no signs of pregnancy induced hypertension or other pregnancy complications.

#2: Understanding How an ECV is Performed

Sometimes fear is simply that of the unknown. When you first hear baby isn’t head down a lot of the concern is not knowing how things will unfold. With an ECV, the fear can be similar, you aren’t sure what is going to happen.

Every provider is different so the steps may vary, but ECVs are pretty similar among most providers. Your ECV might unfold like this:

Some providers will draw labs to be sure of blood type and iron levels in case an emergency birth becomes necessary
A non-stress test is done to ensure baby is likely to tolerate the procedure well
An ultrasound is done to determine baby’s exact position
Baby’s heart rate is monitored before, during and after the ECV attempt
Some providers offer or recommend an epidural for the procedure
One or two healthcare providers will place their hand on your belly and attempt to gently maneuver baby into a head down position
Following the procedure, successful or not, another non-stress test might be performed to be sure baby handled the procedure well

ECV are successful about 65% of the time. The procedure is stopped if it seems baby will not safely turn, if the mother-to-be is too uncomfortable, if any placental concerns arise or if baby’s heart rate becomes concerning.

#3: Are You Comfortable With Attempting The Procedure?

An ECV can be physically uncomfortable for some as well as emotionally taxing. Being okay with the potential for discomfort and even pain (though many mamas do not report pain) is part of the decision making process.

Some providers will administer an epidural for an ECV. An epidural can eliminate pain and discomfort, but also weighing the benefit and risks of an epidural is important. An epidural can also help mama to relax, as well as her uterus. In rare cases, the relaxation alone can facilitate baby moving without the ECV being performed. An epidural might also be helpful in the case of emergency complications.

Baby is manually moved and guided from the outside. For some parents this is concerning. If an ECV is desired, choosing a care provider that is comfortable, confident and experienced with ECV can eliminate some concerns.

#4: Are You Prepared to Have Baby Today?

On the day of your ECV, it’s important to be prepared to give birth that day, just in case. If the version is successful, some (but not all) providers will offer an induction so baby does not have the opportunity to turn again.

If baby’s heart rate drops, there are signs of cord concerns, or there are any concerns about the placenta, an emergency c-section may become necessary.

If the version is successful and you and baby tolerate it well, you might be sent home to wait until labor begins on its own. Some babies do turn back to breech/transverse positions following a version. In this case some will attempt a second ECV.

Before the version, weigh the benefits and risks of this so you aren’t having to make a stressful decision in the moment.

#5: External Cephalic Version Risks

Knowing the benefits and the risks of an ECV will help you make an informed decision.

Some of the benefits of an ECV include:

The ability to have a low risk vaginal birth with baby head down
Possibly avoid a c-section which eliminates the risks associated with surgery
When successful, mama and baby reap the benefits of a vaginal birth
The possibility of a faster birth recovery than a c-section or vaginal birth with complications
When induction or c-section birth isn’t necessary and an ECV is successful, baby is able to be born spontaneously

Some risks associated with an ECV:

Complications during an ECV can necessitate an emergency c-section
A small risk of placental abruption, and risks associated with that
Cord compression, twisting, etc
Fetal distress
Premature rupture of membranes (water breaking before labour begins)

When pregnancy and birth deviate from what we expected, it can certainly hit us for six. Fortunately, there are several options available to help baby safely arrive earth-side. Making a decision can be difficult, but weighing your birth preferences, benefits and risks can help you decide if an ECV might be for you.