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External cephalic version (ECV) - breech pregnancy - Breech presentation

You may be offered an external cephalic version (ECV) if your baby is breech. This is a procedure to turn your baby in the womb. This may be discussed with you if you are 36 weeks pregnant and your baby is still breech.

How an ECV works

An experienced obstetrician normally performs the ECV procedure. Your baby's heart will be monitored during and after the procedure. Many obstetricians also use an ultrasound scan to guide the procedure.

Gentle pressure is applied to your abdomen (tummy). This helps the baby turn from a breech position to a head-down position.

Around 50% of breech babies can be turned using ECV. The main advantage is a vaginal birth if your baby turns into a head-first position.

You may feel uncomfortable during the ECV. If you do, let your obstetrician know as they can stop or alter the position of their hands.

Like any procedure, there is a small risk of complications. In about 1 in 200 ECV procedures the baby will need to be birthed immediately by caesarean section. This is due to a problem with their heartbeat or bleeding from the placenta.

When an ECV might not be suitable

An ECV is normally not carried out on women with:

  • previous caesarean births
  • twin or other multiple pregnancies
  • an unusually-shaped womb
  • large fibroids
  • any bleeding from the vagina in the previous week
  • a baby whose heart rate is slower or faster than normal
  • a baby who is too deeply engaged (the baby has moved too far down the pelvis)
  • a baby who is too big

Other options

Your obstetrician will discuss your birth options with you if:

  • the ECV was not possible
  • the ECV does not work
  • the ECV worked but your baby turned to the breech position again
  • you do not want an ECV

Page last reviewed: 20 April 2023
Next review due: 20 April 2026