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If Your Baby Is Breech: External Cephalic Version (ECV)

Toward the end of pregnancy, most babies move into a head-first position for childbirth. But in some cases, a baby is in a breech position. This means the baby’s buttocks or feet are in place to be delivered first. A breech position makes it hard to have a vaginal delivery.

If your baby is in a breech position, your healthcare provider may try to turn the baby so that he or she is head-first. This procedure is called an external cephalic version (ECV). An ECV may be done if you are between 36 to 38 weeks (near term) in your pregnancy, unless there are reasons not to do it. If the ECV works well, a vaginal delivery is more likely.

Before the procedure

This procedure is usually done in a hospital. Follow all instructions you’re given for not eating or drinking before the procedure.

Before the ECV, the medical team will connect you to a fetal monitor. This is done to check your baby’s well-being during and after the procedure. You may also need these tests:


This may be done to:

  • Confirm that the baby is in a breech position

  • Find out how much amniotic fluid is in the uterus

  • Confirm where the placenta is

  • Find or rule out any birth defects (congenital problems)

Nonstress test and biophysical profile

These tests check your baby's heart, well-being, and contraction pattern. One or both of these tests may be done before and after the ECV.

Blood tests

Medical staff will take a small sample of your blood to test. This is done to find out your blood type, screen for problems, and do a complete blood count in case of an emergency.

During the procedure  

  • Your provider may use ultrasound during the procedure.

  • An IV (intravenous) line may be placed in your arm to give fluids or medicines if needed.

  • The team may give you medicine to relax your uterus. This medicine can make it easier for the healthcare provider to rotate your baby.

  • You will be placed in position on the hospital bed.

  • The healthcare provider will then put his or her hands at certain points on your lower belly over your uterus. 

  • The provider will try to push the baby into a head-down position. This is done by trying to make the baby do a slow-motion forward roll or back flip. You will feel pressure during this part of the procedure. 

  • Once the procedure is done, the medical team will raise the head of your bed. This will help keep the baby in the head-down position.

Changing your baby’s position

Image of doctor moving baby

Your healthcare provider presses down on your belly and locates your baby’s head and bottom.

Image of doctor moving baby

By pressing down on your belly, your healthcare provider may be able to rotate the baby into a head-first position. This often will allow a vaginal birth.

After the procedure

  • You will stay connected to the fetal monitor. This is done to check your baby’s well-being. It also checks for contractions, which can happen after an ECV. You will be monitored up to 2 hours after the ECV, or as directed by your provider.

  • If you are Rh-negative, you may have an Rh immunoglobulin injection. This is done to prevent an immune system response (Rh sensitization). Rh sensitization can cause problems in a future pregnancy if the baby's blood goes into your bloodstream.

  • Once you are home, follow any directions your healthcare provider gives you for eating or drinking after the procedure.

  • Follow all discharge instructions from your healthcare provider.

Follow-up appointments

You may need to have appointments more often to check your baby’s position. Follow the instructions from your healthcare provider.

When to call your healthcare provider

Call your healthcare provider if any of these happen:

  • You have more contractions

  • Fluid or blood is leaking from your vagina

  • Your baby is moving less

  • You have other signs or symptoms as directed by your healthcare provider

  • You have a lot of vaginal bleeding 

Delivering your baby after ECV

Even if your baby’s position can’t be changed, you may be able to have a vaginal delivery. The type of delivery you have should depend on your healthcare provider’s experience. Most providers prefer to do a cesarean section (C-section) for a breech baby. This is a delivery done with surgery. For a C-section, you will have medicine to block pain (anesthesia). But you are usually awake and alert.

Online Medical Reviewer: Daniel N Sacks MD
Online Medical Reviewer: Donna Freeborn PhD CNM FNP
Online Medical Reviewer: Heather Trevino
Date Last Reviewed: 7/1/2020
© 2000-2020 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.