Pregnancy is a very exciting and beautiful time in every mother's life. As the baby grows inside the womb day by day, those expectations increase even more. So when this time finally arrives, that is, when you are about 36 weeks old, your doctor may tell you, "The baby is still in the breech position." Sometimes hearing this can make you a little scared and worried. You may think, "Oh, will I have to have a cesarean section?" But don't worry. In most cases, there is a special method that can turn the baby back into the correct position, that is, head down. That is the method we are going to talk about today.
What is External Cephalic Version (ECV)?
Simply put, External Cephalic Version , which we call (ECV) for short, is a procedure in which the doctor places his hands on the outside of your abdomen and very carefully rotates the baby inside the womb, turning it so that the head is down.
Normally, the baby rotates back and forth in the womb during the early months of pregnancy. However, by about 36 weeks, as labor approaches, most babies naturally turn into a head-down position (cephalic or vertex presentation). This is the best position for a normal vaginal birth.
But some babies may not turn like that, but may be in a breech position or transverse lie. That's when your doctor will talk to you and suggest the ECV procedure. This is done to try to increase the chances of a normal delivery without having to go through surgery.
Are there times when an ECV cannot be performed?
Yes, not every pregnant woman can have ECV. Your safety and that of your baby are the most important things. Therefore, doctors do not recommend this procedure if you have certain health conditions. Your doctor will review your complete health history to determine if this is right for you.
The table below can explain this further.
| Reasons for not using the ECV method | |
|---|---|
| Decreased amount of amniotic fluid in the uterus. | If you have had vaginal bleeding before. |
| If you are pregnant with twins or more. | If the baby's heart rate is unusually low or high. |
| If the placenta is located covering the cervix completely or partially (placenta previa). | If your uterus is abnormally shaped. |
| If you have conditions such as high blood pressure or diabetes. | If you are scheduled to have a cesarean section for another health reason. |
At what point during pregnancy is this done?
Doctors usually perform this ECV procedure around 37 weeks of pregnancy . Why choose that time?
Remember, if you do it before 36 weeks, the baby may turn breech again. Also, sometimes the baby may turn head to the side on its own. If you do it after 38 weeks, the baby is already quite big, and there is less space inside the uterus. Then it becomes very difficult to turn the baby. Therefore, 37 weeks is considered the best and safest time for this procedure.
What happens when you do ECV? Let's find out step by step
This is done in a hospital, usually near an operating room, so that in the rare event of an emergency cesarean section, it can be prepared quickly.
1. Preparation: First, your doctor may give you medicine (an injection) to relax your uterine muscles, reduce pain, and possibly stop your uterus from contracting. He or she will then explain the entire procedure to you and answer any questions you may have.
2. Monitoring the baby's heartbeat: Next, you will be connected to a machine that can listen to the baby's heartbeat (CTG monitor). This will monitor the baby's condition throughout the ECV and after it is done. If at any point a change in the baby's heartbeat is detected, the procedure will be stopped immediately.
3. Ultrasound Scan: Next, an ultrasound scan is performed to check the exact location of the baby, the location of the placenta, and the amount of amniotic fluid surrounding the baby.
4. Turning the baby: This is the most important step. Your obstetrician will place his or her hands on your belly and, using very gentle but firm pressure, will slowly turn the baby into a head-down position. You may feel some pressure and discomfort in your belly at this point. This will last for a few minutes.
5. After the procedure: After the baby is successfully turned, you and your baby will be monitored for a while. Once everything is confirmed to be fine, you can go home the same day.
What are the chances of ECV being successful?
The success rate of ECV is slightly over 50% , meaning that more than one in two people who perform it successfully turns their baby.
The most important thing is that this is done by an experienced doctor, in a hospital with the right facilities.
There are several factors that contribute to this success:
- If there is a good amount of amniotic fluid in the uterus.
- If the baby has not yet moved into the pelvis.
- If you are a mother who has given birth before (because the walls of the uterus are more loose).
- If done at 37 weeks.
Sometimes, this can fail if the uterus is hard, or if the doctor is unable to get a good grip on the baby's head. Also, very rarely, the baby will revert to its previous position after being successfully turned.
What are the benefits and risks of this?
The biggest advantage is that it can increase the chances of a normal delivery without having to undergo a cesarean section . Since there are some risks involved in trying to deliver a breech baby naturally, a cesarean section is often recommended. So if the ECV is successful, you have a better chance of having the birth you were hoping for.
Of course, like all medical procedures, there are some very small risks. But these occur very rarely.
- Premature rupture of membranes
- Placental abruption
- Preterm labor
- Fetal distress
- Vaginal bleeding
These risks are very low (less than 1%). Your doctor will explain all this to you and decide whether ECV is safe for your condition. In case of an emergency, the hospital will have all the necessary facilities (ETU, operating room) ready for this.
What to do if the ECV doesn't work?
If the ECV is not successful, don't panic. What's most important is what's safest for you and your baby. Your doctor will talk to you and decide on the best next option. Most likely, a planned cesarean section (planned c-section) will be scheduled. This will allow you to deliver a healthy baby without any risks to both you and your baby.
Take-Home Message
- External Cephalic Version (ECV) is a safe medical procedure in which a baby in a breech position is turned head down by touching the outside of the abdomen.
- The main goal of this is to avoid a cesarean section and increase the chances of a normal delivery.
- This is usually done at 37 weeks of pregnancy. This is not for everyone, and your doctor will decide if it is right for you.
- You may feel some discomfort during this process, but it is temporary.
- The success rate is over 50%, and the risk is very low.
- Talk openly with your doctor about any concerns, fears, or doubts you have about ECV. The ultimate goal is always a healthy baby and a healthy mother.
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