Breech and External Cephalic Version (ECV)
It is recommended that all women with a breech baby at term should be offered ECV. The procedure attempts to turn the baby around in a somersault-action, so that they are ‘head down’ before labour starts. It is recommended that ECV is performed from 36 weeks’ of pregnancy where women are expecting their first baby and from 37 weeks’ where this is their second or subsequent baby. Depending on your situation, ECV can be performed right up until you give birth. Other studies have however, found benefits to offering ECV earlier in pregnancy when women are between 34 to 35 weeks, although this is undertaken cautiously because of the concern that it may cause preterm labour.
What does ECV involve?
If you have not already had a detailed scan to confirm that your baby is breech, this will be done. The scan enables the doctor to assess whether ECV is appropriate and to discuss in more detail what is involved.
You will be asked to lie down on the bed and the doctor will place their hands against the skin of your abdomen (tummy) and by pushing gently but firmly, will attempt to push your baby, so they turn into the head down position. You may also be offered a drug called Salbutamol or Terbutaline. This encourages the muscles of your uterus to relax, which makes it easier to turn the baby. Salbutamol makes your heart beat faster for a few minutes after having it, but this will settle down again. While the doctor is performing the ECV, an ultrasound scan is used to check the baby’s position and a fetal heart rate trace (Cardiotocograph – CTG) will be performed to ensure that your baby is well and not distressed by the procedure. See also our article, ‘Monitoring your baby’s heart rate in labour’.
If you are a Rhesus negative blood group you may be offered an anti D injection following the procedure. This is given as a precaution just in case a small amount of the baby’s blood leaks into your blood stream during the ECV. If your baby happens to be Rhesus positive; this may cause your body to produce antibodies against your baby’s blood.
Studies have found that in around 50% of all cases, ECV is successful. The procedure is not harmful to the baby and most babies will remain head down afterwards. ECV is more successful where the doctor is experienced in performing the procedure and where the breech baby is not ‘engaged’ (ie is in the pelvis).
If the baby doesn’t want to turn, it is possible for the doctor to have another attempt on another day. ECV can be uncomfortable but you can ask the doctor to stop at any time; some women will decline a further attempt for this reason.
Is ECV safe for everyone?
ECV is generally safe and does not cause labour to begin; however, like any medical procedure, complications can arise. The baby’s heart beat is monitored before, during and following ECV, and in around 0.5% of ECVs the baby will need to be delivered by emergency section immediately following the procedure. This is due to bleeding from the placenta (afterbirth), because of changes to the baby’s heart beat or because the membranes have ruptured. For these reasons, an ECV is only ever performed in facilities where the baby can be delivered by caesarean section, should the need arise.
There are a number of situations in pregnancy when your doctor would advise against performing ECV because the procedure could prove harmful either to you and/or your baby. Circumstances when this would apply include the following:
- ECV is contraindicated in multiple pregnancies
- Is not undertaken if you have a history of problems with your uterus – this can include uterine surgery
- Your membranes have ruptured
- Vaginal bleeding that has occurred in the week before your planned ECV
- ECV is contraindicated where there are any concerns about your baby’s health and wellbeing. This includes any concerns about the rate and pattern of your baby’s heart beat
- You need a caesarean section for other reasons
- Your uterus is a different shape to the usual pear-shape; some women have a heart-shaped uterus (called a ‘bicornuate’ uterus).
There are other circumstances which the doctor would want to discuss with you before making the decision to perform ECV. These aren’t as serious as those listed above, but the doctor will still want to make sure that ECV would not cause harm to you and/or your baby’s health and wellbeing. They include the following:
- Where you have hypertension (raised blood pressure)
- Your baby’s growth is restricted (they are smaller than they should be)
- Unstable lie – where your baby’s position is not stable and keeps changing
- Where there is a smaller volume of amniotic fluid around your baby than there should be (called oligohydramnios).