Turning a breech baby by external cephalic version (ECV)

Most babies are in a head-down position before birth. But sometimes, a baby is positioned with their bottom or feet facing down instead. This is called the breech position. Many babies are in the breech position earlier in pregnancy but turn naturally before birth. If your baby is still in breech later in pregnancy, your midwife or doctor may talk to you about trying to turn your baby.

Although breech babies can be delivered vaginally, it is generally safer and easier to deliver babies head first.

Most women with a breech baby after 34 weeks can have an ECV. You cannot have an ECV if:

• you have had recent vaginal bleeding
• your placenta is too low in the uterus
• your baby has an irregular heartbeat or is not growing well
• there is too little fluid around the baby, or your waters have broken
• you are pregnant with twins or more
• you have an unusually shaped uterus.

Before the procedure, you will have:

• an ultrasound to confirm your baby’s position
• a heart rate check to make sure your baby is well
• medicine to relax your uterus (this is safe and often used to stop early labour).

The procedure may feel uncomfortable but should not be painful. During the procedure you will like down while the doctor finds your baby's head and bottom. They will then use their hands to try to gently turn your baby.

Pain relief

You may be offered an epidural (anaesthetic injected into your lower back) to numb the lower half of your body. This makes the procedure more comfortable and increases the chances of success.

ECV is a safe procedure and is done under ultrasound monitoring. However, there is a very small risk (less than 1%) of:

• your waters breaking early
• a small amount of bleeding
• the umbilical cord being compressed, reducing blood flow to the baby
• changes in your baby’s heart rate, which might lead to an emergency caesarean
• your baby returning to a breech position after a successful ECV.

After an ECV:

• if your baby turns successfully, you can go home and continue with regular pregnancy care
• if the first attempt is unsuccessful, you may be able to try again with pain relief
• if your baby stays breech, your doctor or midwife will discuss your birth options with you.

Some breech babies can be born vaginally, but there is a higher risk of complications such as umbilical cord issues or reduced oxygen supply.

If you are healthy, near your due date, and your baby is growing well, your midwife or doctor may discuss a vaginal breech birth with you. However, most breech babies are delivered by caesarean section.