When it comes to all things fertility, pregnancy, birth and even parenthood… there are so many acronyms! And when you’re on the TOLAC / VBAC / HBAC journey, there are even more (see what I did there?). Today we’re doing a deep dive on one of the most common acronyms in the breech community – ECV or External Cephalic Version. 

While this isn’t something unique only to VBAC moms, an ECV is definitely of particular interest in the VBAC community…

So, let’s dive into what you need to know about ECV and VBAC!

What is it?

As explained by ACOG, an external cephalic version or ECV is “a technique, performed late in pregnancy, in which the doctor attempts to manually move a breech baby into the head down position.” 

Why would I need one?

When a baby is in a breech presentation, with the body being delivered first, there is a concern that the cervix may not stretch enough for the head to navigate the birth canal safely. Breech presentation is typically considered a complication in labor and delivery, and not all providers are comfortable with or trained in delivering breech babies. When a VBAC mom also has a baby in a breech position, providers can be even more hesitant to support TOLAC (trial of labor after cesarean), which makes ECV a consideration for many. 

Who is it right for?

An ECV is an option for those who are at least 34 weeks pregnant with a baby in a breech, oblique or transverse position. Many ECVs are performed after 37 weeks or even during labor. 

With a success rate of 60%, ECVs are low-cost options for those who want to avoid cesarean delivery and / or those with limited access to medical services (NIH, 2023). 

In general, most pregnant women are good candidates for an ECV, however, according to the American Academy of Family Pediatrics, women with the following may not be:

• Vaginal bleeding
• Placenta Previa or Accreta
• A low levels of amniotic fluid
• An abnormal fetal heart
• Premature rupture of the membranes
• Twins or other multiples gestation

Is it safe for VBAC?

Previous cesarean delivery is not a contraindication for an ECV. A 2021 study concluded ECVs for women with prior cesarean delivery to be low-risk and relatively successful. Additionally, a study published in 2018 looked at 100 pregnant women with one prior cesarean who had an ECV. The results showed no cases of uterine rupture or other complications. 

Also, in 2023 the American Journal of Obstetrics & Gynecology stated that “TOLAC after a successful ECV is associated with a high rate of vaginal birth after cesarean (VBAC) without an increased risk of adverse neonatal outcomes.”

We find the results of these studies to be really encouraging for VBAC mamas with breech babies.

How is it performed?

ECVs are typically done in a delivery room, possibly with an extra set of hands and / or an ultrasound machine. The provider uses firm pressure on the outside of the abdomen and attempts to roll the baby’s body into a head down position. ECVs can take less than a minute or up to 16 minutes (EBB, 2021). The baby’s heart rate is monitored during the procedure since it may be temporarily affected.

What does it feel like?

And ECV can be uncomfortable during the procedure and possibly cause some pelvic pain or discomfort afterwards. There are pain management options that your provider may suggest or you can request like nitrous oxide or an epidural. 

According to research compiled by Evidence Based Birth, it seems that an ECV was most uncomfortable for women whose procedure was unsuccessful in turning their babies, which tells us that the pain may seem more tolerable if associated with a positive outcome.

What are the advantages & disadvantages?

Specifically for VBAC moms, rates of successful ECVs are similar to those with no prior c-sections (EBB, 2021). And again, ECV is a low-cost option requiring little time and basic effort that can be done by one’s provider before term, at full term or during labor, making it easily accessible for most people. Perhaps most importantly, in general, ECVs result in significantly lower rates of c-section, breech positioning and needing to have repeat c-sections in the future (EBB, 2021).

While complication rates are generally low, risk level is relative and can be advantageous for some and disadvantageous for others. According to Evidence Based Birth, ECV complication rates are around 6%, including complications like cord prolapse, temporary abnormal heart rate of baby, vaginal bleeding, water breaking or emergency c-section. Very serious complications like stillbirth or placenta abruption were even lower at .24%. (EBB, 2021).

So, to wrap all of that up, here’s what we know – 

According to multiple studies, ECV seems to be relatively safe and effective for VBAC moms. It’s important to discuss options with your provider and ensure that they feel comfortable performing an ECV if it’s something you’re interested in. 

And at the end of the day, as with every other decision throughout your VBAC journey, you get to decide what’s right for you because you are in charge of your birth experience.

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We’re so grateful to be on this journey with you!

​Don’t forget to join our Facebook community, follow us on Instagram, check out our Parents VBAC and HBAC Education course and give our podcast a listen where lots of incredible women share their VBAC journeys.

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Sources

“EBB 151 – Updated Evidence on the Pros and Cons of Membrane Sweeping,” Rebecca Dekker, Oct 2020, https://evidencebasedbirth.com/updated-evidence-on-the-pros-and-cons-of-membrane-sweeping/ 

Finucane EM, Murphy DJ, Biesty LM, Gyte GML, Cotter AM, Ryan EM, Boulvain M, Devane D. Membrane sweeping for induction of labour. Cochrane Database of Systematic Reviews 2020, Issue 2. Art. No.: CD000451. DOI: 10.1002/14651858.CD000451.pub3