
Every pregnancy journey has its twists, quite literally, and when it's your first pregnancy, the stress and surprises multiply! From questions like Is the baby fine in there, to Is he getting enough nutrition, to Is he in the right position, all come to the surface! Yes, you read it right, even the position of the baby matters a lot and determines the delivery process. Breech position is a matter of concern for many parents, and in this blog, we will talk all about it and its impact on the delivery.
Synopsis
External Cephalic Version in Breech Babies
A breech baby is one whose feet are lying on the lower part of the uterus instead of the head. When a baby settles in a breech (feet- or bottom-first) position at term, External Cephalic Version offers a comforting twist in the story. External Cephalic Version is a gentle, manual technique performed by trained providers near 37 weeks of gestation, nudging the baby into a head-down position to significantly increase the likelihood of a safe vaginal birth.
Backed by major medical organisations across the globe, it has been shown to reduce cesarean rates by approximately two-thirds when applied appropriately. With success rates around 50–60%, External Cephalic Version provides an evidence-based, low-risk alternative, offering expectant families hope, choice, and a gentler path toward delivery.
Listed below are some major concerns that parents often have regarding this position and how helpful the External Cephalic Version technique is.
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When should we be worried about this position?
Before 34-36 weeks, the baby keeps moving, hence the breech position is not considered permanent. After 36 weeks, if the baby is head up, it is considered permanent. There is nothing to be worried about; it’s just a position in which the baby is comfortable.
Understanding Breech Position in Pregnancy: Causes, Concerns, and Treatment Options
When should we be worried about this position?
Before 34-36 weeks, the baby keeps moving, hence the breech position is not considered permanent. After 36 weeks, if the baby is head up, it is considered permanent. There is nothing to be worried about; it’s just a position in which the baby is comfortable.
Causes of a breech position in the baby?
Low-lying placenta, twin pregnancy, common in first pregnancies, too much or too little fluid around the baby.
What if I have a twin pregnancy and one baby is breech?
If your first baby is breech and the second is cephalic. Your gynaecologist in Dwarka will advise a caesarean section. If your first baby has a cephalic and your second breech, you can go for normal delivery, because after the 1st baby, which is head down, comes out, the second breech can come out easily, even if breech.
What is external cephalic version?
External Cephalic Version (ECV) is a manual procedure performed near term (usually around 37 weeks) where an experienced obstetrician applies pressure on your abdomen to turn a breech or transverse baby into the optimal head-down (vertex) position for vaginal delivery.
Why is an external cephalic version performed?
ECV is performed to convert a non-cephalic (breech) fetal presentation into a cephalic one, increasing the chances of a safer vaginal birth and reducing the likelihood of needing a cesarean section.
How common is an external cephalic version?
About 3–4% of babies remain in breech or transverse presentation at term, making ECV a relevant option in those cases.
Can any pregnant woman have an external cephalic version?
Not all women are eligible. Contraindications of external cephalic version include multiple pregnancy, low amniotic fluid, placenta previa, fetal anomalies, ruptured membranes, abnormal fetal heart activity, uterine abnormalities, or other maternal health conditions. Your obstetrician, along with your gynaecologist, will evaluate eligibility individually.
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Procedure Details
When Is ECV Performed?
ECV is typically offered around 37 weeks of gestation, once spontaneous fetal turning likelihood drops and before space becomes too limited in the womb. Breech position should be confirmed by 36 weeks via ultrasound or physical exam to allow scheduling. Performing ECV earlier may risk prematurity; later attempts often face reduced success due to crowding.
What Happens Before ECV?
Before the procedure, you’ll receive counselling and consent covering risks and benefits. An ultrasound evaluates presentation, placental location, and amniotic fluid. Fetal well-being is assessed via a nonstress test (NST). Tocolytic medication may be given to relax the uterus, and optional pain relief (nitrous oxide or epidural) is offered. You'll empty your bladder and lie tilted slightly to improve safety.
How Is ECV Performed?
An obstetrician (often with a second clinician) gently applies pressure on your abdomen to lift and rotate the breech upward and guide the baby into a forward or backward roll. Ultrasound and continuous fetal heart monitoring ensure safety; the procedure is stopped immediately if distress or excessive discomfort occurs. It typically takes a few minutes but may span up to two hours, including prep and monitoring.
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What Happens After The Procedure
After ECV, fetal heart rate, maternal vitals, and uterine activity are monitored for 30–60 minutes. Rh-negative mothers receive anti-D prophylaxis if indicated. Assuming stability, most patients go home the same day. You’ll resume routine prenatal care, often with a follow-up ultrasound within a week to ensure the fetus remains head-down. Avoid strenuous activity and report any bleeding, decreased fetal movement, or contractions immediately.
Success Rates of ECV
Overall success rate averages around 58% (range 40–64%). First-time mothers have lower success (~40–50 %), while multiparous individuals typically achieve ~60–70 % success. Outcomes are more favourable with an adequate amniotic fluid index (>7–10 cm), posterior placenta, non-engaged breech, and previous vaginal deliveries. Skilled providers also improve success. Spontaneous reversion to breech after ECV occurs in roughly 5–8 % of cases.
ECV remains a safe, guideline-endorsed option to lower cesarean rates for breech presentations, with well-defined patient selection and monitoring protocols ensuring optimal outcomes.
Risk and Benefits
What are the advantages of an external cephalic version?
ECV can significantly reduce the need for a cesarean delivery by turning a breech baby to a head-down position, increasing the likelihood of a vaginal birth. It lowers maternal surgical risks, hospital stay, and healthcare costs while facilitating the birth plan you prefer.
What are the complications of an external cephalic version?
Complications are rare but may include temporary fetal heart rate changes, premature rupture of membranes, placental abruption, cord prolapse, preterm labour, or vaginal bleeding. Emergency C-section may be needed if the baby shows signs of distress.
Recovery & Outlook
Can an external cephalic version make you go into labour?
Yes, though uncommon (<1%), ECV can trigger early labour. Because of this, it’s performed in a controlled setting with immediate delivery options available, if needed
What happens if an external cephalic version doesn't work?
If ECV fails, options include attempting again later or exploring alternatives like acupuncture, moxibustion, or the Webster chiropractic technique. Most often, cesarean delivery becomes the recommended and safer route, depending on your and your baby’s health.
Consult our Obstetrics and Gynaecology team in Manipal Hospitals Delhi if you need treatment and care.
FAQ's
ECV carries low complication rates (~1–2%), with rare risks like placental abruption or fetal distress. Planned C‑sections have higher surgical and anaesthetic risks for the mother.
It often causes moderate discomfort or pain, typically rated around 4–6/10. Pain is usually brief, and practitioners offer pain relief or uterine relaxants during the procedure.
ECV is generally cost-effective since it avoids the higher expense of a C‑section. Charges may include ultrasound, monitoring, and possibly tocolytics or sedation for the procedure.
Lie on your left side with pillows under your bump and between your knees to improve comfort, reduce reflux, and encourage fetal turning, though its effect on breech position remains debated.
Most breech babies are healthy. The main concern is increased delivery complications, managed through planned C‑section or ECV. Many survive and thrive without long-term issues.
No. ECV must be performed by trained professionals in a hospital setting with monitoring and emergency surgical backup if needed.