External cephalic version (ECV) to turn a breech baby

This video shows an ECV to turn a breech baby to head-first. It is offered to women at 36-37 weeks and reduces the chance of needing caesarean section. It is a safe procedure and is successful about 40-50% of the time. On this occasion I used a drug to help relax the womb first. While most women find it uncomfortable, it isn't usually painful. If you have a tender uterus anyway, it is more likely to hurt.

The baby in this video had a reassuring fetal monitoring right before I started the procedure and the fetal heart was checked afterwards. If a longer attempt at ECV was carried out then we check half way through too with the ultrasound. Transient changes in the baby's heart rate are not uncommon and usually settle after a few minutes. Very occasionally they don't settle and a caesarean section needs to be done.

For the ECV shown, the baby does a forward somersault anticlockwise. The first step is to lift the baby's bottom out from your pelvis and move her to lying transversely. Often that is the most difficult part. Overall, it normally takes between 1 and 2 minutes to do the turn - any longer than that and the chance of success goes down. It is more likely to succeed in the following situations:

- if you have had a baby before
- if there is a normal amount of water around the baby
- if your baby has his knees bent
- if his or her bottom isn't engaged in your pelvis
- if the baby's head is not right up against the placenta

During an ECV uterine contractions can occur and we generally just wait until they pass.

Is it safe? One of the best quality research on safety comes from Oxford in the UK (incidentally, where I trained to do them) and they looked at just over 800 consecutive ECVs. The chance of needing emergency CS during or just after the ECV was 1 in 200. The risk of the placenta coming away (abruption) was 0.1% and no babies died due to the procedure. These figures are similar to other research that is available and confirm the safety of ECV. Approximately 3% of babies turn back to breech after successful ECV and 3% of unsuccessful ECVs turn spontaneously to head-first afterwards. This is the research study:
http://www.ncbi.nlm.nih.gov/pubmed/17355270

Thanks to the mother here who kindly gave her consent to the video being published for educational purposes.

Oh, and sorry for the music - it was the only 'baby' result in my iTunes library!

Dr Tucker
http://dannytucker.net/health

Link to this video:
http://dannytucker.net/go/ecv

Category:

Education

Tags:

• ECV
• external version
• turning breech baby
• breech
• pregnancy
• cesarean
• caesarean
• turning breech

[UTMomof4]

She must've had an Epidural, I've heard it's really painful. I had one done with my second baby, and my dr. did give me an epidural first. The only point it got uncomfortable was when the baby was squished up against my diaphragm. the version was successful, and the dr. immediately broke my water and started pitocin. I delivered her 12 hours later with no c-section, and she was healthy. It's not for everyone, but it worked just fine for me.

[drdtucker]

@UTMomof4 I never have used an epidural. 

[smoky19851985]

i dont know from where you get this data that is so safe procedure but its considered risky and kind of controversial among doctors thats its not worthy even this risk and i must be defininietely performed by experianced doctor...and about 40 % success but its quite painfull and stressfull...many doctors in europe are strongly against it...so please be more honest and dont try to make from it totally safe procedure like for example diagnostic ultrasound or something like this...

[drdtucker]

@smoky19851985 If you want to read the information and medical literature that supports its safety, type 'ecv green top' into google and read the first link (youtube won't let me post a url here). Of course it must be performed by an experienced doctor.

[tweetsmommy]

There is NO way that she didn't have some type of epidural or spinal. She was way too calm & didn't wince EVEN ONCE. I went through this & got the baby turned 180 degrees and I couldn't take it anymore. I had trebutelyne (sp) to relax the uterus....needless to say, I had bad bruising & was sore for a week. I am at 40 weeks this week & I am going to get an epidural to turn the baby or to have a c-section. This is per my dr.'s recommendation.

[drdtucker]

@tweetsmommy Sorry, but she did not have an epidural - I've never done it with one. I do agree that for some women their uterus is too tender to do an ECV so I can see that it might be helpful in that situation, but there aren't many that can't tolerate an attempt in my experience.

[dimocratmsu]

I had a very easy "version" done at 38 weeks. Thanks for posting this video showing how simple it can be...I know so many women who have opted for a c-section without even trying the ECV because of all the horror stories on the internet. I had a little discomfort (nothing compared to what I imagine recovering from a c-section would be though) and I didn't get an epidural or any other pain medication. It was definitely worth it for us!

[flobud]

Thank you so much for posting this - we watched it before our ECV at 40 weeks today and it was really reassuring and informative. I kept thinking about your patient's calm face and it really helped me! And, even better, the ECV was a success! Many thanks.

[SequoiaKai1]

Without performing an ultrasound right at labor, is there any way to tell if a baby is face up? And is there a way to turn a baby from face up to face down? I had a c-section when my son got stuck during labor. I was told it was because he was face up and it made it too hard for him to come out, since he was already a big baby. I am wanting a natural deliver soooo badly for my now 33 week pregnancy and hope he is head down/face down at labor, or it will be another miserable c-section!

[yourpeanutsshell]

thats soo neat!!!



[f3cktherich]

Hot doctor indeed!

[MrOwl2424]

and he look like he is using all his energy to turn th child

[MrOwl2424]

how does the doc fell when he is turning the baby ? is the belly soft flexible or soft?

[MrOwl2424]

wut happen if the baby get stuck side ways like in the position at 1:05?

[KJtheMC]

Hello, this physician is skilled. Big ups from Latvia.