If nature and natural methods do not help your baby settle into a proper pre-birth position, you have a medical option at 37 weeks.  The Manual Version or External Cephalic Version (ECV) is a medical procedure (we do not do them here!) used to guide your baby from breech or other non-headfirst presentation to headfirst (vertex). The medical doctor pushes on your baby through your abdomen, either creating a forward roll like a somersault or a back flip.  Whether or not to do an ECV is a personal decision that you should make with your partner and your doctor.  To help you make an informed decision, we offer a brief description of the procedure below.  All information should be confirmed with your medical doctor.

Image 1


Picture 1. Beginning the forward roll. The doctor places his or her hands on the abdomen, moving the baby up out of the pelvic bones.

Image 2


Picture 2. The baby is turned either forward or backward ...

Image 3


Picture 3. ... until the baby is in the vertex (head-down) position.


Since all transverse babies and most breech babies are born by cesarean, moving the baby to cephalic presentation increases the chance of having a vaginal birth.  Research has shown that offering ECV to all mothers with breech babies at 37 weeks gestation decreases the cesarean rate for that group of women.  The success rate for rotating a baby to headfirst position appears to be about 65%. Many factors affect your individual chances of sucess including how close you are to your due date, how much fluid is around the baby, how many pregnancies you've had, how much your baby weighs, how the placenta is positioned and how your baby is positioned.  For example, the procedure is more successful in women who have had other children, since the baby can move around more easily, than it is for a first-time mom whose baby sits low in her pelvis.  We suggest the Webster technique immediately prior to an ECV so that we can try to relax your pelvic bones and muscles to create more room for the maneuver.

Like all procedures (including natural ones) the ECV is associated with possible negative side effects.  Often the baby's heart rate will slow during or immediately after the version, especially when it is successful. The heart rate usually comes back to normal within a few moments, and there is no evidence that these short-lived heart-rate changes harm the baby in any way.  In very rare situations, the heart rate stays slow long enough that practitioners will start the initial preparations for a possible emergency cesarean section.  Although preparation is sometimes necessary, emergency C-sections are extremely rare under these circumstances.

While it's rare to have a serious complication of ECV, it may be uncomfortable or even moderately painful.  You always have the right to stop the procedure for any reason. (Remember, it's your body!) If you can keep your abdominal muscles relaxed, you might be more comfortable and the procedure may be more likely to succeed.  You may feel sore for a few days.  Ideally, you will want a support person with you during the version, and you'll need someone to drive you home afterward.

The procedure usually is not done earlier than 37 weeks, since there is a remote possibility that the baby will need an emergency delivery as a result of the procedure--and you don't want to risk the baby being born that early if possible.  Certain factors, such as premature rupture of the membranes, contraindicate the use of an ECV.  Your doctor will tell you if you are a candidate for the procedure.  Akthough the risk of complications is small, some doctors prefer not to try an external cephalic version.

ILLUSTRATIONS BY FLOYD E. HOSMER

Much of the information contained herein comes from familydoctor.org and drspock.com.

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