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External cephalic version (ECV)
Category: Women's Health & Childbirth · All women's health & childbirth
What it is
External cephalic version is a procedure to turn a breech baby (bottom-down) to head-down by applying pressure with hands on the mother's abdomen, guided by ultrasound, to increase the chance of a vaginal birth.
Why it is done
It is offered for breech presentation near the end of pregnancy (usually from around 36 weeks) when there is no reason a vaginal birth would otherwise be unsafe.
How to prepare
You will have an ultrasound to confirm position, the placenta site and fluid around the baby, and a heart-rate recording (CTG) before and after. Tell the team your blood group — anti-D may be needed if you are Rh-negative. You may be given a medicine to relax the womb.
What happens during the procedure
On the labour ward, with monitoring available, the doctor applies firm, steady pressure to lift the baby's bottom out of the pelvis and guide a forward or backward roll. It can be uncomfortable, occasionally painful, and takes up to about 10 minutes of attempts; it is stopped if you ask or if monitoring causes concern.
Afterwards — recovery & results
The baby's heart rate is monitored afterwards for a while. Success is roughly around half of attempts overall, varying with circumstances. If successful, normal care continues with a note that the baby occasionally turns back. If unsuccessful, options — planned caesarean or vaginal breech birth in suitable cases — are discussed.
Risks & considerations
Risks are low: temporary changes in the baby's heart rate are the commonest, and rarely an emergency caesarean is needed (well under 1 in 100). There is a small chance of starting labour or of the waters breaking.
Watch: External cephalic version (ECV) videos
Real procedure videos from the MedicalVideos.com library. Some clinical footage is graphic — that is the nature of a medical video library.
Related guides on MedicalVideos.com
Frequently asked questions
Does it hurt?
Most women describe strong pressure and discomfort rather than sharp pain, and you can ask to pause or stop. Relaxation and sometimes gas and air help.
Why not simply book a caesarean?
Many women prefer to aim for a vaginal birth, and a successful ECV avoids caesarean surgery and its implications for future pregnancies. It is your choice after balanced discussion.
Related procedures — Women's Health & Childbirth
Browse the E section of the A–Z list or return to the Procedures & Tests hub.