Additional information ECV and breech position

When will the ECV take place?

Not too soon, so we’ll give your baby a chance to turn by itself. We also want to reduce the risk of a baby turning back after ECV.

Also not too late, so there is enough room for a baby to turn.

Generally somewhere between 35 and 37 weeks gestation. That depends on the space in your tummy, the size of your baby and whether it’s your first baby or not. It also depends on the availability of the ECV practitioner.

What are the chances of ECV succeeding?

Whether the ECV attempt will succeed is not easy to predict. In general, the earlier in pregnancy and the more amniotic fluid, the easier it is to rotate the baby. There is also a downside: if the baby is easy to turn, there is a good chance that it will turn back by itself.

On average, ECV succeeds in 50 out of 100 women. If it is your first pregnancy, the success rate is between 30 and 40%. If you have had a baby before, 60 to 70% of all ECV’s will succeed. This is because your abdominal wall is usually less-taut after you have already been pregnant once and therefore there is more room to rotate the baby.

Both the experience of the ECV practitioner and the degree by which you are able to relax give a higher chance of success. Also, the use of medication to relax your uterus increases the chance of success. This medication can sometimes have mild side effects for you and is only given in the hospital and not at a community setting.

Medication used during the ECV

Ritodrine is a drug that inhibits contractions and relaxes the uterus. You get this through a jab in your thigh or in your buttock and it works almost instantly.

Side effects Ritodrine:

  • Palpitations/high heart rate.
  • Feeling shaky, trembling, restlessness.
  • Nausea.
  • Sweating.
  • Flushing sensation.

If you experience side effects from the medication, they usually subside within 2 to 4 hours.

Ritodrine is only given in the hospital and not in a community-setting.

Alternative therapies for ECV

Besides the use of medication (Ritodrine) there are other ways in which you could increase the chances of your baby turning. These alternatives are not all scientifically proven to be effective. However, experience shows that they can make a positive contribution to the preparation for an attempt at ECV, either resulting in a spontaneous ECV (baby turns on his own without help) or during an ECV attempt.

Acupuncture

  • Acupuncture is an alternative Oriental medicine with the aim of restoring body balance and health by stimulating acupuncture points. Usually, very thin needles are used to prick specific areas of the skin. It’s a virtually painless treatment.

  • Acupuncture and breech position. By stimulating a specific acupuncture point with thin needles or pressure from about 32 weeks of pregnancy, your baby could turn to head-down position. This can also be done in combination with a Moxa therapy.

Contact a qualified acupuncturist through your midwife/ECV practitioner or directly yourself, to make an appointment. Any compensation depends on your level of (additional) insurance.

Moxa therapy

  • Moxa is compressed herb (mugwort) Moxa therapy is a treatment from traditional Chinese medicine. 
  • Moxa therapy and breech position. A lighted Moxa stick is held close to the bottom of the little toe, there is an acupuncture point. The warm heat of this Moxa stick stimulates this point, which stimulates your baby to rotate to head-down position.

The treatment is often used in combination with acupuncture, but you can also apply it yourself. The use of a Moxa stick can be used as early as 32 weeks of gestation in breech position. Moxa sticks are for sale directly at various locations or through an acupuncturist.

More information about Moxa therapy and breech position can be found online or via your midwife/ECV practitioner. The use of Moxa will not be reimbursed. If it is used during an acupuncture treatment, it may sometimes be reimbursed by your insurance.

Chiropractic therapy

  • Chiropractic therapy is an alternative medicine aimed at the treatment of musculoskeletal disorders. In particular, by eliminating disturbances between the joints of the spine and the nervous system, health is improved. The chiropractor uses his hands to apply a degrees of pressure to the body.
  • Chiropractic therapy and breech position. With the techniques of a chiropractor, especially the Webster technique, the position of your pelvis can be improved. This allows your baby to have more space to turn towards a head-down position.

Contact a qualified chiropractor through your midwife/ECV practitioner or directly yourself to make an appointment. Reimbursement depends on your level of (additional) insurance.

Physiotherapy

  • Physiotherapy is a paramedical treatment method for complaints of your musculoskeletal system. A physiotherapist can reduce pain and make the body function better through different treatments. In addition to dealing with complaints, attention is also paid to the prevention or return of complaints.
  • Physiotherapy and breech position. Through various exercises to relax the uterus, the muscles and the tendons around it, more room is made for your baby to be able to rotate.

You can make an appointment directly with a physiotherapist. Or contact your midwife/ECV practitioner. Any compensation depends on your level of (additional) insurance.

Hypnotherapy/hypno-birthing

  • Self-hypnosis eliminates conscious thoughts that cause pain and stress. Body and mind can then relax. You are conscious and more focused on positive thoughts. In hypno-birthing, this form of therapy is used in preparation for childbirth, usually in the form of a course or series of sessions.
  • Hypnotherapy and breech position. Tension and stress can be unknowingly held in the lower part of your uterus. This can, in addition to a physical cause, also be a reason that your baby is not turning. In order for your baby to rotate spontaneously, it is important that you remove the tension from your uterus.

Contact a competent hypno-birthing therapist/teacher directly for individual appointments or a course. Or ask your midwife/ECV practitioner for more information. Sometimes a hypno-birthing course is reimbursed by your insurance in preparation for childbirth. Check with your insurer.

Exercise therapy (Mensendieck)

  • Exercise therapy or Mensendieck is aimed at preventing and eliminating complaints due to an incorrect posture and movement pattern. In addition to treatment, the Mensendieck therapist also gives you exercises and advice to promote your own understanding of functional exercise and prevent complaints.
  • Mensendieck and breech position. The therapy focuses on improving your posture and your movement and can thus make more room in the uterus and your baby.

Contact a physiotherapist/Mensendieck therapist directly or through your midwife/ECV practitioner. Any compensation depends on your level of (additional) insurance.

Osteopathy

  • Osteopathy is an alternative medicine, which assumes that a reduced mobility of tissues and structures in the body has a detrimental effect on health.
  • Osteopathy and breech position. By removing the tension in the pelvis, the room for the baby to turn is optimized and therefore the baby can possibly rotate better.

Contact a competent osteopath directly or through your midwife/ECV practitioner. Any compensation depends on your level of (additional) insurance.

Rebozo massage

  • A Rebozo massage is given with one or more cloths. The Rebozo (the cloth) is draped around a body part and tension is applied so that it provides support and envelops you. After that, small or larger movements can be made with the Rebozo, which causes the person to be cradled and moved in the canvas. This makes for a very relaxing and soothing massage..
  • Rebozo massage and breech position. If your baby wants to be able to turn itself around, your tailbone should not be stuck inwards in your pelvis. In this is the case you can, by wrapping the (Rebozo) around your body attempt to lift your baby out of the pelvis while shaking the cloth during the massage.

This massage is used by various lay, in preparation for (spontaneous) ECV of a baby lying in a breech position. Ask your midwife for advice and referral or check the website of Rebozo.nl.

Spinning babies exercises

  • With this series of exercises you bring the pelvis more in balance and you create more space in the abdomen and thus also for the baby. This allows your baby to move more easily to the ideal birth position.
  • Spinning babies and breech position. By doing these exercises, you could promote the chance of your baby spontaneously turning from breech to head-down position.

See https://spinningbabies.com/learn-more/techniques/other-techniques/breech-tilt/

Drawbacks and risks of ECV

The chances of something going wrong with ECV are very, very small. The risks occur in less than 1 in 100 ECV’s. We therefore can call it a safe procedure.

Due to the chance of problems following ECV being much less than the chance of problems when you give birth to a baby in breech position, we recommend having an ECV .

Below you can read more information regarding what problems can possibly occur with an ECV.

  • Although the ECV is not painful for your baby, the process of turning the baby externally (and the feeling of pressure on your stomach can be unpleasant, sometimes even painful. This may be a reason for us to stop the ECV attempt and may sometimes mean we can’t perform it.
  • The baby’s heart rate can sometimes temporarily slow down or accelerate as an effect of the ECV. This is a normal reaction and the heart rate usually recovers within ten minutes. This happens to 2 to 7% of babies after ECV, regardless of whether the ECV attempt has succeeded or not.
  • In rare cases, the heart rate does not recover within the desired time. This may be a sign that the baby is having difficulty following the procedure. If this happens, we will return the baby to its original position or stop the ECV. In case of a low heart rate which does not recover, the baby may have to be born by caesarean section. In this case, we will refer you directly to the obstetrician. Even if the ECV attempt does not take place in the hospital, there is always a direct contact to the obstetrician from the OLVG-West. International research shows that 4 out of 1,000 (0.4%) women need a caesarean section for this reason. However, in a Dutch study no caesarean sections were required as a result of an ECV.
  • There is a very small chance that the water bag may break during or immediately after ECV. We never really know for sure whether the ECV attempt itself is the cause or that the waters would break even without an attempt at ECV.
  • The same applies if labour was to start prematurely following the ECV attempt (due to contractions or the waters breaking ).
  • A very rare but serious complication is the possibility of placental abruption (where the placenta becomes detached from the wall of the uterus) this occurs in 1 in 1000 women (0.12%). Again, it has not been shown if this is due to the ECV or other causes.
What is ECV?
Giving birth to a baby in breech position