About 4 to 5% of babies are not in a “head-first” position at 36 weeks gestation. Most of these babies will still be in an abnormal position when labor starts and the most common recommendation in this situation is for the baby to be delivered by cesarean section. A cesarean section may be safer for the baby in this situation but, when compared to a vaginal delivery, a cesarean section may increase the mother's risks for complications such as bleeding or infection, and also involves a longer recovery time. A cesarean may also then be required by with future pregnancies, as well. External cephalic version (ECV) is a procedure that can make it less likely for a patient to need a cesarean section for abnormal position of the baby. External cephalic version refers to a procedure where, at about 36 to 38 weeks gestation, the baby is externally rotated to a “head-first” position so that vaginal delivery will be more likely.
Usually, these procedures are done in labor and delivery, so that if there is a problem (such as the baby’s heart beat slowing), the baby can be delivered immediately. These types of complications are very rare, occurring in less than 1% of ECV.
If your doctor notices that your baby is in something other than a “head-first” position at 36 to 37 weeks gestation, you may be referred to Rocky Mountain Perinatal Associates to discuss the possibility of an external cephalic version. An ultrasound will be performed to confirm the baby’s position (about 10% of the time, the baby will have already turned to a “head-first” position), as well as to look at the baby’s growth, amniotic fluid volume, placental position, etc. The risks and benefits of the procedure will be discussed with you, as will other options for delivery. The main benefit of ECV is giving you a better chance at an uncomplicated vaginal delivery. The main theoretic risks are complications such as bleeding or changes in the baby’s heart beat during the procedure that would require an immediate delivery but the risk of these types of complications is less than 1%.
If, after this discussion, you decide that you would like to try this procedure, it will be scheduled in the labor and delivery area. You should have nothing to eat or drink for 8 hours prior to the procedure. The procedure consists of trying to externally turn the baby to a head first position. The procedure involves firm pressure on your lower abdomen as the physician attempts to turn the baby to a head first position. If at any time you felt too much discomfort, the procedure is stopped. The entire procedure, whether it is successful or unsuccessful, lasts less than 5 minutes. ECV is successful in about 65 to 70% of cases in converting the baby to a “head-first” position. If the baby is converted to a “head-first” position, you will have about an 80 to 90% chance of delivering vaginally, although, sometimes, even when the procedure is successful, a patient can still end up with a cesarean section.
After the procedure, the baby will be placed back on the heart monitor for about 30 minutes and if the heart monitor is reassuring, you would generally be discharged. If the procedure is successful, you will follow up with your regular doctor while awaiting spontaneous labor. If the procedure is unsuccessful, a cesarean section may be scheduled, usually at about 39 weeks gestation or later. The chance of the baby turning back around after a successful procedure is less than 5%.
