External Cephalic Version (ECV) – 5 Things to Consider Before Having One

External Cephalic Version (ECV) - 5 Things to Consider Before Having One

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.

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Maria Silver Pyanov is a mama of four energetic boys and one unique little girl. She is also a doula and childbirth educator. She's an advocate for birth options, and adequate prenatal care and support. She believes in the importance of rebuilding the village so no parent feels unsupported.


  1. Another thing to consider. Please get checked for a bicornuate uterus first & If you have one, I wouldn’t recommend having an ECV done.

    I went for the ECV & found it so painful. It had no effect on me & it was only during an emergency cesarean (after going through natural labour) that they discovered I had a bicornuate uterus which prevented bub turning. Apparently that was why it was so painful for me.

  2. if there’s another mom out there looking for answers (like I did before EV) I can hopefully help them out! I tried EVERY natural way to turn my breeched baby. Acupuncture twice with the moxiboustin technique, all the inversion exercise, walking, relaxing, etc, webster technique. I truly believe it was musculoskeletal in my case…the baby had trouble getting his head down my right side (which is where his head was stuck, he was in a transverse position). Anyway I wanted to try everything I could to do a natural birth (i haven’t gone into labor yet), so after a lot of going back and forth i decided to try external version at 37 weeks.

    First, you HAVE to have a good doctor. Mine was great but it took 3 to turn him. Secondly, partner needs to be with you i couldn’t have gotten through it without him. They tell you it shouldn’t hurt…and i watched a video where the woman did not seem to be in pain, but honestly it was painful but a very DOABLE pain. its hard to describe…its not nerve pain. Its a lot of pressure….also my baby wouldn’t turn the easy way so they had to completely flip him which may have been why mine was so intense. Normally procedure takes a few mins, mine took close to 20 mins. again, doctor has to be good. she enforced the staff to take plenty of breaks when I needed it and as soon as they stop so does the pressure and pain. again, its not nerve pain or stabbing or anything like that its just a TON of pressure….also afterwards my uterus went haywire for a few days. i actually thought i was going into labor. i could teen stand from the spams and pain shooting down my vagina. I think it was getting used to having the babes head there—whatever that was my exeprience but it was successful and i would totally do it all over again if i had to. hope that helps!

    1. Thanks. You are encouraging me. I am in the exact same boat. I have been doing excercises and chiropractor and everything else. My pregnancy was super easy and never once had an issue. And now i feel so defeated. He has been in the same position this whole time and i just cant get him to move.

  3. I have just had an ECV performed at 37 weeks. Baby was breech from 32 weeks. This is my 3rd baby. I had 2 normal previous pregnancies and vaginal births. I assumed this baby wouldn’t be any different and would turn in time for labour. What I wasn’t told was that 3rd babies are often breech because they have more room to move. Also they are unlikely to turn after 36 weeks. If I had known I would have tried excercises earlier to try to move baby to a head down position.
    I decided to go for the ECV believing this was a the best and safest option for me and my baby. I am 41 and due to age discrimination I am in a high risk category. In NHS years I’m apparently ancient! Allow a full day for ECV as there is a lot of waiting time and monitoring. I was given an injection in my tummy to relax the uterus, which was painless. I wasn’t expecting any pain during the ECV as I had watched it on YouTube and it looked uncomfortable but not painful. I had a young doctor that had just successfully performed a ECV on another lady which was encouraging. He tried to push baby one way but baby wouldn’t budge and I was shocked that it possibly hurt more than childbirth itself. I couldn’t have taken much of it but after a few minutes of trying, he tried turning the baby the other way which was a bearable pain. I can liken it to a firm massage which hurts but you know you will feel the benefit later! The whole thing took under 10 minutes. I will have another scan in a week to ensure baby hasn’t turned again. It was important for me to discuss my options. What happens after the baby is turned. They were keen to induce me a week before my due date which I am not. I think there are risks attached to induction and as both previous babies were late I don’t suppose this one will be early. Even with induction. I’m just not prepared to put myself or my baby under the stress of induction. I was pleased to hear that I can still have the baby naturally in a birthing centre. I can have a water birth and although I can’t have any additional monitoring of the placenta, I can have the option of a c section if I do go over my due date. So reflexology booked, lots of walking and a bit of the other!

    1. After having an ECV and baby successfully turning to head down position. I beat the system and the doctors by going into spontaneous labour and giving birth naturally to a beautiful baby girl. I say beat the system because what they don’t necessarily tell you is they will want to automatically induce you in the weeks following a successful ECV.

      Due also to my age I had to fight not to be induced. Only after a lot of stressful appointments did I finally get to the truth from a leading consultant. Because I am a fit 41 year old and had previous children naturally I am of no greater risk than any other woman and was allowed to go over my due date by 10 days, was supported with extra monitoring and had a wonderful experience at my birthing centre. Not in hospital, with continuous monitoring as I was originally told.

      After a pretty frightening third stage of labour, we discovered that the ambilical cord was around our baby’s neck. Our baby’s head had remained high after the ECV and the midwife said it explained a lot of the problems I had been experiencing. I truly believe the cord had wrapped around our baby’s neck during the ECV. I now know that although you are monitored and scanned before and after a ECV, the cord can not be seen on the scan. If I had of known this before, I would have never have gone through with having an ECV. This is not a risk we were told.

      Most importantly we have a healthy little girl. Our baby and I made a great team. I was told to get her out in 3 pushes and we did it!

  4. Yet another article which is all about the baby and treats the mother as a vessel.

    Does anyone ask the mother if she wants to put the baby first? Or is it all about the medics seeing the baby as their patient and wanting to avoid lawsuits blaming them for poor outcomes for the baby?

    We expectant mothers are not all the same. I know I can cope with bereavement. If my baby is dead, I don’t have to worry about her. I can’t cope with a C section or a traumatised child through a C section though.

    1. What kind of terrible thing is that to say? A human being- your child- inside of you should be of extreme importance to you. Yes, of course, the mother is a patient as well, but this procedure is to benefit both mother and baby. Your comment insinuates you’d rather your child die than for you to have to have a c-section. Horrid.

    2. I’m in this same boat my baby is breech and low and I’m scared to death of a c section I really want to be able to have her natural but in the end this is my child! I would rather die than something happen to my baby and in the end if a c section is what’s best for her then c section it is. I really hope and pray that once your baby comes you have your motherly instincts kick in because once u become a mother that baby needs to be put first and it’s so selfish u feel ur baby would be better off dead than u having to a c section

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