One of the biggest deterrence for a vaginal delivery is a baby that is in a breech position. There are a lot of risks and complications that can arise if you attempt a vaginal delivery while a baby is breech and many providers will encourage you to try something called EVC to turn the baby or opt for a scheduled C section.
So what is EVC and is it painful? Knowing what to expect and what your options are is important in making a decision if a vaginal delivery is still your goal!
- What is ECV and why do we do it?
- What can I expect and is it painful?
- What are the risks, benefits, and alternatives?
Table of Contents
What is Extra Cephalic Version or ECV?
External Cephalic Version, or commonly referred to as ECV, is a medical procedure designed to turn a baby from a breech position into a head-down position, ideally getting your baby in a position to have a smoother and safer vaginal birth. There can be a lot of apprehension for mothers going into ECV as they may not truly understand how it will work and what to expect.
Why is ECV Recommended for Breech Babies at 37 Weeks?
Breech positions occur when a baby is poised to come out buttocks or feet first during delivery. Ideally, the baby moves to a head-down, or cephalic, posture in preparation for birth on their own, as this minimizes complications for both mother and child. An External Cephalic Version becomes a consideration when a fetus remains in a breech position as the pregnancy approaches term.
The rationale behind targeting the 37-week mark for this procedure centers on a delicate balance: the baby is developed enough that complications are less likely, yet there’s usually still enough space and amniotic fluid to allow for a successful turn without inducing premature labor. At this gestational age, the likelihood of the baby reverting to a breech position after a successful ECV is also reduced, setting the stage for a safer vaginal delivery.
Who Can Undergo an ECV?
So who should and should not consider ECV? Generally, this procedure is considered for those nearing full-term pregnancy whose babies haven’t turned into the head-down position. To better understand if you may be a suitable candidate for ECV, let’s walk through the qualifying factors and the specific circumstances that may prevent you from undergoing this procedure.
- Eligibility Criteria: Those carrying a single baby who remains in a breech position as they approach 37 weeks of gestation often qualify for ECV. It’s particularly recommended if you’ve had a smooth pregnancy without serious complications. Sufficient amniotic fluid is also necessary to allow the baby the space to turn.
- Gestational Age: While the procedure is most commonly done at 37 weeks, your healthcare provider will determine the optimal time based on the specifics of your pregnancy.
- Normal Ultrasound: A prior ultrasound should show that the baby doesn’t have any abnormalities which would make vaginal delivery potentially unsafe post-turning.
- Non-Stress Test: A reassuring non-stress test would typically be required to ensure the baby is doing well and can tolerate the procedure.
- Healthcare Provider’s Discretion: Your provider’s comfort level with performing ECV is also a key factor. They will evaluate based on comprehensive medical historical data and other individual health aspects.
Conversely, certain situations could make ECV inadvisable. These include but aren’t limited to placental issues such as placenta previa, decreased levels of amniotic fluid, multiple pregnancies (twins, triplets, etc.), previous uterine surgery, or any condition that may put you or the baby at risk of complications from the procedure. You should engage in an open discussion with your healthcare provider about any potential risks in the context of your unique circumstances.
What Can You Expect in an ECV Procedure: Step-by-Step?
- Review of Medical History: Your provider most likely knows you medical history but in the case that a different provider is performing the procedure they should be fully aware of your medical history.
- Informed Consent: This means you should be given the opportunity to discuss the benefits, risks, and alternative forms of treatment to turn your breech baby. You should also be able to ask any questions you have until you feel you have enough information to move forward. (learn more about informed consent here)
- Prenatal Testing: Previous testing such as an ultrasound and other tests to assess the baby’s position, amniotic fluid levels, and check for any conditions that may complicate the procedure.
- Fetal Monitoring: Before the ECV begins, staff will connect you to monitors that track the baby’s heart rate and your uterine activity, ensuring that any signs of fetal distress are detected immediately.
- Administration of Medications: Some providers may give you medication to help relax the uterus, which can facilitate the turning process and potentially ease discomfort for you.
- Manual Maneuvering: Your healthcare provider applies firm but gentle pressure on your abdomen to encourage the baby into a head-down position, and they should be constantly communicating with you throughout the procedure.
- Ongoing Monitoring: The baby’s heart rate is monitored continuously to detect any signs of distress during the maneuver.
- Confirmation of Baby’s Position: An ultrasound is performed after the maneuver to ensure the baby is in the correct cephalic position.
- Post-Procedure Monitoring: Your provider will often have you remain under observation for a short time to make sure both you and the baby remain stable and there are no immediate complications after the ECV.
This is a quick look at how a midwife performs ECV. Midwives are known to use less interventions than most medical providers for those of you that are choosing midwifery care. This is why you see less monitoring devices throughout the procedure.
Is ECV Painful?
It is a perfectly reasonable concern for an expectant mothers to worry about whether the external cephalic version (ECV) procedure is painful. I can say it is not painless. However, the degree of discomfort depends on the individual and their situation. Reports of pain vary widely among individuals as pain is subjective.
The pressure of the manual pressure performed by your provider to turn the baby as they manual try to turn them is often described by most women as similar to intense menstrual cramps. Other women may feel a more acute sensation depending on factors such as the baby’s size, the amount of amniotic fluid, and your pain thresholds.
During ECV, you’re under close observation, and you provider will often take certain measures to manage discomfort and ensure your safety and that of your baby. Mild sedatives or pain relief medications may be administered to reduce the sensation of pain. It’s crucial for you to communicate with your healthcare provider throughout the procedure; informing them about your level of discomfort helps them tailor their techniques and make necessary adjustments to alleviate pain. You don’t have to be strong and suffer through.
While the idea of potential pain can be daunting, many women find the procedure tolerable and worth the result—a higher chance of a head-down baby and, therefore, a more likely scenario for a vaginal birth and decrease their risk of C-section.
What are Your Pain Relief Options?
There are several pain relief options available to support you through an ECV if you are concerned about pain.
- No pain medication: This allows you to perform the procedure in your providers office.
- Nitrous Oxide: This is a gas that is often called laughing gas. You may have used it during a dental procedure in the past. It will not take away the pain completely but can often help significantly and help you relax. It is often used during labor as well to provide pain relief.
- Regional analgesic: This could be an epidural or spinal block similar to what you would get during delivery of your baby. This can provide significant pain relief, making the procedure much more comfortable but does come with side effects so please discuss your options with your provider.
- Tocolytic medication: This could be a great option that helps relax the uterus and can in turn reduce your discomfort.
Apart from medicinal approaches, there are also non-medicinal strategies that can help manage pain and anxiety. Techniques such as deep breathing, visualization, or the presence of a support person can provide emotional comfort.
Some find listening to calming music or going through the procedure in a serene environment helps maintain a relaxed state. It’s essential to communicate with your healthcare provider about your pain tolerance and discuss which pain relief options are right for you.
What Are the Risks with ECV?
Turning a baby from a breech to a head-down position via external cephalic version (ECV) carries inherent uncertainties. Although often safe, complications such as:
- Premature rupture of membranes
- Placental abruption
- Preterm labor
- Fetal distress
- Vaginal bleeding
- Uterine contractions
You and the baby will be closely monitored for signs of distress or changes in heart rate using fetal monitoring technology throughout the process. To ensure if you do experience any of these complications your provider is ready to address them.
This is also why your healthcare provider will consider your complete medical history, gestational age, and specific pregnancy details. The position of the baby, the amount of amniotic fluid, and the flexibility of the uterus are also key factors in determining the appropriateness of ECV for you.
Your provider will carefully balance these risks against the potential benefits, aiming to facilitate a safe delivery while minimizing the need for a cesarean section. Ultimately, the decision to proceed with ECV should be made collaboratively with your informed consent.
What Can You Expect After the Procedure?
After completing an external cephalic version, You will stay under close monitoring by the healthcare team to watch for any signs of distress from you or the baby. Typically this will involve checking the baby’s heartbeat and your uterine activity to detect contractions or changes in the baby’s movement. It is common to feel cramping or discomfort after the procedure, but this usually subsides within a few hours.
Your provider will also go over with you anything you need to watch for at home and when you would need to call or come in and see them if you have any concerns. They will often also schedule a follow up visit with an ultrasound to confirm that your baby remains in the head down position.
This way you can continue to discuss the best steps moving forward to your upcoming birth. Whether ECV was successful or not, your medical team will want to make arrangements for the safest and most appropriate delivery possible.
What are My Other Alternatives or Options if ECV Fails?
If an external cephalic version (ECV) does not successfully reorient the baby into the head-down position, there are still other options to consider for your childbirth.
One Option: schedule a cesarean delivery. This may be the best option to ensure the safety of both the mother and baby, particularly if a breech position persists. If your baby keeps flipping there may be a reason for it that you and your provider can’t see. Don’t feel discouraged, your baby may be telling you that a C-section is the safest option for you.
Second Option: consult with a healthcare provider about the potential for a vaginal breech delivery. This path requires careful consideration of the specific circumstances and potential risks involved.
Other Alternative Options: Some parents also choose to explore additional alternative methods, such as moxibustion, chiropractic techniques like the Webster Technique, pelvic tilts, Spinning babies, or the Miles Circuit can be appropriate options to try that may encourage the baby to turn naturally.
It’s essential for parents to engage in open conversations with their healthcare team to understand the implications of each option, as well as the associated risks and benefits. This collaborative approach helps ensure that decisions align with the parents’ values, health considerations, and personal preferences regarding childbirth.
How Can You Navigate the Decision of ECV?
This might seem like a lot to take in. Making an informed choice about external cephalic version (ECV) is a lot and making the right choice for you starts with open dialogue between you and your healthcare provider. It involves weighing ECV’s potential discomfort against the risks and benefits it presents for your pregnancy’s outcome. I recommend preparing a list of queries to clarify any uncertainties and to help you understand every aspect of the procedure. Questions may include:
- What is my baby’s current position? Ask for a detailed explanation of the breech position and how it might affect your delivery.
- How does ECV fit into my situation? Have your provider discuss why ECV is being recommended for you specifically.
- What are the success rates of ECV for someone in my condition? Explore statistics and personal odds of a successful version.
- What does the ECV procedure entail, and how long will it take? Knowing the steps can help you mentally prepare for the experience.
- Can you describe the pain or discomfort I might feel during ECV? Find out what sensations to expect and how they are managed.
- What are the risks involved with ECV? Discuss both common and rare complications and what measures are in place to monitor and address them.
- What happens if the ECV is not successful? Understand alternative plans for delivery, including scheduled cesarean or attempting a vaginal breech birth.
- Are there any factors that might influence the timing of the procedure? Ask about aspects like amniotic fluid levels and gestational age.
Such conversations are essential for making an educated decision that aligns with your preferences and safety considerations. Remember, the ultimate choice lies with you, informed by the insight and expertise of your healthcare team. Trusting this partnership is crucial as you navigate the specifics of your particular pregnancy journey.
Preparing for birth will require you to make a lot of decisions, some of them easy and some of them not. This is a great time to practice building trust with your medical team and asking the hard questions. They have developed the knowledge and skills to be able to support you through the challenges of your pregnancy. Some of them though aren’t as good at explaining to you the why and how of what they recommend. Don’t be afraid to ask the hard questions so that you can feel confident about the choices you are making for your birth and build confidence in your healthcare team. I wish you the best of luck mama!
Jess is a registered nurse with over 6+ years of critical care experience for patients young and old and is the mother of two small children. After having her own children she felt inspired to provide mothers with real actionable guidance and education to make informed decisions throughout their pregnancy and postpartum experience.