How successful is an ECV (external cephaloversion)?
If you have been told your baby is in breech position, you have likely been offered an ECV. You may have lots of questions about this procedure. Incredible Obstetrician Victoria Medland here explores exactly what an ECV is, any associated risks, and how successful is an ECV.
Here at The Bump to Baby Chapter we believe knowledge is power. This blog should help you to weigh up your options and make an informed decision that is best for both you and your baby.
Firstly- what is an ECV?
ECV (external cephaloversion) is a procedure where an obstetrician attempts to turn your baby from the breech position to be head down. ECVs are done in hospital with appropriate monitoring of your baby’s position and heart rate.
Why should I consider an ECV?
ECVs are offered because a vaginal breech birth has more risks than a non-breech vaginal birth. The increase is small, but for reference:
A planned elective caesarean at 39 weeks has a perinatal mortality risk of 0.5 babies per 1000 livebirths.
The rate for a planned head down vaginal birth is 1/1000.
A planned vaginal breech birth rate is 2/1000.
So an ECV can reduce the overall risk to the baby by turning the baby to a head down position. It also reduces your chances of needing a planned or unplanned caesarean section along with the risks that this might entail.
How is an ECV done?
An ECV is usually done after 36 or 37 weeks of pregnancy but can be performed right up until the early stages of labour. Prior to the ECV you will have an ultrasound scan to confirm your baby’s position. The ultrasound will also look at a number of things. These are; the amount of fluid around the baby, the position of the placenta, and your baby’s wellbeing by monitoring the heartbeat.
ECV involves applying firm pressure to your abdomen to help your baby turn in the uterus to lie head-first. You will also be given a medication called terbutaline. This relaxes uterine muscle to improve the chances of turning your baby. This is given by injection before the ECV and is safe for both you and your baby. It may make you feel flushed and you may be aware of your heart beating but this will soon wear off.
What happens after the ECV?
After the ECV, the ultrasound scan will be repeated to see whether your baby has turned, and your baby’s heart rate will also be monitored again after the procedure.
If you have any bleeding, abdominal pain, contractions or reduced fetal movements after ECV you’ll be advised to contact the hospital.
An ECV can be uncomfortable and occasionally painful. Your healthcare professional will stop if you are experiencing pain, and the procedure will only last for a few minutes. You can use gas and air as pain relief during the procedure if needed. If your healthcare professional is unsuccessful at their first attempt in turning your baby then, with your consent, they may try again on another day. After ECV has been performed, you will normally be able to go home on the same day.
If your blood type is rhesus D negative, you will be advised to have an anti-D injection after the ECV and to have a blood test.
Is an ECV safe?
In terms of safety, ECV is generally safe with a very low complication rate, but there are situations in which it may not be advised, for instance if there are concerns that your baby is not growing or moving normally, or in twin pregnancies, where it isn’t possible to manipulate the position of the first twin. Notably, ECV after one caesarean appears to carry no greater risk than on an unscarred uterus.
Overall, there does not appear to be an increased risk to your baby from having ECV. When you do go into labour, your chances of needing an emergency caesarean section, forceps or vacuum (suction cup) birth is slightly higher than if your baby had always been in a head-down position. Immediately after ECV, there is a 1 in 200 chance of you needing an emergency caesarean section. This is because of bleeding from the placenta or changes in your baby’s heartbeat.
How successful is an ECV?
The overall success rate is about 50%. An ECV is more successful in women who have been pregnant before, and less successful in first pregnancies. This is partly because in a first pregnancy, the uterus is as stretched as it has ever been. It is therefore a little tighter around the baby, with less room for manoeuvre. If your ECV is successful, fewer than 5% of babies turn back from being head-down. If your first attempt is not successful and you remain keen to aim for head-down vaginal birth, a second attempt at a later date, and potentially, a different obstetrician can be offered.
You may or may not find it comforting to learn that there’s no robust evidence that lying down or sitting in a particular position can help your baby to turn. Therefore it is not in any way your fault or responsibility that your baby is breech!
Is there anything else I could try?
There is some evidence that the using moxibustion. This involves burning a herb called “mugwort”. It may help your baby to turn into the head-first position by stimulating your baby’s movements. Always ensure this is done by a licensed practitioner.
