- When Not To Do It
To perform an external cephalic version (ECV), the doctor needs to apply firm, steady pressure over the distended belly. Hence, a moderate amount of pain is felt during the procedure, which is tolerated by most women. To make you comfortable and minimize the pain, the doctor may give pain medication or epidural (into your spine) anesthesia. Uterine muscle relaxants may also be given to keep the discomfort at its minimal level.
ECV is a technique used by doctors to externally manipulate the baby’s position so that the head faces down toward the opening of the birth canal (cervix).
The newborn is more likely to position itself with its head downward (cephalic presentation) the birth canal by the 36th week of pregnancy. Cephalic presentation is the most normal position of the baby for a successful vaginal delivery. However, there are times when the baby’s hand or butt fixes itself near the uterine mouth even after the end of the 36th week. These positions are known as breech presentations, and they can make vaginal birth more difficult and even risky.
What makes you unfit for an external cephalic version?
External cephalic version (ECV) will not be attempted in all women who have the baby in breech presentation. You will be deemed unfit for ECV if
- You are carrying more than one baby.
- The baby suffers from some health issues.
- The amniotic fluid levels are too high or too low.
- Your reproductive system has certain abnormalities.
- The placenta is not in its normal position/place.
What is done before the external cephalic version?
Ultrasonography of the pelvic region will be performed to confirm the breech position and size of the baby.
The doctor may give medications to relax your uterus.
Both you and your baby’s heart rate will be monitored before and after the procedure.
How is the external cephalic version performed?
The doctor feels for the parts of the baby by pressing on your lower abdomen. Then, they apply firm pressure to bring the rolled-up head toward the mouth of the uterus (cervix). The doctor may need an assistant to help them. An ultrasonography machine can be used during this process to monitor the turning of the baby.
There will be mild to moderate pain while doing an external cephalic version (ECV). Throughout the procedure, the doctor will keep asking you whether you can bear the pain. However, if the pain becomes excruciating, the doctor will right away stop ECV. If any problems occur, an emergency cesarean delivery may also be planned immediately.
The ECV procedure will usually take a few minutes, whereas the entire monitoring process before and after ECV can take one to three hours.
What are the possible complications of an external cephalic version?
External cephalic version (ECV) carries few risks that include:
- Increased risk of membrane rupture (water breaking) just before labor
- Increased or decreased heart rate of the baby
- Placental abruption (early separation of the placenta from the uterus)
- Preterm labor (labor that occurs a few weeks before the due date)
The complications of ECV can manifest in the form of abdominal pain, vaginal bleeding, leaking of fluid from the vagina, increase in contractions, or decrease in the movements of the baby.
What are the alternatives to external cephalic versions?
External cephalic version (ECV) turns out to be successful in more than 50% of women. It has certainly helped in reducing the persistence of breech presentation during a full-term pregnancy. However, in some cases, babies return to their previous breech presentation even after ECV. At such times, ECV can be attempted again, but the increasing size of the baby with the passage of time poses difficulty to carry a hassle-free ECV.
If ECV fails or cannot be tried in certain women, the only options that remain are
- vaginal breech birth and
- cesarean section (90 out of 100 breech babies get delivered by planned cesarean delivery).
Your doctor will discuss which one of the two alternatives will be the most appropriate for you.
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Fok WY, et al. Maternal experience of pain during external cephalic version at term. Acta Obstet Gynecol Scand. 2005 Aug;84(8):748-51.
If Your Baby Is Breech. Available at: https://www.acog.org/womens-health/faqs/if-your-baby-is-breech
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