What is external cephalic version?

An external cephalic version is a procedure used to help turn a baby in the womb before delivery. During the procedure, your healthcare provider places their hands on the outside of your belly and attempts to manually turn the baby.

This procedure may be recommended if your baby is in a breech position. This means that their bottom or feet are pointing down toward the vagina, and their head is at the top of your uterus, near your rib cage. A vaginal breech birth is more complicated than a birth where the baby is head down, so it’s preferable that baby is head down before labor starts.

Some women opt to birth their babies via cesarean delivery (C-section) rather than attempt a vaginal breech birth if they’re near or past their estimated due date and the baby still hasn’t turned.

Is it safe?

Most women who are 37 weeks pregnant with a baby in the breech position are candidates for an external cephalic version. The procedure has been found to be successful in turning these babies into a head-down position in around 50 percent of cases. Since breech babies often result in C-sections, a successful external cephalic version may reduce your need for this type of delivery, which is considered an abdominal surgery.

There are some situations in which your healthcare providers may suggest an external cephalic version isn’t right for you. This procedure may not be right for you if:

  • you’re already in labor or experiencing any vaginal bleeding
  • you’ve had any issues with your placenta during the pregnancy
  • there are signs of or concerns for fetal distress
  • you are pregnant with more than one baby, such as twins or triplets
  • you have any structural abnormalities in your uterus, like large fibroids

Your healthcare provider may also advise against the procedure if you’ve had a previous C-section, your baby is suspected to be larger than average, or you have low or high levels of amniotic fluid. These risk factors are based upon clinical opinion, so you should talk with your healthcare provider to see what they recommend based on your individual pregnancy.

You discuss external cephalic version between 34 and 37 weeks of pregnancy with your doctor if your baby is noted to be breech. Babies often turn on their own before 34 weeks, so there is no need to attempt the procedure earlier in the pregnancy.

The procedure does increase your risk for premature labor and fetal distress. For that reason, most healthcare providers recommend waiting until you’re at term, or 37 weeks pregnant, to attempt this procedure. That reduces risk for complications in your baby if you do need to deliver shortly following the procedure.

You can also talk with your doctor about waiting past 37 weeks, as the baby may spontaneously turn to a head-down position.

The most common risk with an external cephalic version is a temporary change in your baby’s heart rate, which occurs in about 5 percent of cases. Serious complications are extremely rare but can include the need for emergency C-section, vaginal bleeding, loss of amniotic fluid, and umbilical cord prolapse.

What to expect during the procedure

The procedure will normally be performed by an obstetrician. During an external cephalic version, your doctor will place their hand on your belly to physically push the baby into the optimal position. The procedure usually takes around 5 minutes and your baby’s heart rate will be monitored before, during, and after the procedure. If your doctor suspects your baby isn’t responding well to the procedure, it will be stopped.

Many women report that the procedure is uncomfortable, but medications can be used to reduce the amount of pain felt. Using certain medications during the procedure may also increase the chances of successfully turning the baby. This may be because the medication helps your muscles and uterus relax, allowing the healthcare provider to successfully turn the baby more easily.

How will this procedure affect labor and delivery?

If an external cephalic version is successful, then most of the time labor progresses in a regular way following the procedure. The procedure doesn’t generally affect the length of your labor.

There is a small risk that the procedure will rupture membranes e. This can mean that you will begin labor earlier than you might otherwise have done, and your contractions may be more intense from the beginning of labor instead of building in intensity as the labor progresses.

If the procedure is unsuccessful and your baby remains in the breech position, you could opt for a C-section or choose to attempt a vaginal breech delivery.

One of the main risks involved with a vaginal breech delivery is that your baby’s head could become trapped in the birth canal. The other serious concern is umbilical cord prolapse. With umbilical cord prolapse, the umbilical cord leaves your body before your baby. That increases the risk of the cord becoming compressed during delivery, which cuts off the baby’s supply of oxygen and nutrients.

Both of these complications are a medical emergency. Evidence does show an increased risk of perinatal mortality in planned vaginal breech birth as opposed to a C-section with breech presentation.

Are there other ways to turn the baby?

There are a number of different exercises you can try to attempt to turn your baby from the breech position, though these haven’t been proven in studies to be effective in spontaneously turning the breech baby. Always talk to your healthcare provider before trying these exercises to make sure that they are safe for your pregnancy.

Hip tilt

  1. Lie on the floor in front of a sofa or chair, with your feet on the sofa or chair. Place cushions under your hips to offer additional support. Your hips should be elevated about 1.5 feet above your head, and your body should be at a 45-degree angle.
  2. Hold this position for 10 to 15 minutes, three times a day. It’s best to do this when your baby is active.

Pelvic rotations

  1. Stand or sit on an exercise or birthing ball.
  2. Once you are in position, gently rotate your hips clockwise in a circular movement. Repeat 10 rotations.
  3. Switch directions, rotating your hips counterclockwise for 10 rotations.
  4. Repeated three times a day

Rocking back and forth

  1. Place your hands and knees on the floor.
  2. Keeping your hands and knees in place, gently rock your body back and forth.
  3. Do this for 15 minutes. Repeat up to three times a day.

Walk or swim

  1. Walk, swim, or engage in another low-impact exercise.
  2. Do this for 30 minutes a day. Staying active may help your baby move out of the breech position.

The takeaway

It’s recommended that an external cephalic version be offered to all women who have a baby in breech position at or close to term, where there are no other complications. The procedure has been shown to be successful in around half of all cases and may lower the likelihood that a C-section will be needed. There are some possible risks, so be sure to discuss the risks and benefits with your healthcare provider before moving forward with this procedure.