External Cephalic Version

External cephalic version uses gentle pressure on the abdomen to turn a breech baby head-down.

External cephalic version, or ECV, is a procedure used when a baby is lying bottom- or feet-first late in pregnancy. A clinician places their hands on your abdomen and guides the baby toward a head-down position. Ultrasound and monitoring help the team assess the baby before and after the attempt. ECV is discussed individually because the position of the placenta, fluid, womb and baby can affect suitability.

The team reviews your pregnancy, checks the baby’s position with ultrasound and monitors the baby’s heartbeat. You may receive medicine to relax the womb. While you lie back, the clinician uses steady pressure and guiding movements over your abdomen. The attempt may be stopped if you or the baby show signs of distress. Monitoring follows, and ultrasound confirms the new position if the baby turns.

ECV is carried out where the baby can be monitored and urgent birth care is available. It can feel uncomfortable and may cause temporary soreness, cramping or changes in the baby’s heartbeat. Rarely, bleeding, waters breaking or another urgent problem may require delivery. Tell the team about bleeding, painful contractions, reduced movements, placenta concerns or previous uterine surgery. Follow the unit’s instructions about seeking help after you leave.

You can accept ECV, decline it, or discuss whether another attempt is appropriate if the baby turns back. If the baby remains breech, choices include planned vaginal birth in selected circumstances or a planned [Caesarean Section](/treatments/pregnancy-and-birth-care/caesarean-section/). Your maternity team will explain the position of your baby, your health and the birth setting before you decide. Read more about [Breech Baby](/conditions/breech-presentation/).

ECV is an external procedure, so no instrument enters the womb. Ultrasound helps confirm position, while fetal monitoring checks wellbeing. A baby may turn back after a successful attempt. A successful turn does not remove the need for routine pregnancy care or a birth plan.

ECV may be discussed when ultrasound shows a breech baby and there is no clear reason that turning would be unsafe. The team considers the type of breech position, placenta location, fluid around the baby, your pregnancy history and any medical concerns. It is not an automatic requirement; your consent matters.

You change into a comfortable position and the team checks your vital signs and the baby’s heartbeat. Ultrasound identifies the baby’s head, back and limbs. If suitable, prescribed medicine may relax the womb. The clinician then uses both hands to lift and guide the baby in a controlled movement. Monitoring and a final scan follow before discharge or further care.

You are observed after ECV and may feel abdominal tenderness or mild cramping. Contact your maternity unit promptly for vaginal bleeding, leaking fluid, regular painful contractions, reduced movements or severe pain. If the baby remains head-down, your team updates the birth plan; if not, they discuss breech birth care and planned Caesarean Section.

ECV may not turn the baby, and a turn can sometimes reverse. Pressure can be uncomfortable. The team also considers uncommon but serious problems such as bleeding, membrane rupture or fetal distress, which is why monitoring and access to urgent maternity care are arranged.

If you do not have ECV, or if it does not work, your midwife or obstetrician can discuss continuing with a breech birth plan or Caesarean Section. The decision depends on your baby’s position, your pregnancy and the expertise available at the birth facility.

Ask for ECV at a maternity unit with ultrasound, fetal monitoring and immediate access to obstetric and newborn care. Before attending, ask when you should eat, which medicines are planned, how long observation lasts and which symptoms require an urgent call.