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External Cephalic Version (ECV)

ECV, External Cephalic Version, Menopause Center of Los Angeles External Cephalic Version, also known simply as “version,” is a non-surgical procedure for turning the baby from a breech or transverse position to a head-first position before the mother goes into labor.

In breech position, the baby is poised to come out feet first or buttocks first. In transverse position, the baby is laying sideways across the mother’s pelvis. Neither of these positions is well-suited for a vaginal delivery. Before labor begins, your OB-GYN will try to position the baby head-first, and if the procedure is unsuccessful, a Cesarean birth might be recommended to preserve the health of you and your baby.

Version Procedure

Usually a version is conducted around 37 weeks. Before 36 weeks, there’s a good chance that the baby will turn around on its own. Too long after that, the baby may start to descend into the pelvis, which would make a version much more difficult.

Version is typically performed in a hospital or surgical center. This is because there is a very small chance that the procedure will trigger early labor or put the fetus into distress. In the worst case scenario, the doctor would perform an emergency Cesarean section.

To avoid the worst case scenario, your doctor will continually monitor the baby’s position and health with a fetal ultrasound and electronic fetal heart monitoring. If the baby becomes distressed, the doctor may stop the version procedure.

The doctor will administer drugs to relax the uterine muscles and prevent contractions, and then firmly but gently press their hands on the surface of your tummy to rotate the baby’s head closer towards the pelvis.

The procedure is considerably uncomfortable for the mother, especially if it triggers uterine contractions. Your doctor may suggest an epidural anesthetic to help you relax.

Is Version Right for My Pregnancy?

The success rate for version procedures is just under 60%. Some conditions help a version to be successful, and some conditions make a version impossible. Your doctor will evaluate your condition and make an appropriate recommendation.

A version can only be attempted when:

  • Obstetrics, Pregnancy Procedures, External Cephalic Version, Menopause Center of Los AngelesThe pregnancy is between 36-42 weeks
  • There is only one baby
  • The baby’s bottom, foot, or leg has not descended into the pelvis
  • There is plenty of amniotic fluid to facilitate the baby’s movement

Usually, a version will work best if the mother has already carried at least one pregnancy to term. This means that her uterine tissue is strong and elastic.

A version usually won’t be attempted if:

  • The water has broken
  • The mother has heart or other health problems
  • The mother’s uterus is abnormally shaped
  • There are problems with the placenta (placenta previa or placenta abruptio)
  • The fetus is in poor health or is in a dangerous position in the womb

External Cephalic Version Risks

Because your fetus will be under constant monitoring, the risks with this procedure are low. If anything starts to go wrong, there is immediate feedback from the ultrasound and fetal heartrate monitor to alert the doctor. The procedure can be stopped at any time.

However, as with any medical procedure, there are some risks for complication.

  • The procedure may squeeze or twist the umbilical cord, which would decrease blood flow and oxygen to the fetus.
  • The procedure may trigger preterm labor, beginning with your water breaking early (premature rupture of membranes).
  • The placenta may become separated from the uterine wall (placenta abruptio) or damage may be done to the uterus or umbilical cord.
  • There may be internal bleeding, causing the baby and mother’s blood to mix. If the two are Rh incompatible, the mother may need to be treated for Rh sensitization.

These complications are very rare. If any of these should arise, and you do require an emergency C-section, you are in the best possible hands with your doctor and the surgical staff on hand at the hospital.


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